Assessment of Perfusion CT Imaging in the Hepatic Blood Flow of Hepatocellular Carcinoma Based on Cirrhosis

目的 对正常肝实质、肝硬化和肝硬化基础上肝癌患者的64层螺旋CT灌注成像进行分析,评价多层螺旋CT灌注成像对肝硬化基础上肝癌肝血流变化的诊断价值.资料与方法 无肝脏疾病的30例作为对照组.实验组包括49例肝硬化疾病患者,其中27例确诊为原发性肝癌(HCC).所有研究对象知情同意后,选择癌灶中心层面或肝门层面行CT灌注扫描,采用低剂量扫描:120 kV,60 mA,扫描范围为40mm.以4～5 ml/s流率,按照1.0ml/kg体重用量静脉团注对比剂.在注入对比剂5s后行50 s连续的扫描,360.旋转/s,5 mm层厚进行图像重组,矩阵大小512 ×512像素.利用去卷积数学模型获得与肝血流变化相关的灌注参数值:肝血流量(HBF),肝血容量(HBV),肝动脉灌注分数(HAF),肝动脉灌注量(HAP),门静脉灌注量(HPP).对不同的感兴趣区进行三次灌注参数测量后取平均值进行灌注结果分析.感兴趣区包括:对照组的正常肝实质、癌灶边缘区、癌灶周围的肝实质和无癌灶的肝硬化肝实质.结果 与对照组灌注参数比较,癌周围肝实质的HBF、HAP、HPP、HBV及癌灶边缘区的HBF、HAP、HPP有统计学差异(P＜0.05).与对照组相对应灌注参数比较,癌周的HAP、HPP及对照组的HBF、HAP、HPP有统计学差异(P＜0.05).与癌边缘区HAF对比,癌灶周围肝实质、对照组和无癌灶的肝硬化组均有统计学差异(P＜0.05).对照组和无癌灶的肝硬化组间灌注参数无明显差异(P＞0.05).结论 CT灌注成像能很好地反映肝硬化基础上肝癌的肝血流变化信息,为肝血流动力学变化的影像研究提供新的方法.     

16层螺旋CT灌注成像对原发性肝癌血流动力学的研究

目的:探讨16层螺旋CT灌注成像对原发性肝癌血供评价的应用价值。方法:对17例原发性肝癌行多层螺旋CT灌注成像扫描,分别算出肿瘤组织、瘤旁组织及正常肝组织肝血流量(HBF)、肝血容量(HBV)、平均通过时间(MTT)、毛细血管通透性(PS)、肝动脉供血分数(HAF)、肝动脉灌流量(HAP)、门静脉灌流量(PVP)。结果:肿瘤组织、瘤旁组织及正常组织灌注参数中HBF、MTT、HAF、HAP差异有显著性意义。结论:多层螺旋CT灌注成像技术对评价原发性肝癌血流动力学具有重要价值,其中HBF、MTT、HAF、HAP可用于定量评价肝癌血供情况。     

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.     

CT灌注成像对原发性肝癌、肝转移瘤和肝血管瘤的鉴别诊断价值

目的探讨CT灌注成像对原发性肝癌、肝转移瘤和肝血管瘤的鉴别诊断价值。方法对24例原发性肝癌、11例肝转移瘤和21例肝血管瘤的病灶实性部分,周围肝实质以及正常肝实质的CT灌注参数进行分析。结果比较各组病灶实质部分的参数,原发性肝癌组的肝血流量(HBF)、肝动脉灌注分数(HAF)明显高于肝转移瘤组和肝血管瘤组,原发性肝癌和肝血管瘤组的肝血容量(HBV)高于肝转移瘤组,原发性肝癌组的平均通过时间(MTT)则依次短于肝转移瘤组、血管瘤组,三组间的毛细血管表面通透性(PS)无显著性差异;比较病灶周围实质部分的参数,原发性肝癌组和肝转移瘤组的HBF明显高于肝血管瘤组,而HAF均低于肝血管瘤组,肝转移瘤组的PS高于肝血管瘤组,三组间的HBV、MTT无显著性差异;对于正常肝实质部分,原发性肝癌组的MTT短于肝转移瘤组和肝血管瘤组,原发性肝癌组的HAF高于肝转移瘤组和肝血管瘤组,三组间的HBF、HBV、PS无显著性差异。结论CT灌注成像灌注参数值的测定对于原发性肝癌、肝转移瘤和肝血管瘤的鉴别诊断以及对邻近的肝组织受累情况的评估具有重要的临床意义。     

