CT灌注扫描结合甲胎蛋白检测在评价TACE术后病灶复发中的临床价值  

Clinical value of CT perfusion scanning combined with AFP detection in evaluating HCC recurrence after TACE

作　　者：蒲建元[1] 汪伟民[1] 刘作金[1] 丁雄[1] 李生伟[1] 罗小平[1] 龚建平[1] 

机构地区：[1]重庆医科大学附属第二医院肝胆外科,重庆400010

出　　处：《现代医药卫生》2016年第10期1457-1459,1462,共4页Journal of Modern Medicine & Health

摘　　要：目的评价CT灌注扫描在原发性肝细胞癌经动脉插管化疗栓塞（TACE）术后活性灶评估中的临床应用价值。方法选取2010年1月至2014年1月在该院肝胆外科及介入治疗中心行TACE的原发性肝细胞癌患者62例作为研究对象。于术前1~5 d、术后1~3个月行上腹部CT灌注扫描并行数字减影血管造影（DSA）检查,同时抽取TACE术后1周内及CT灌注扫描前1~3 d空腹检测血液甲胎蛋白（AFP）水平。以CT灌注分析软件获得全肝灌注参数,将DSA检查结果作为标准、参考AFP水平,评估CT灌注扫描对肝癌TACE术后活性灶的发现情况。结果 62例TACE术后患者扫描65次,评估病灶69个,CT灌注发现活性病灶25个,其病变相应的血流量、动脉灌注量（AP）、肝动脉指数在肿瘤活性灶高于非瘤区肝组织和碘油沉积区,差异有统计学意义（P〈0.01）;平均通过时间（TTP）在肿瘤活性灶低于非瘤区肝组织和碘油沉积区,差异有统计学意义（P〈0.01）,其被认定是具有活性或部分活性病灶。CT灌注成像诊断正确率为89.86%,灵敏度92.00%,特异度88.63%。结论 CT灌注扫描作为无创治疗手段对TACE术后活性病灶有较高的灵敏度和特异性,在肝癌TACE术后随访中具有极高的临床价值。Objective To evaluate the clinical value of CT perfusion scanning in the activity lesion evaluation of primary hepatocellular carcinoma（HCC） after transarterial chemotherapy embolization（TACE）. Methods Sixty-two cases of primary HCC in the hepatobiliary surgery department and interventional therapy center of our hospital from January 2010 to January 2014 were selected as the research subjects. The upper abdominal CT perfusion scanning and digital subtraction angiography （DSA）were performed on preoperative 1-5 d and at postoperative 1-3 months ,at the same time the fasting blood AFP levels at 1 week after TACE and on 1-3 d before CT perfusion scanning were determined. The discover situation of HCC activity lesion after TACE by the CT perfusion scanning was evaluated with the CT perfusion analysis software for obtaining the total perfusion parameter , with DSA examination results as the standard and referring to the AFT level. Results In 62 cases of TACE, 65 times of scanning were performed,69 lesions were evaluated,25 active lesions were found by CT-perfusion,their lesions corresponding blood flow amount,AP and hepatic artery index in the tumor active lesion were higher than those in the non-tumor liver tissue and iodipin de-positional district, the differences were statistically significant（P〈0.01）;the mean transit time（MTT） in the tumor active lesion was lower than that in the non-tumor liver tissue and iodipin depositional district,the difference was statistically significant（P〈0.01）, which were affirmed as the active lesion or partially active lesion. The accuracy rate of CT perfusion imaging was 89.86%,sensi-tivity was 92.00%and specificity was 88.63%. Conclusion CT perfusion scanning as the non-invasive treatment measure has higher sensitivity and specificity on the active lesions after TACE and has extremely high clinical value in the follow up after TACE in HCC.

关 键 词：癌 肝细胞 血管造影术 数字减影 体层摄影术 X线计算机 甲胎蛋白类 经动脉插管化疗栓塞 

分 类 号：R743.304[医药卫生—神经病学与精神病学]