CT灌注成像评价肝细胞癌TACE前后血供的初步经验

目的:探讨经导管动脉化疗栓塞术(TACE)治疗肝细胞癌(HCC)前后血流灌注变化。材料和方法:对21例HCC患者TACE治疗前、后1个月行CT灌注成像扫描,测量肿瘤组织治疗前后肝动脉灌注值(HAP)、门静脉灌注值(HPP)及肝动脉灌注指数(HPI)。结果:治疗前7例肿瘤组织肝动脉灌注图呈均匀高灌注,14例呈不均匀高灌注,液化坏死区无血流灌注。门静脉灌注图,20例呈低灌注,1例无血流灌注。TACE后肿瘤组织HAP及HPI显著减少,HPP无明显变化。5例病灶碘油完全充填,16例病灶部分区域碘油充填,碘油区无血流灌注,肿瘤残留区仍有血流灌注。结论:CT灌注成像为评价TACE疗效提供了一个新方法。     

动脉内恩度联合化疗栓塞术治疗原发性肝癌前后CT灌注成像的随机对照研究

目的 随机对照研究动脉内重组人血管内皮抑制素(恩度TM EndostarTM)联合化疗栓塞(TACE)治疗原发性肝癌(HCC)前后CT灌注参数的变化.资料与方法 40例临床诊断为HCC的患者,随机分成两组,各加例,分别使用动脉内恩度加TACE术及单纯TACE术,所有病例于TACE术前、术后1个月行CT灌注成像(CTPI)扫描,测量肿瘤组织治疗前后血流量(BF)、血容量(BV)、血管表面渗透面积(PS)、肝动脉灌注值(ALP)、门静脉灌注值(PVP)及肝脏灌注指数(HPI).结果 动脉内恩度加TACE术组HCC患者术后1个月CTPI扫描肿瘤组织BF、ALP及HPI水平较术前降低,PVP水平较术前升高,BV、PS水平与术前相比无显著性差异;单纯TACE术组HCC患者术后1个月ALP水平较术前降低,PVP水平较术前升高,BV、BF、PS及HPI水平与术前相比无显著性差异.结论 通过比较两组HCC患者TACE前后CT灌注参数的变化,说明恩度对肿瘤血管生成有一定的抑制作用.     

原发性肝癌经导管动脉化疗栓塞术治疗前后血清血管内皮生长因子与CT灌注成像的相关性研究

目的探讨原发性肝癌（PLC）患者行经导管动脉栓塞（TACE）术前、术后血清血管内皮生长因子（VEGF）与肿瘤组织CT灌注参数的相关性。方法对18例PLC患者TACE术前1d,术后6～8d、32～40d行血清VEGF检测及CT灌注扫描成像（CTPI）,得到血清VEGF、肿瘤组织肝动脉灌注量（ALP）、门静脉灌注量（PVP）、肝动脉灌注指数（HPI）等参数值,并进行统计学分析。结果根据TACE治疗效果分为完全缓解（CR）组和部分缓解及无变化（PR＋SD）组。术前两组血清VEGF及ALP、PVP、HPI差异无统计学意义（P〉0.05）;术后6～8d两组血清VEGF及PVP较术前变化差异无统计学意义（P〉0.05）,而ALP、HPI较术前明显降低（P〈0.05）。术后32～40d,CR组血清VEGF较术前明显降低（P〈0.05）,PR＋SD组则较术前增高,但差异无统计学意义（P=0.221）。血清VEGF与肿瘤组织ALP、HPI呈正相关。结论血清VEGF能间接反映TACE术后肿瘤组织微血管及侧支循环生成情况 CTPI能直观和定量反映肿瘤组织TACE术前后的血流动力学变化 血清VEGF与肿瘤组织ALP、HPI呈正相关。故联合应用血清VEGF及CTPI有助于TACE疗效的评价,对进一步治疗时间、方案的确定提供重要参考依据。     

多层螺旋CT灌注成像对肝癌TACE前后血供变化初步探讨

目的:探讨多层螺旋CT灌注成像在肝细胞癌(HCC)经导管动脉化疗栓塞术(TACE)前后血供变化.方法:对17例HCC患者于TACE前1天及治疗后7～10天行CT灌注扫描,测量肿瘤组织及正常肝组织灌注参数.结果:肿瘤组织TACE术前、术后HBF、HBV、HAP存在显著差异,MTT、PS、HAF、PVP无显著差异.正常组织TACE术前、术后各灌注参数无显著差异.结论:多层螺旋CT灌注成像对评价TACE疗效及指导进一步治疗有着重要价值.     

