双源CT全肝灌注成像对原发性肝细胞肝癌TACE术后疗效的评估  

Dual-source CT Hepatic Perfusion in Evaluating the Therapeutic Effect of TACE for HCC

作　　者：朱炳印 郭顺林[1] 姚永杰[1,2] 郑玉荣[1,2] 郭奇虹[1] 翟亚楠[1] 辛文龙 

机构地区：[1]兰州大学第一医院放射科,甘肃兰州730000 [2]兰州大学第一临床医学院,甘肃兰州730000

出　　处：《中国CT和MRI杂志》2017年第8期80-84,共5页Chinese Journal of CT and MRI

摘　　要：目的利用双源CT灌注成像评价肝细胞肝癌(HCC)经动脉导管化疗栓塞术(TACE)治疗前后血流动力学变化,对治疗效果进行评估。方法 23例证实为中晚期HCC的患者。分别于术前1-2天行双源CT平扫、三期增强扫描及全肝脏灌注扫描,术后3-5天及术后一个月行双源CT三期增强扫描及全肝脏灌注扫描。经肘静脉弹丸式注射非离子型碘对比剂(碘帕醇370mg I/m L)50m L,随后追加生理盐水50m L,流速均为5m L/s,获得25个动态扫描;利用灌注软件处理分别产生术前及术后一个月病灶灌注伪彩图,分别测量其前后灌注参数:血容量(BV)、开始时间(TTS)、肝动脉灌注量(ALP)、门静脉灌注量(PVP)及肝灌注指数(HPI),评估TACE术后疗效。结果 23例HCC中5例HCC术后完全被碘油栓塞,18例术后部分被碘油栓塞,对碘油完全栓塞的病灶,灌注参数较术前原发病灶,BV、ALP、HPI明显降低(P<0.05),TTS、PVP明显升高(P<0.05);对比碘油栓塞不完全病灶的碘油沉积区与术前原发病灶的灌注参数值,TTS、PVP值明显增加(P<0.05),ALP、HPI值明显减小(P<0.05);对比残余病灶区与术前原发性病灶的灌注参数值,HPI明显增加(P<0.05),ALP轻度增加,PVP值明显减小(P=0.021);对比碘油栓塞不完全病灶的碘油沉积区与残余病灶区灌注参数,TTS、PVP值明显减低(P<0.05),ALP、HPI明显增加(P=0.00)。结论 CT灌注成像可用于HCC TACE术治疗疗效的评估及术后残余病灶的监测。Objective Use perfusion parameters of dual-source CT to evaluate the effections of TACE thattreatsthe HCC. Methods 23 cases of the advanced HCCwhich confirmed by liver pathology,erology and imaging without any treatment,that consists with Barcelona（BCLC）criteria for diagnosis of HCC, with the percontrast, postcontrast triple-phase of dual-source CT low dose scaningand the whole liver perfusion scaning performed 1-2 days before operation and a month after postoperation.Intravenous bolus injection of 50mL nonionic iodinated contrast agent（iopamidol 370mg/mL） at a 5mL/s, then additional saline 50mLat a 5mL/s, to get 25 dynamic scans. The spcial perfusion softwarewas used to produce perfusion pseudo-color imaging, lastly, the following quantitative data of BV,TTS,ALP,PVP,HPI were used to assess the effect of preoperative and postoperative treatment with TACE. Results BV,ALP and HPI ot the focus of iodine oil completely embolismare lower than preoperation,TTS and PVP are higher, the difference has statistical significance（P〈0.05）. TTS and PVP of the focus of iodine oil incompletely embolismare higherthan preoperation,ALP and HPI are lower,the diffcrence has statistical significance（P〈0.05）. In the residual lesion area, compared with preoperation, ALP and HPI are higher, PVP is lower, the difference has statistical significance（P〈0.05）. The parameters in the focus of iodine oil incompletely embolism,compared with the residual lesion area, TTS and PVP are lower（P〈0.05）, ALP and HPI are clearly higher（P〈0.01）. Conclusion CT perfusion imaging can be used to evaluate the effection of the TACE and monitor the postoperative residual lesions.

关 键 词：CT灌注成像 肝细胞肝癌 经动脉导管化疗栓塞术 

分 类 号：R735.7[医药卫生—肿瘤]