CT灌注成像对原发性肝癌、肝转移瘤和肝血管瘤的鉴别诊断价值

目的 探讨CT灌注成像对原发性肝癌、肝转移瘤和肝血管瘤的鉴别诊断价值.方法 对24例原发性肝癌、11例肝转移瘤和21例肝血管瘤的病灶实性部分,周围肝实质以及正常肝实质的CT灌注参数进行分析.结果 比较各组病灶实质部分的参数,原发性肝癌组的肝血流量(HBF)、肝动脉灌注分数(HAF)明显高于肝转移瘤组和肝血管瘤组,原发性肝癌和肝血管瘤组的肝血容量(HBV)高于肝转移瘤组,原发性肝癌组的平均通过时间(MTT)则依次短于肝转移瘤组、血管瘤组,三组间的毛细血管表面通透性(PS)无显著性差异;比较病灶周围实质部分的参数,原发性肝癌组和肝转移瘤组的HBF明显高于肝血管瘤组,而HAF均低于肝血管瘤组,肝转移瘤组的PS高于肝血管瘤组,三组间的HBV、MTT无显著性差异;对于正常肝实质部分,原发性肝癌组的MTT短于肝转移瘤组和肝血管瘤组,原发性肝癌组的HAF高于肝转移瘤组和肝血管瘤组,三组间的HBF、HBV、PS无显著性差异.结论 CT灌注成像灌注参数值的测定对于原发性肝癌、肝转移瘤和肝血管瘤的鉴别诊断以及对邻近的肝组织受累情况的评估具有重要的临床意义.     

256层CT全肝灌注评估肝硬化段性功能储备

目的:以临床Ch ild-pug h分级为标准,应用256层CT全肝灌注扫描对肝硬化患者行段性功能储备评估。方法:20例无明显肝脏疾患的患者及23例肝硬化患者均行全肝灌注检查,得到肝脏灌注图像,分别测量肝脏各段灌注参数:肝动脉灌注量(HAP)、门静脉灌注量(HPP)、肝总灌注量(TLP)、肝动脉灌注指数(HAPI)以及门静脉灌注指数(HPPI)。对正常组及肝硬化组行肝段性灌注测量,对肝脏各段血流灌注参数行统计学分析。结果:正常肝脏各段间HAP、HPP、TLP、HAPI、HPPI均无统计学差异,HAP:HPP=1/3~1/4;Ch ild-pug h A级H A P、T LP存在段间差异(P<0.05),H A P:H PP=1/2~1/3;Ch ild-pug h B级H A P存在段间差异(P<0.05),HAP:HPP=1/2~1/3;Child-pugh C级各灌注参数均存在段间差异(P<0.05),HAP:HPP=2/1~2/3。正常组与肝硬化各组间比较:除Ⅱ、Ⅲ段HAP组间无统计学差异外,Ⅰ-Ⅷ段各灌注参数均存在部分组间差异(P<0.05),Ⅰ-Ⅷ段HPP肝硬化各组与正常组均有统计学差异,随着肝功能受损程度的加重,肝脏各段HAP、HAPI值呈上升趋势,HPP、TLP、HPPI值呈下降趋势,肝动脉与门静脉系统血供比例逐渐增大。结论:256层CT全肝灌注模式可用于直观定量反映肝硬化肝脏各段血流灌注特征,对肝脏储备功能分段评估具有一定临床应用价值。     

多层螺旋CT灌注成像对兔VX2肝移植瘤无水酒精介入治疗疗效的评价

目的 探讨MSCT灌注成像对兔VX2肝移植瘤无水酒精介入治疗后疗效评价的价值.方法 15只日本长耳大白兔按数字表法随机分成实验组及对照组,均接种VX2肝移植瘤,对照组5只兔于肿瘤接种后14 d行肝MSCT灌注扫描后牺牲,取肿瘤边缘组织行免疫组织化学分析,观察微血管密度(MVD).实验组10只兔于肿瘤接种后14 d行MSCT灌注扫描后行开腹肿瘤内无水酒精介入治疗,再于介入治疗后3及30 d行CT灌注扫描,牺牲后取肿瘤边缘组织行免疫组织化学分析,对比肿瘤边缘组织CT灌注参数,包括肝血流量(BF)、血容量(BV)、平均通过时间(MTT)、毛细血管表面通透性(PS)、肝动脉灌注指数(HAF)和肝动脉灌流量(HAP)的变化规律.应用重复测量方法比较实验组兔无水酒精介入治疗前后不同时间肿瘤边缘区CT灌注参数的变化,采用独立样本t检验比较实验组与对照组间的MVD结果,对照组灌注参数与MVD结果比较采用线性相关性分析.结果 肿瘤周边区治疗前、治疗后3及30 d BF分别为(280.62±59.87)、(322.03±86.94)、(177.05±75.%)ml·min-1;HAF分别为0.59±0.08、0.89±0.12、0.23±0.07;HAP分别为(189.26±25.46)、(251.57±31.78)、(40.90±5.17)ml·min-1·m-1.治疗后3 d HAP较治疗前明显升高(P＜0.05);治疗后30 d较治疗后3 d BF、HAF、HAP均降低(P均＜0.05);治疗后30 d较治疗前BF、HAF、HAP均降低(P均＜0.05).对照组移植瘤种植后14 d BF、PS、HAF、HAP与MVD呈正相关(r值分别为0.916、0.726、0.870、0.889,P＜0.05).实验组介入治疗后30 d MVD(21.8±3.5)条/高倍视野(HP)较对照组MVD(43.9±4.0)条/HP减低(t=12.271,P＜0.05).结论 CT灌注成像可评价兔VX2肝移植瘤无水酒精介入前后的肝血流动力学改变,可以代替MVD评价肿瘤的血管生成.     

