128层4DCT全肝灌注成像在肝肿瘤诊断中的价值  

Application of 128-slice 4DCT whole-liver perfusion imaging in hepatic tumor

作　　者：于永梅[1] 张华[2] 朱建辉 王文成 郭美玲[1] 

机构地区：[1]济宁市第一人民医院CT室,山东济宁272000 [2]山东省医学科学院基础医学研究所,山东济南250012 [3]新疆麦盖提县人民医院CT室,新疆麦盖提844600

出　　处：《山东大学学报（医学版）》2014年第7期66-70,共5页Journal of Shandong University:Health Sciences

基　　金：山东省自然科学基金(ZR2012HL46)

摘　　要：目的探讨128层4DCT全肝灌注成像在肝肿瘤诊断中的价值。方法 45例原发性肝癌患者和40例肝血管瘤患者行128层CT全肝灌注扫描,所得数据经灌注软件处理后,自动生成灌注参数和4D-CTA图像:血流量(BF)、肝动脉灌注量(ALP)、门静脉灌注量(PVP)和肝动脉灌注指数(HPI)。根据各灌注图像及相关参数评价原发性肝癌病灶、肝血管瘤病灶及其周围1 cm内肝实质之间、肝血管瘤病灶及原发性肝癌病灶之间的血流动力学特点,观察肝肿瘤供应血管、肝内大血管阻断、狭窄及栓塞情况。结果①原发性肝癌病灶的BF、ALP、HPI高于周围1 cm内肝实质(P<0.01),原发性肝癌病灶的PVP显著降低(P<0.01);肝血管瘤病灶内的BF、ALP、HPI高于周围肝实质(P<0.05);肝血管瘤病灶的BF、ALP高于原发性肝癌病灶(P<0.05),而HPI低于原发性肝癌病灶(P<0.05)。原发性肝癌病灶的PVP降低,与肝血管瘤病灶相比差异有统计学意义(P<0.01)。②45例原发性肝癌中,肿瘤供血动脉28例,20例供血动脉增粗、僵直、扭曲,门静脉癌栓14例。40例肝血管瘤中,23例血管推压移位。17例血管正常。结论应用128层4DCT进行灌注检查,可准确反映原发性肝癌、肝血管瘤的血流动力学特征,为肝肿瘤的诊断、手术切除范围及判断预后提供可靠的依据。Objective To investigate the significance of 128-slice 4D CT whole liver perfusion imaging in the diagnosis of hepatic tumor. Methods Data of 45 cases of primary liver carcinoma and 40 cases of liver hemangioma obtained from 128 CT of the whole liver perfusion scan were processed with the perfusion software,automatically generating4D-CTA images. Blood flow（ BF）,arterial liver perfusion（ ALP）,portal venous perfusion（ PVP） and hepatic perfusion index（ HPI） were analyzed. With reference to the parameters,the blood vessels supply of liver tumor,intrahepatic vessel occlusion,stricture and embolism were evaluated. Results ① The BF,ALP and HPI in primary liver carcinoma were obviously higher than those of surrounding lesions within 1cm in hepatic parenchyma（ P 〈0. 01）; the PVP of primary liver carcinoma reduced significantly; the BF,ALP and HPI of liver hemangioma were higher than those of peripheral parenchymal（ P 〈0. 05）; the BF and ALP of liver hemangioma lesions were higher than those of primary liver cell cancer focus（ P 〈0. 05） and the HPI was lower than that of primary liver cell cancer focus（ P 〈0. 05）; the PVP of primary liver cell carcinoma focus was reduced compared with liver hemangioma（ P 〈0. 01）. ② Of the 45patients with primary liver carcinoma,28 had cancer of feeding artery; 20 had thickened,rigid,disorder or distorted feeding artery; 14 had portal venous embolism. Of the 40 cases of liver hemangioma,blood vessels were pulled in 23cases. Conclusion 128-slice 4D CT whole liver perfusion imaging can accurately reflect the hemodynamic characteristics of primary hepatic carcinoma and hepatic hemangioma,showing great clinical significance in the early diagnosis,differential diagnosis,choice of surgical approach and prognosis for hepatic tumor.

关 键 词：体层摄影术 CT灌注成像 肝肿瘤 诊断 

分 类 号：R814.42[医药卫生—影像医学与核医学]