原发性肝癌TACE前后血清VEGF与CT灌注参数间相关性的研究

目的 探讨原发性肝癌(HCC)患者TACE前后血清血管内皮生长因子(VEGF)水平和CT灌注参数之间的关系. 资料与方法 对17例HCC患者于TACE术前1天及术后7～10天测量血清VEGF水平,同时行CT灌注扫描,计算肝血流量(HBF)、肝动脉灌注分数(HAF),肝动脉灌注量(HAP)、门静脉灌注量(PVP). 结果 原发性肝癌TACE前后HBF、HAP差异有统计学意义,血清VEGF与HBF、HAF、HAP呈正相关. 结论 血清VEGF水平及CT灌注可帮助评价肝癌TACE疗效.     

血清血管内皮生长因子及CT灌注与原发性肝癌栓塞化疗的相关性分析

目的 探讨原发性肝癌(HCC)患者栓塞前后血清血管内皮生长因子(VEGF)水平和CT灌注参数之间的关系.方法 对17例HCC患者于经导管动脉栓塞化疗(TACE)术前1 d、术后7～10 d分别采用酶联免疫吸附定量法测量血清VEGF水平,同时行CT灌注扫描,计算各函数图中肝血流量(HBF)、肝动脉灌注分数(HAF),肝动脉灌流量(HAP)、门静脉灌流量(FVP).结果 原发性肝癌栓塞前后的HBF、HAP存在显著差异,HAF、PVP、VEGF无显著差异.血清VEGF与HBF、HAF、HAP呈正相关,而与PVP无明显相关性.结论 血清VEGF水平及CT灌注对评价肝癌TACE疗效、指导治疗有重要价值.     

前列地尔对肝细胞癌动脉化疗栓塞后肝血流灌注的影响

目的 初步探讨前列地尔(PGE_1)对肝细胞癌(HCC)经动脉化疗栓塞(TACE)后肝血流灌注的影响.方法 连续搜集接受TACE初治的HCC患者64例,随机数字法分为对照组与PGE_1组,每组32例.对照组接受常规TACE治疗,第1次TACE4周后复治;PGE_1组于TACE后经外周静脉推注PGE_11次/d,连续1周,用药量为0.4μg/kg.所有患者于术前1周、术后4周内行非瘤区肝CT灌注成像(CTPI),测量肝动脉灌注量(HAP)、门静脉灌注量(PVP)、肝总血流灌注量(TLP)、肝动脉灌注指数(HPI),TACE后不同时期肝灌注参数的组内比较采用单因素方差分析,对照组与PGE_1组肝各灌注参数组间比较采用t检验.结果 对照组术前1周、第1次术后、第2次术后的HAP分别为(0.18±0.08)、(0.22±0.09)、(0.32±0.10)ml·min~(-1)·ml~(-1);PVP分别为(1.11±0.31)、(0.82±0.27)、(0.59±0.25)ml·min~(-1)·ml~(-1);TLP分别为(1.29±0.33)、(1.04±0.28)、(0.91±0.24)ml·min~(-1)·ml~(-1);HPI分别为(14.31±6.36)%、(21.37±9.07)%、(36.67±13.42)%.TACE不同时间HAP、PVP、TLP、HPI组间差异均有统计学意义(F值分别为19.71、27.47、14.75、41.41,P值均<0.05).PGE_1组术前1周、第1次术后4周、第2次术后4周的HAP分别为(0.17±0.08)、(0.20±0.08)、(0.26±0.08)ml·min~(-1)·ml~(-1);PVP分别为(1.09±0.36)、(1.03±0.40)、(0.91±0.41)ml·min~(-1)·ml~(-1);TLP分别为(1.26±0.38)、(1.23±0.40)、(1.17±0.44)ml·min~(-1)·ml~(-1);HPI分别为(14.04±6.71)%、(17.26±7.86)%、(23.93±8.96)%.其中HAP与HPI组间差异有统计学意义(F值分别为10.78、13.05,P值均<0.05),而PVP与TLP组间差异无统计学意义(F值分别为1.73、0.39,P值均>0.05).第1次术后对照组与PGE1组的PVP与TLP的组间差异有统计学意义(t值分别为-2.37、-2.14,P值均<0.05),而HAP、HPI组间差异无统计学意义(t值分别为0.86、2.24,P值均>0.05);第2次术后对照组与PGE1组的HAP、PVP、TLP、HPI组间差异均有统计学意义(t值分别为2.55、-4.49、-3.41、5.09,P值均<0.05).结论 TACE后肝PVP与TLP减少而HAP与HPI增加,PGE_1能改善以PVP为主的肝血流灌注,有助于减轻TACE对非瘤区肝组织的损害.     

