CT引导肝癌微波消融术后CT灌注参数与近期疗效及预后的关系研究  

The relationship between CT perfusion parameters,short-term efficacy and prognosis after CT-guided microwave ablation of hepatocellular carcinoma

作　　者：周炜[1] 耿娜薇 王颖[1] 臧伟 刘丙木 曹莉明[2] ZHOU Wei;GENG Nawei;WANG Ying;ZANG Wei;LIU Bingmu;CAO Liming(Department of Interventional Radiology,Baoding First Central Hospital,Baoding,Hebei 071000,China;不详)

机构地区：[1]保定市第一中心医院介入治疗科,河北保定071000 [2]联勤保障部队第九八零(白求恩国际和平)医院介入治疗科,河北石家庄050082

出　　处：《中华全科医学》2024年第10期1742-1745,1786,共5页Chinese Journal of General Practice

基　　金：河北省医学科学研究重点课题项目(20211761)。

摘　　要：目的术前CT灌注成像有利于肝癌患者的预后评估,但关于术后CT灌注成像作用的研究较少。本研究分析CT引导肝癌微波消融术(MWA)后CT灌注成像参数与肝癌患者近期疗效和远期预后的关系,以进一步探究其在肝癌患者中的应用价值。方法选取保定市第一中心医院2020年1月—2022年1月收治的原发性肝癌患者150例,根据改良实体瘤疗效评价标准(mRECIST)分为治疗有效组和治疗无效组。比较2组MWA治疗4周后CT灌注参数,应用ROC曲线评价CT灌注参数预测患者近期疗效的价值;以全因死亡为终点事件,使用Kaplan-Meier生存曲线评估CT灌注参数与患者预后的关系并应用log-rank检验进行差异性比较。结果治疗有效组肝动脉灌注量(HAP)低于治疗无效组、门静脉灌注量(PVP)高于治疗无效组(P<0.001);HAP、PVP对患者近期疗效有一定的预测价值,其中二者联合检测预测效能最高,AUC为0.894,灵敏度、特异度分别为94.64%、65.96%;HAP低水平组、PVP高水平组总体生存率分别高于HAP高水平组、PVP低水平组(P<0.05)。结论CT灌注参数与肝癌患者MWA后短期疗效和长期预后均密切相关,术后HAP越高、PVP越低,患者治疗效果和预后越差。Objective Preoperative CT perfusion imaging is beneficial to the prognosis assessment of patients with liver cancer,but there are few studies on the effect of postoperative CT perfusion imaging.This study analyzed the relationship between CT perfusion imaging parameters and short-term efficacy and long-term prognosis of patients with liver cancer af-ter CT-guided microwave ablation(MWA),so as to further explore its application value in patients with liver cancer.Methods A total of 150 patients with primary liver cancer admitted to Baoding First Central Hospital from January 2020 to January 2022 were selected and separated into the effective group and the ineffective group according to the modified response evaluation criteria in solid tumor(mRECIST).CT perfusion parameters between the two groups were compared after 4 weeks of MWA treatment,and the receiver operating characteristic(ROC)curve was used to evaluate the value of CT perfusion parameters in predicting the short-term efficacy;With all-cause death as the end event,Kaplan-Meier sur-vival curve was used to evaluate the relationship between CT perfusion parameters and prognosis of patients,and log-rank test was used to compare the differences.Results Hepatic artery perfusion volume(HAP)in the effective group was lower than that in the ineffective group,and the portal vein perfusion volume(PVP)was higher(P<0.001);Both HAP and PVP had certain predictive value for the short-term efficacy of patients,and their combined detection had the highest predictive efficacy,with AUC of 0.894,sensitivity and specificity of 94.64%and 65.96%,respectively;The overall survival rate of HAP low-level group and PVP high-level group was higher than that of HAP high-level group and PVP low-level group(P<0.05).Conclusion CT perfusion parameters are closely related to the short-term efficacy and long-term prognosis of HCC patients after MWA.The higher the HAP and lower the PVP,the worse the therapeutic effect and prognosis.

关 键 词：肝癌 CT 微波消融术 疗效 预后 

分 类 号：R445.4[医药卫生—影像医学与核医学]