肝细胞癌血流灌注CT测量的原理方法和临床应用  

CT measurement of blood perfusion in hepatocellular carcinoma:from basic principle,measurement methods to clinical application

作　　者：李宇铠 王庆波 梁钰博 柯阳[1] Li Yukai;Wang Qingbo;Liang Yubo;Ke Yang(Department of Hepatobiliary Surgery,The Second Affiliated Hospital of Kunming Medical University,Kunming 650101,China)

机构地区：[1]昆明医科大学第二附属医院肝胆外科,昆明650101

出　　处：《中华肿瘤杂志》2024年第10期940-947,共8页Chinese Journal of Oncology

基　　金：国家自然科学基金青年科学基金项目(82103173);国家级大学生创新创业训练计划项目(202210678012);云南省基础研究计划优秀青年基金(202401AW070003);云南省中青学术和技术带头人后备人才(202205AC160063);昆明医科大学第二附属医院2023年度临床医学省级一流学科建设揭榜挂帅项目昆明医科大学硕士研究生创新基金(2024S305)。

摘　　要：肝细胞癌是全球常见的恶性肿瘤之一,中国肝细胞癌疾病负担尤其严重。生理上,健康肝脏的血流供应以门静脉为主,肝动脉为辅,而肝细胞癌发生过程中,其主要血流供应来源由门静脉转换为肝动脉。肝细胞癌血流供应特征是影像学成像、外科手术、介入治疗、靶向治疗等的重要基础,甚至未来随着质子重离子等放射治疗技术和人工智能技术的发展,肝细胞癌血流灌注可作为新的肿瘤活性生物学标记提供精准的放疗强度信息。因此,精确地测定肝细胞癌血流灌注的变化对指导肝细胞癌诊治有重要意义。测量肝细胞癌血流灌注经历了20世纪中叶惰性气体清除、电磁流量计、放射性核素标记红细胞洗脱等有创技术到现在CT等无创技术的发展历程。近30年来随着CT影像学技术的发展,基于CT成像技术能更为简便和准确地评估器官组织血流灌注状态。文章将各种肝细胞癌血流灌注的CT测量技术归纳为半定量技术、相对定量技术和绝对定量技术3种类型,总结每种类型的基本原理、实现方法和临床应用,以期为临床上诊治肝细胞癌提供参考。Hepatocellular carcinoma(HCC)is one of the common and fatal malignant tumors worldwide,and the burden of HCC is particularly severe in China.Physiologically,the blood supply to healthy liver is mainly from the portal vein,supplemented by the hepatic artery.While in the development of HCC,the main source of blood supply to HCC is changed from the portal vein to the hepatic artery.The characteristics of HCC vascularization are important for imaging,surgery,interventional therapy,targeted therapy,etc.Even in the future,with the development of radiation therapy technology,such as proton and heavy ion therapy and artificial intelligence technology,the dynamic changes in HCC blood perfusion can be used as a new biomarker of tumor activity to provide accurate information on the intensity modulation of radiotherapy,so that accurate measurements of HCC blood perfusion is of great significance in guiding the diagnosis and treatment of HCC.The technologies for measurement of HCC blood perfusion have developed from invasive techniques,such as inert gas scavenging,electromagnetic flowmeter,and radionuclide-labeled erythrocyte elution in the middle of the last century to the present non-invasive techniques of CT.With the development of CT imaging technology in the last 30 years,the CT-based imaging technology can assess the status of organ and tissue perfusion relatively easily and accurately.In this paper,the various CT measurement techniques of blood perfusion in HCC were categorized into three types:semi-quantitative technique,relative quantitative technique,and absolute quantitative technique.Their basic principle,scanning methods,and clinical applications were discussed to provide a reference for the diagnosis and treatment of HCC.

关 键 词：肝细胞癌 测量 计算机断层扫描 血流灌注 血流供应 

分 类 号：R735.7[医药卫生—肿瘤]