Efficacy of double arterial phase dynamic magnetic resonance imaging with the sensitivity encoding technique versus dynamic multidetector-row helical computed tomography for detecting hypervascular hepatocellular carcinoma

Purpose  The aim of this study was to evaluate the efficacy of double arterial phase dynamic magnetic resonance imaging (MRI) with the sensitivity encoding technique (SENSE dynamic MRI) for detection of hypervascular hepatocellular carcinoma (HCC) in comparison with double arterial phase dynamic multidetector-row helical computed tomography (dynamic MDCT). Materials and methods  A total of 28 patients with 66 hypervascular HCCs underwent both double arterial SENSE dynamic MRI and dynamic MDCT. The diagnosis of HCC was based on surgical resection (n = 7), biopsy (n = 10), or a combination of CT during arterial portography (CTAP), CT during hepatic arteriography (CTA), and/or the 6-month follow-up CT (n = 49). Based on alternative-free response receiving operating characteristic (ROC) analysis, the diagnostic performance for detecting HCC was compared between double arterial phase SENSE dynamic MRI and double arterial phase dynamic MDCT. Results  The mean sensitivity, positive predictive value, and mean Az values for hypervascular HCCs were 72%, 80%, and 0.79, respectively, for SENSE dynamic MRI and 66%, 92%, and 0.78, respectively, for dynamic MDCT. The mean sensitivity for double arterial phase SENSE dynamic MRI was higher than that for double arterial phase dynamic MDCT, but the difference was not statistically significant. Conclusion  Double arterial phase SENSE dynamic MRI is as valuable as double arterial phase dynamic MDCT for detecting hypervascular HCCs.     

Dual input computed tomography perfusion in evaluating the therapeutic response of transarterial chemoembolization for hepatocellular carcinoma

Objective

To assess diagnostic role of multi-detector computed tomographic perfusion in evaluating the therapeutic response of trans-arterial chemo-embolization in hepatocellular carcinoma.

Correlation of magnetic resonance signal characteristics and perfusion parameters assessed by volume perfusion computed tomography in hepatocellular carcinoma: Impact on lesion characterization

AIMTo find out if magnetic resonance (MR)-signal characteristics of hepatocellular carcinomas (HCC) correlate with perfusion parameters assessed by volume perfusion computed tomography (VPCT).METHODSFrom October 2009 to January 2014, 26 (mean age, 69.3 years) patients with 36 HCC lesions who underwent both VPCT and MR liver imaging were analysed. We compared signal intensity in the T1w- and T2w-images and wash-in/wash-out kinetics on post-contrast MR images with mean values of blood flow (BF, mL/100 mL per minute), blood volume (BV, mL/100 mL), k-trans (mL/100 mL per minute), arterial liver perfusion (mL/100 mL per minute), portal venous perfusion and hepatic perfusion index (HPI, %) obtained by VPCT. Signal intensity on magnetic resonance imaging (MRI) was classified hyper/iso/hypointense compared with surrounding liver parenchyma.RESULTSSignal intensity on native T1w- and T2w-images was hyper/iso/hypo in 4/16/16 and 21/14/1 lesions, respectively. Wash-in and wash-out contrast kinetics were found on MRI in 33 of 36 lesions (91.7%) and 25 of 36 lesions (69.4%), respectively. The latter was observed significantly more often in higher graded lesions (P < 0.005). HPI was 94.7% ± 6.5%. There was no significant relationship between lesion’s MR-signal intensity, MR signal combinations, size and any of the VPCT-perfusion parameters. However HPI was constantly high in all HCC lesions.CONCLUSIONVPCT parameters add limited value to MR-lesion characterization. However in HCC lesions with atypical MR signal characteristics HPI can add a parameter to ensure HCC diagnosis.     

Image quality and radiation dose in 256-slice cardiac computed tomography: Comparison of prospective versus retrospective image acquisition protocols

Purpose

To assess coronary artery image quality and patient radiation exposure in patients who underwent clinically indicated 256-slice CTA.