CT灌注成像评价前列地尔脂微球对TACE前后非癌肝组织血流灌注的影响

目的 运用CT灌注成像评价前列地尔脂微球(liposome prostaglandin E1,Lipo-PGE1)对经动脉化疗栓塞术(transarterial chemoembolization, TACE)治疗肝细胞癌(hepatocellular carcinoma,HCC)前后非癌肝组织血流的影响.资料与方法 连续搜集46例HCC患者资料,随机分成实验组和对照组,各23例.采用CT灌注扫描比较两组患者的肝血流灌注情况.结果 TACE术前实验组肝动脉灌注量(HAP)、门静脉灌注量(PVP)及总肝灌注量(TLP)分别为(0.18±0.13) ml·min-1·ml-1、(1.64±0.44) ml·min-1·ml-1及(1.82±0.32) ml·min-1·ml-1,对照组则分别为(0.16±0.17) ml·min-1·ml-1、(1.41±0.37) ml·min-1·ml-1、(1.57±0.28) ml·min-1·ml-1, 其中PVP、TLP组间比较差异有统计学意义(P=0.00)、(P=0.01),HAP组间比较差异无统计学意义(P>0.05);对照组TACE术后1个月HAP、PVP、TLP分别为(0.09±0.07) ml·min-1·ml-1、(1.35 ±0.27) ml·min-1·ml-1、(1.44±0.18) ml·min-1·ml-1,与术前HAP、TLP组间比较差异有统计学意义(P=0.00)、(P=0.02);PVP组间比较差异无统计学意义(P>0.05);实验组TACE术后1个月HAP、PVP、TLP分别为(0.19±0.11) ml·min-1·ml-1、(1.71± 0.34) ml·min-1·ml-1)、(1.90±0.33) ml·min-1·ml-1,与术前组间对比差异无统计学意义(P>0.05).结论 CT灌注成像可定量评价TACE前后非癌肝组织血流灌注的变化;Lipo-PGE1能促进肝血流灌注,有利于肝功能的恢复和改善.     

肝移植术后移植肝血流灌注异常的CT灌注研究

目的 运用CT灌注成像(CTP)探讨肝移植术后肝脏血流灌注的影响因素.方法33例肝移植术后患者接受CT血管成像(CTA)及CTP检查.计算主动脉强化峰值的95%可信区间范围,排除此范围以外的病例.测量无并发症患者肝动脉灌注量(HAP)、门静脉灌注最(PVP)、总肝灌注最(TLP)及肝动脉灌注指数(HPI)的平均值及其95%可信区间范围,并在此基础上分析有术后并发症患者的肝脏血流灌注情况及上述各项指标的影响因素.结果29例患者纳入该研究,其中无术后并发症15例,有术后并发症14例.无术后并发症患者HAP、PVP、TLP和HPI的95%可信区间范围分别为(0.1509～0.3183)、(0.7223～1.3859)、(0.8367～1.7231)ml·min-1·ml-1和17.83%～31.63%.14例有并发症的患者中,HAP降低7例,其巾肝动脉狭窄5例、脾大3例;HAP增高2例,均为中、重度门静脉狭窄患者.PVP减低13例,其中门静脉狭窄或闭塞8例、脾肾分流4例、脂肪肝2例;TLP减低12例,全部与PVP减低有关.仅2例HAP减低患者HPI减低.结论CTP技术通过定量测量肝动脉、门静脉血流灌注,能够无创性评价各种移植肝血流灌注异常,客观评价移植肝缺血的程度和类型,对指导临床治疗具有重要价值.     