肝脏CT灌注成像在肝癌早期诊断中的价值

目的:通过对比不同大小肝癌病灶以及小肝癌病灶与肝硬化实质间的灌注差异,探讨肝脏CT灌注成像在肝癌早期诊断中的价值。方法:对59例肝癌患者(合并肝硬化30例)的59个病灶及周围肝实质行肝脏MSCT灌注扫描。测量肝癌病灶和硬化肝实质的CT灌注值包括血流量(BF)、血容量(BV)、肝动脉分数(HAF),平均通过时间(MTT)、血管表面通透性(PS)和对比剂到达时间,并获得相应的灌注伪彩图。结果:不同大小肝癌病灶间各灌注值的差异无显著性意义(P>0.05)。59个病灶中≤3cm病灶14个,其血流量、血容量及肝动脉分数值均明显高于肝硬化实质(P<0.05),接受者工作特征曲线(ROC)下面积分别为0.757、0.848和0.969;其它的灌注值在两者间差异无显著性意义(P>0.05)。结论:肝脏CT灌注成像有助于在肝硬化实质中检出早期肝癌,尤其是肝动脉分数的测定,当临界值设定为0.308时,敏感度和特异度可分别达到100%和90%。     

Clinical Value of 64 Multidetector Spiral CT Perfusion Imaging in Differential Diagnosis of Common Hepatic Tumors

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.     

肝细胞癌和肝海绵状血管瘤16层螺旋CT灌注成像的临床应用

目的:探讨正常肝脏及肝细胞癌和肝海绵状血管瘤的16层螺旋CT灌注成像(CTPerfusion)方法及临床应用价值。方法:24例无肝脏疾病的患者和40例经病理或临床证实肝脏疾病的患者。所有病例均依次常规行全肝平扫,采用16层螺旋CT进行灌注扫描。所得数据经灌注软件处理后,自动生成时间密度曲线(TDC)和灌注参数。包括肝血流量(HBF),肝血容量(HBV),平均通过时间(MTT),肝动脉射血分数(HAF),毛细血管表面通透性(PS),和对比剂到达时间(IRFTO)和基础图像(Base)。结果:肝细胞癌组和肝海绵状血管瘤组HBV,HAF与正常肝组织组之间均有显著差异(P<0.01),而肝细胞癌组与肝海绵状血管瘤组两组之间无显著差异(P>0.05)。肝细胞癌组HBF与正常肝组织组,海绵状血管瘤组之间有显著差异(P<0.01)。结论:CT灌注参数和函数图可定量评价正常和病变肝组织血流状态,血管通透性和肝动脉供血的比例。HBV,HAF升高对鉴别肝细胞癌,肝海绵状血管瘤与正常肝组织具有显著意义。HBF升高对肝细胞癌的诊断具有显著意义。MTT缩短,PS升高对肝海绵状血管瘤的诊断具有显著意义。     

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。     

肝炎后肝硬化的CT灌注功能变化研究

目的：研究肝炎后肝硬化形成中的CT灌注变化规律。方法：120例分为正常对照组34例,肝炎肝纤维化组21例,肝炎后肝硬化组65例（Child-Pugh A组27例,Child-Pugh B组23例,Child-Pugh C组15例）经16层CT扫描得到肝脏实质各期的灌注指标：血流量（blood flow,BF）、血容量（blood volume,BV）、平均通过时间（mean transit time,MTT）、毛细血管表面通透性（permeability surface area product,PS）、肝动脉灌注分数（hepatic arterial fraction,HAF）、到达时间（IRF time of arrival,IRFTO）,诸指标分别采用单析因方差分析（one-way ANOVA）评价各时期肝脏灌注指标差异性,P〈0.05被认为有显著性差异。结果：5组肝脏实质BF、BV、MTT、PS、HAF均有统计学意义。随着病程进展,BF、BV逐步下降,MTT、PS、HAF逐渐上升,但在部分阶段改变不明显。结论：在肝炎后肝硬化的形成发展过程中,肝脏实质的灌注指标具有一定的变化规律。     

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。     

Perfusion measurement of the whole upper abdomen of patients with and without liver diseases: initial experience with 320-detector row CT

Objectives

To report initial experience of upper abdominal perfusion measurement with 320-detector row CT (CTP) for assessment of liver diseases and therapeutic effects.

