肝癌TACE前后癌灶及癌旁CT灌注成像血流定量变化及指导疗效评估的价值  

Quantitative Changes of Blood Flow in Focal and Para-cancerous CT Perfusion Imaging in Liver Cancer before and after Tace and Evaluation Value in Curative Effect

作　　者：冯坤鹏[1] 王兴龙[1] 董备[1] 李依明[1] 郑吟诗[1] FENG Kun-peng;WANG Xing-long;DONG Bei;LI Yi-ming;ZHENG Yin-shi(CT Room,Shangqiu First People's Hospital,Shangqiu 476100,Henan Province,China)

机构地区：[1]商丘市第一人民医院CT室,河南商丘476100

出　　处：《中国CT和MRI杂志》2024年第11期102-105,共4页Chinese Journal of CT and MRI

基　　金：商丘市第一人民医院院级课题(20220214)。

摘　　要：目的探讨肝癌肝动脉化疗栓塞术(TACE)前后癌灶及癌旁计算机断层扫描灌注成像(CTPI)血流定量变化及指导疗效评估的价值。方法回顾性选取2022年8月至2024年3月在本院行TACE治疗的肝癌患者63例,均分别于TACE术前1~3d及术后7d进行CTPI检查,对比肿瘤组织与癌旁1cm组织手术前后肝血流量(BF)、肝血容量(BV)、平均通过时间(MTT)、肝动脉灌注指数(HPI)、肝动脉灌注量(HAP)、门静脉灌注量(PVP)变化情况。根据术后7d肝癌患者疗效情况分为有效组和无效组,对比两组手术前后上述血流灌注参数变化,绘制受试者工作曲线(ROC)分析CTPI血流参数对肝癌患者疗效的评估价值。结果术前、术后肿瘤组织BF、BV、HPI、HAP均高于癌旁1cm组织,PVP、MTT均低于癌旁1cm组织(P<0.05);术后,肿瘤组织BF、BV、HPI、HAP水平较术前均降低(P<0.05),PVP、MTT均升高但与术前比较无差异(P>0.05);术后癌旁1cm组织上述参数水平较术前无变化(P>0.05)。TACE后7d肝癌患者有效率为65.07%(41/63),无效34.92%(22/63)。有效组手术前后△BF、△BV、△HPI、△HAP、△PVP、△MTT与无效组比较差异均有统计学意义(P<0.05)。ROC结果显示,△BF、△BV、△HPI、△HAP、△PVP、△MTT及其联合检测评估肝癌患者TACE疗效的曲线下面积(AUC)分别为0.703、0.751、0.737、0.746、0.770、0.732、0.928(P均<0.05)。结论TACE后肝癌患者肿瘤组织的BF、BV、HPI、HAP均下降,PVP、MTT均升高,但癌旁组织上述指标无变化,临床可通过CTPI血流定量变化对肝癌患者早期疗效予以准确评估。Objective To explore quantitative changes of blood flow in focal and para-cancerous computed tomography perfusion imaging(CTPI)in liver cancer before and after transcatheter arterial chemoembolization(TACE)and evaluation value in curative effect.Methods A total of 63 patients with liver cancer undergoing TACE in the hospital were retrospectively enrolled between August 2022 and March 2024.All underwent CTPI examination at 1-3d before TACE and 7d after TACE.The changes of hepatic blood flow(BF),blood volume(BV),mean transit time(MTT),hepatic artery perfusion index(HPI),hepatic artery perfusion volume(HAP)and portal vein perfusion volume(PVP)before and after surgery in cancer tissues and para-cancerous 1cm tissues were compared.According to curative effect at 7d after surgery,patients with liver cancer were divided into effective group and ineffective group,and changes of the above blood perfusion parameters before and after surgery were compared between the two groups.The evaluation value of CTPI blood flow parameters for curative effect in patients with liver cancer was analyzed by receiver operating characteristic(ROC)curves.Results Before and after surgery,BF,BV,HPI and HAP in cancer tissues were higher than those in para-cancerous 1cm tissues,while PVP and MTT were lower than those in para-cancerous 1cm tissues(P<0.05).After surgery,BF,BV,HPI and HAP were decreased(P<0.05),while PVP and MTT were increased in cancer tissues,but there was no difference compared with those before surgery(P>0.05).Before and after surgery,there was no change in the above parameters in para-cancerous 1cm tissues(P>0.05).At 7d after TACE,effective rate and ineffective rate were 65.07%(41/63)and 34.92%(22/63)in patients with liver cancer.There were significant differences in△BF,△BV,△HPI,△HAP,△PVP and△MTT between effective group and ineffective group before and after surgery(P<0.05).The results of ROC curves analysis showed that area under the curve(AUC)values of△BF,△BV,△HPI,△HAP,△PVP,△MTT and combined detection

关 键 词：肝癌 肝动脉化疗栓塞术 CT灌注成像 血流灌注 疗效 

分 类 号：R735.7[医药卫生—肿瘤]