原发性肝癌经肝动脉化疗栓塞术后16层螺旋CT表现与血清AFP变化相关性分析

目的 探讨原发性肝细胞性肝癌(HCC)介入治疗后16层螺旋CT表现与血清甲胎蛋白(AFP)含量变化的关系.方法 对42例HCC患者,均行经导管肝动脉化疗栓塞术(TACE),术后3～4周行上腹部平扫及双期增强扫描,观察碘油沉积范围和肿瘤强化范围,并同时测定患者血清AFP水平并计算治疗前后其下降百分率,使用统计软件分析两者的相关性.结果 42例HCC患者TACE术后,肿瘤强化范围0%～100%不等,其中＜25% 5例,25%～50% 15例,＞50% 22例,与患者血清AFP含量下降百分率呈负相关( r =-0.776,P＜0.05 ).碘油沉积范围0%～100%不等,其中无碘油沉积4例,＜25% 12例,25%～50% 16例,＞50% 10例,与血清AFP含量下降百分率呈正相关(r=0.907,P＜0.05 ).结论 HCC患者TACE后16层螺旋CT表现与血清AFP含量下降百分率具相关性,可以作为介入治疗效果的评价指标.     

双源CT双能量成像在肝癌经皮肝动脉化疗栓塞术后复查中的应用价值

目的 评价双源CT(DSCT)双能量成像对肝癌经皮肝动脉化疗栓塞(TACE)术后病灶复查的应用价值.方法 对27例接受TACE治疗的原发性肝癌患者资料进行回顾性分析,27例均行常规肝脏平扫及动态三期增强扫描,其中动脉期图像由双能量扫描方式获得.采用2种方法观察,A法观察常规平扫、动脉期、门静脉期及延迟期图像,B法观察虚拟平扫、动脉期、门静脉期及延迟期图像,评价2种方法对栓塞病灶内部及其周围肝组织内强化信息的判断.以DSA结果为参照标准,计算A、B2法的敏感性、特异性等指标,采用x2检验比较两种方法的诊断能力.结果 27例TACE术后复查患者中共检出63个病变,DSA明确其中39个病变有强化,24个病变无强化.B法的敏感性为94.9％( 37/39),高于A法的74.4％( 29/39;x2=6.303,P＜0.05);B法的特异性为95.8％( 23/24),与A法的83.3％ (20/24)差异无统计学意义(x2 =2.009,P＞0.05).结论 以动脉期双能量扫描代替常规CT平扫与动脉期增强扫描,与常规CT动态增强相比,对TACE术后肝癌病灶的评估更加准确.     

Arterial blood supply to the posterior aspect of segment IV of the liver from the caudate branch: demonstration at CT after iodized oil injection

PURPOSE: To retrospectively evaluate the arterial blood supply to the posterior aspect of segment IV of the liver with computed tomography (CT) after transcatheter arterial chemoembolization (TACE) with iodized oil through the caudate arterial branch of the liver for treatment of hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Institutional review board approval and patient informed consent were not required for this retrospective study. Twenty-four patients (11 men and 13 women; mean age, 68 years) with HCC originating in the caudate lobe (n = 23) or posterior aspect of segment IV (n = 1) were selected. TACE of the caudate arterial branch was performed in all patients, including one patient with HCC in the posterior aspect of segment IV who underwent TACE of the caudate arterial branch after CT helped confirm that iodized oil was not distributed in the tumor after TACE of the medial segmental artery. The distribution of iodized oil in the posterior aspect of segment IV was analyzed with CT 1 week after TACE. The number and origin of all arteries supplying the caudate lobe and the number of arteries embolized were determined. RESULTS: Thirty-three caudate arterial branches were embolized. Twenty-nine branches were derived from the right hepatic artery and four were derived from the left hepatic artery. A single branch was seen in 17 patients, two branches were seen in five, and three branches were seen in two. Eight patients simultaneously underwent additional TACE of branches of the right hepatic artery (n = 6) or right inferior phrenic artery (n = 2). At CT, iodized oil was seen to be distributed entirely (n = 19) or partially (n = 5) in the caudate lobe. Distribution of iodized oil at the posterior aspect of segment IV was observed in 16 patients (67%), including 13 (54%) whose caudate arterial branches were derived entirely from the right hepatic artery. CONCLUSION: The results of this study suggest that the caudate arterial branch, which is mainly derived from the right hepatic artery, frequently supplies the posterior aspect of segment IV. This knowledge is important for managing HCC in the posterior aspect of segment IV by means of TACE.     