Materials and methods

Thirty-eight patients who were suspected of having a liver disease underwent CTP. There were two patients with liver metastases, two with hemangiomas, and four with cirrhosis (disease group). CTP was repeated for four patients with cirrhosis or hepatocellular carcinoma (HCC) after therapy. Hepatic arterial and portal perfusion (HAP and HPP) and arterial perfusion fraction (APF), and arterial perfusion (AP) of pancreas, spleen, stomach, and intra-portal HCC were calculated. For disease-free patients (normal group), the values were compared among liver segments and among pancreatic and gastric parts. The values were compared between groups and before and after therapy.

Results

No significant differences were found in the normal group except between APFs for liver segments 3 and 5, and fundus and antrum. Mean HAP and APF for the disease group were significantly higher than for the normal group. APF increased after partial splenic embolization or creation of a transjugular intrahepatic portosystemic shunt. HPP increased and AP of intra-portal HCC decreased after successful radiotherapy.

Conclusions

320-Detector row CT makes it possible to conduct perfusion measurements of the whole upper abdomen. Our preliminary results suggested that estimated perfusion values have the potential to be used for evaluation of hepatic diseases and therapeutic effects.     

Hepatic perfusion changes in patients with cirrhosis indices of hepatic arterial blood flow.

PURPOSE: This study used radionuclide angiography to evaluate semiquantitatively the hepatic arterial blood flow changes associated with cirrhosis. METHODS: The parameters of net arterial hepatic perfusion were estimated by analysis of first-pass flow studies in 11 control participants and in 15 patients with cirrhosis (Child-Pugh classification B-C). Hepatic, renal, and splenic time-activity curves were generated, normalized per pixel, and corrected for background. The rate of hepatic arterial blood flow was compared with the reference kidney and spleen perfusion using the hepatorenal and hepatolienal perfusion indices, respectively. These indices were defined as: PI = area under hepatic curve limited by time of the renal (splenic) curve peak/area under renal (splenic) curve to its peak RESULTS: The values of both these perfusion indices are significantly greater in the patients with cirrhosis than in controls (hepatorenal perfusion index, P < 0.01; hepatolienal perfusion index, P < 0.05). The values of the hepatic perfusion index (the ratio of the arterial to the total liver blood flow), which were also calculated, were elevated in the patients with cirrhosis (P < 0.01). CONCLUSIONS: The results confirm that the net hepatic arterial blood flow is increased in patients with cirrhosis. Radionuclide angiography accompanied by calculation of arterial perfusion indices may provide semiquantitative parameters of net hepatic arterial blood flow.     

CT hepatic perfusion measurement: comparison of three analytic methods

Objectives

To compare the efficacy of three analytic methods, maximum slope (MS), dual-input single-compartment model (CM) and deconvolution (DC), for CT measurements of hepatic perfusion and assess the effects of extra-hepatic systemic factors.

Materials and methods

Eighty-eight patients who were suspected of having metastatic liver tumors underwent hepatic CT perfusion. The scans were performed at the hepatic hilum 7–77 s after administration of contrast material. Hepatic arterial and portal perfusions (HAP and HPP, ml/min/100 ml) and arterial perfusion fraction (APF, %) were calculated with the three methods, followed by correlation assessment. Partial correlation analysis was used to assess the effects on hepatic perfusion values by various factors such as age, sex, risk of cardiovascular diseases, arrival time of contrast material at abdominal aorta, transit time from abdominal aorta to hepatic parenchyma, and liver dysfunction.

Results

Mean HAP of MS was significantly higher than DC. HPP of CM was significantly higher than MS and CM, and HPP of MS was significantly higher than DC. There was no significant difference in APF. HAP and APF showed significant and moderate correlations among the methods. HPP showed significant and moderate correlations between CM and DC, and poor correlation between MS and CM or DC. All methods showed weak correlations between HAP or APF and age or sex. Finally, MS showed weak correlations between HAP or HPP and arrival time or cardiovascular risks.

Conclusions

Hepatic perfusion values arrived at with the three methods are not interchangeable. CM and DC are less susceptible to extra-hepatic systemic factors.