256层CT全肝灌注成像在原发性肝癌肝动脉化疗栓塞术中的价值  

256-S1ice CT perfusion imaging in transcatheter arterial chemoembolization for hepatocellular carcinoma

作　　者：黄丽娜[1] 倪衡建[1] 姜建威[2] 殷允娟[2] 侯海燕[2] 

机构地区：[1]南通大学医学院,226000 [2]无锡市第三人民医院影像科

出　　处：《中华肝胆外科杂志》2015年第8期512-516,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨256层CT全肝灌注成像在原发性肝癌肝动脉化疗栓塞术（TACE）治疗中的应用价值。方法收集23例原发性肝癌患者，于TACE术前一周行全肝灌注扫描。采用JOG技术，经灌注软件分析肿瘤组织及全肝灌注情况。术后4～6周随访并观察TACE治疗前后肿瘤组织的血流灌注变化。结果（1）TACE术前8例病灶均匀高灌注，15例灌注呈混杂状态。与全肝灌注参数比较，肝动脉灌注量（HAP）及肝动脉灌注指数（HPI）增高，门静脉灌注量（HPP）则降低，三者差异均有统计学意（P〈0．05）；（2）TACE术后7例瘤灶内碘油沉积均匀致密，13例碘油沉积部分缺损，3例沉积稀少。碘油沉积致密区域及肿瘤坏死区域无血流灌注，碘油沉积不均或稀疏区域内仍有血流灌注。其中21例于6～8周后再次行TACE治疗，治疗时肝动脉数字减影血管造影（DSA）结果与其吻合率为100％。肿瘤组织TACE术后HAP、HPI降低，差异均有统计学意义（P〈0．05），HPP变化无统计学意义（P〉0．05）。术后活性灶较术后全肝灌注HAP、HPI升高，HPP则显著降低，差异有统计学意义（P〈0．05）。结论256层MSCT全肝灌注检查能定量评估原发性肝癌的异常灌注情况、判断术后活性灶，对TACE术前评估及术后随访都具有很好的指导意义。Objective To explore the clinical value of256-slice CT whole hepatic perfusion imaging in transcatheter arterial chemoembolization （TACE） for hepatocellular carcinoma （HCC）. Methods Twenty-three patients with hepatocellular carcinoma underwent whole hepatic perfusion with the JOG tech- nique one week before TACE. The scanning data of cancer and liver tissues were analyzed using the perfu- sion software. The cancer tissue perfusion was repeated 4 to 6 weeks after treatment and was compared with that before treatment. Results （ 1 ） Before TACE, the HCC lesions were shown on the hepatic arterial per- fusion （HAP） map as homogeneous hyper-perfusion lesions in 8 patients and as inhomogeneous hyper-perfu- sion lesions in 15 patients. The HAP and hepatic arterial perfusion index （HAPI） values of the tumor were higher than those of the liver tissues, while the hepatic portal perfusiou （HPP） values of the tumor was lower than that of the liver tissues. The differences were all significant （ P 〈 0. 05 ）. （ 2 ） After TACE, the tumors were totally filled with lipiodol in 3 patients, partially filled with lipiodol in 13 patients, and sparsely filled with lipiodol in the remaining 3 patients. There was no blood perfusion in the lipiodol-filled areas and in the cancer necrotic tissues, but in the sparsely or partially lipiodol-filled areas blood perfusion could still be seen. 21 patients received another session of TACE 6 to 8 weeks later. The results between the hepatic arterial digital subtraction angiography （DSA） and the CT perfusion were 100% matching. The HAP and HAPI values of the tumor decreased when compared with before treatment, and the difference was significant （ both P 〈 0. 05 ）. The HPP values decreased slightly with no significant difference （ P 〉 0. 05 ） , while higher HAP and HPI and lower HPP were observed in the active cancer tissues when compared with the liver tissues after treatment （P 〈 0. 05 ）. Conclusion 256-slice MSCT whole liver perfusion imagin

关 键 词：原发性肝癌 CT灌注成像 肝动脉化疗栓塞术 多层螺旋CT 

分 类 号：R735.7[医药卫生—肿瘤]