MSCT灌注成像在肝脏常见肿瘤鉴别诊断中的临床应用价值

目的探讨CT灌注成像在肝脏常见肿瘤鉴别诊断中的应用价值。资料与方法将61例肝脏肿瘤患者分为肝细胞癌组、肝转移瘤组及肝血管瘤组,进行全肝灌注成像,感兴趣区(ROI)分别选放于病灶内(A点)、病灶周围1 cm处(B点)及正常肝实质(C点),分析其灌注彩图、灌注参数及时间-密度曲线(TDC)特点。结果 (1)肝细胞癌、约81%肝转移瘤在肝动脉灌注量(HAP)图上表现为不均匀高灌注,坏死区呈低灌注,门静脉灌注量(HPP)图上呈不均匀低灌注;肝血管瘤边缘结节样强化区域HAP图上呈明显高灌注,HPP图上部分呈低灌注,早期无强化区域在HAP及HPP图上均呈低灌注。(2)肝细胞癌TDC呈速升速降型,在30 s前达到峰值;肝转移瘤TDC一般在30 s前达到峰值,但顶峰多不明显;海绵状血管瘤TDC呈速升缓降型,一般在30 s后才达到高峰。(3)肝细胞癌组及肝转移瘤组B点参数值与A点有相似改变,而血管瘤组B点与C点灌注参数值无差异。肝细胞癌组、肝转移瘤组A点HPP值低于肝血管瘤组,肝动脉灌注指数(HPI)值高于肝血管瘤组。肝细胞癌组、肝转移瘤组B点HPP、总肝灌注量(TLP)值低于肝血管瘤组,HPI值高于肝血管瘤组;各组B点间HPI差异无统计学意义。(4)灌注参数受试者工作特征(ROC)曲线分析发现A点HPP、HPI及B点HPP、TLP、HPI灌注参数的曲线下面积(AUC)均位于0.7～0.9之间。结论 CT灌注成像在肝脏常见良恶性肿瘤的鉴别诊断中有一定价值;ROC曲线分析有望用于评价灌注参数在肝脏肿瘤良恶性鉴别中的诊断效能,并选择合适的诊断参考值。     

Usefulness of cone-beam volume CT with flat panel detectors in conjunction with catheter angiography for transcatheter arterial embolization

PURPOSE: To assess the usefulness of cone-beam volume computed tomography (CT) (cone-beam CT) with use of flat panel detectors of the direct conversion type in conjunction with conventional digital subtraction angiography (DSA) in the diagnosis and treatment of patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Forty-nine consecutive patients (52 suspicious lesions) were prospectively examined. All patients underwent intraarterial rotational angiography with a flat panel detector system, and the cone-beam CT scans were reconstructed from the volume data set. The authors evaluated the diagnostic quality of cone-beam CT for the transcatheter arterial chemoembolization (TACE) procedure. RESULTS: The diagnostic quality of conventional DSA plus cone-beam CT with regard to tumor staining was superior to that of DSA alone. Cone-beam CT showed tumor staining in five lesions that were difficult to diagnose with confidence on the basis of the DSA findings alone. The extent of contrast medium perfusion was sufficiently visualized on all cone-beam CT scans at the tip of the catheter positioned in either the segmental or subsegmental hepatic arteries. In 42 of the 52 lesions (81%), cone-beam CT provided additional useful information for therapeutic decision making or TACE compared with DSA. CONCLUSIONS: Intraarterial cone-beam CT with a flat panel detector can provide clinically acceptable image quality in the assessment of HCC, thereby improving the detection of tumor staining due to HCC and the visualization of the extent of contrast medium perfusion.     

同轴微导管肝动脉化疗栓塞联合射频消融治疗原发性肝癌

目的 探讨经肝动脉微导管化疗栓塞(TACE)联合射频消融(RFA)术治疗原发性肝癌(HCC)的疗效.方法 回顾分析1000例HCC的DSA表现与术前多层螺旋CT(MSCT)检查结果.其中179例病灶局限于1个肝段,采用微导管超选择插管栓寒.术后4周复查动态增强CT和(或)MR,对40例病灶碘油聚集不良者,进行RFA,术后1个月复查.结果 DSA发现直径3 cm以上肿块670例,3 cm以下病灶202例,子灶400例,动静脉瘘、动门脉瘘482例,异常血供430例,门脉癌栓362例.局限于1个肝段的病灶,微导管栓塞后4周,肿瘤局部控制率为77.6%;控制不良者行RFA后1个月,肿瘤局部控制率为97.5%.结论 DSA对于发现3 cm以下小病灶(含子灶)、肿瘤血供、动静脉瘘、动门脉瘘具有绝对的优势,对HCC的术前评价具有不可替代性的作用.RFA是HCC的有效的治疗方法,是TACE疗效不佳者的理想选择.     

Early response evaluation using CT-perfusion one day after transarterial chemoembolization for HCC predicts treatment response and long-term disease control

PurposeTo determine the value of CT perfusion (CTP) for early response assessment after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).Materials and methodsBetween April 2013 and April 2015, 41 HCC (16 patients) were included in this study. CT perfusion was performed before and one day after TACE. Blood flow (BF), blood volume (BV), time to start (TTS), arterial liver perfusion (ALP), portal liver perfusion (PVP) and hepatic perfusion index (HPI) were measured. Quantitative perfusion values before and after TACE were compared to the response assessed using mRECIST criteria six weeks after TACE and long-term outcome was assessed.ResultsTwenty-one lesions (51%) had complete remission (CR) and five (12%) had partial response (PR) six weeks after TACE. CTP parameters were significantly reduced after TACE in responders (PR, CR, p < 0.001) while no difference was observed in non-responders. ALP_post was superior in the prediction of CR compared to BF_post and BV_post (p < 0.001) with a sensitivity, specificity, PPV, NPV, and accuracy of 90%, 90%, 91%, 90%, and 91%, respectively. Only 3/21 lesions with CR recurred, with a mean local-recurrence-free survival of 19.6 months.ConclusionCT perfusion detects lesions with complete response one day after TACE, and is a feasible tool for early response assessment.     

Hepatic arterioportal shunts not directly related to hepatocellular carcinoma: findings on CT during hepatic arteriography, CT arterial portography and dual phase spiral CT

AIM: To evaluate findings of arterioportal shunts not directly related to hepatocellular carcinoma (HCC) which were seen within third-order portal branches on computed tomography (CT) during hepatic arteriography (CTHA), arterial portography (CTAP), and dual phase spiral CT.MATERIALS AND METHODS: At CTHA in 112 patients, we examined third-order portal vein branches to find arterioportal shunts not directly related to HCC. Six cases were found. We evaluated the findings of these shunts on CTHA and investigated whether CTAP (n = 6) and dual phase spiral CT (n = 5) showed perfusion defects in the corresponding areas on arterioportal shunts. RESULTS: Five of six cases showed abrupt visualization of portal branches without visualization of the proximal portion of CTHA. Five of six cases showed no perfusion defect on CTAP and no hyperattenuating area on CTHA. Four of five cases showed no hyperattenuating area on hepatic arterial phase spiral CT. CONCLUSION: Arterioportal shunts not directly related to HCC and occuring within third-order portal branches mainly showed abrupt visualization of portal branches on CTHA. These occurred frequently without perfusion defects on CTAP and without a hyperattenuating area on CTHA and hepatic arterial phase spiral CT.Park, C. M. (2000). Clinical Radiology55, 465-470.