Methods

Consecutive patients (n = 193) underwent 256-slice CTA, using (1) retrospective gating without radiation dose modulation, (2) retrospective gating with radiation dose modulation and (3) prospective gating. Image quality was determined by consensus of two experienced observers using a 5-grade scale. The effective dose was calculated.

Results

In all patients, CTA was performed without adverse events. Retrospective CTA was assessed in 39 patients with and 39 without dose modulation, while 115 patients underwent prospective CTA. Heart rate was related to image quality with all protocols (r = 0.46, p < 0.001). Up to a heart rate of 75 bpm no significant difference in overall image quality was observed for all three protocols, while no significant differences could be observed between retrospective CTA with and without dose modulation for any segments or heart rates. Prospective and retrospective CTA with dose modulation showed radiation savings of ∼75% and ∼30%, respectively compared to retrospective CTA without dose modulation (p < 0.001).

Conclusions

In patients with heart rates up to 75 bpm prospective CTA should be the first choice acquisition protocol. For heart rates >75 bpm, retrospective CTA with dose modulation should be considered.     

Computed tomography perfusion imaging for monitoring transarterial chemoembolization of hepatocellular carcinoma

PurposeTo prospectively monitor changes in tumor perfusion of hepatocellular carcinoma (HCC) in response to doxorubicin-eluted bead based transarterial chemoembolization (DEB-TACE) using perfusion-CT (P-CT).Methods and materials24 patients (54–79 years) undergoing P-CT before and shortly after DEB-TACE of HCC were prospectively included in this dual-center study. Two readers determined arterial-liver-perfusion (ALP, mL/min/100 mL), portal-venous-perfusion (PLP, mL/min/100 mL) and the hepatic-perfusion-index (HPI, %) by placing matched regions-of-interests within each HCC before and after DEB-TACE. Imaging follow-up was used to determine treatment response and to distinguish complete from incomplete responders. Performance of P-CT for prediction and early response assessment was determined using receiver-operating-characteristics curve analysis.ResultsInterreader agreement was fair to excellent (ICC, 0.716–0.942). PLP before DEB-TACE was significantly higher in pre-treated vs non-treated lesions (P < 0.05). Mean changes of ALP, PLP and HPI from before to after DEB-TACE were −55%, +24% and −27%. ALP and HPI after DEB-TACE were correlating with response-grades (r = 0.45/0.48; both, p < 0.04), showing an area-under-the-curve (AUC) of 0.74 and 0.80 respectively for identification of complete response.ConclusionHigh arterial and low portal-venous perfusion of HCC early after DEB-TACE indicates incomplete response with good diagnostic accuracy.     

Quantification of aortic valve area at 256-slice computed tomography: Comparison with transesophageal echocardiography and cardiac catheterization in subjects with high-grade aortic valve stenosis prior to percutaneous valve replacement

Purpose

The purpose of this study was to compare planimetric aortic valve area (AVA) measurements from 256-slice CT to those derived from transesophageal echocardiography (TEE) and cardiac catheterization in high-risk subjects with known high-grade calcified aortic stenosis.

Methods and materials

The study included 26 subjects (10 males, mean age: 79 ± 6; range, 61–88 years). All subjects were clinically referred for aortic valve imaging prior to percutaneous aortic valve replacement from April 2008 to March 2009. Two radiologists, blinded to the results of TEE and cardiac catheterization, independently selected the systolic cardiac phase of maximum aortic valve area and independently performed manual CT AVA planimetry for all subjects. Repeated AVA measurements were made to establish CT intra- and interobserver repeatability. In addition, the image quality of the aortic valve was rated by both observers. Aortic valve calcification was also quantified.

Results

All 26 subjects had a high-grade aortic valve stenosis (systolic opening area <1.0 cm²) via CT-based planimetry, with a mean AVA of 0.62 ± 0.18. In four subjects, TEE planimetry was precluded due to severe aortic valve calcification, but CT-planimetry was successfully performed with a mean AVA of 0.46 ± 0.23 cm². Mean aortic valve calcium mass score was 563.8 ± 526.2 mg. Aortic valve area by CT was not correlated with aortic valve calcium mass score. A bias and limits of agreement among CT and TEE, CT and cardiac catheterization, and TEE and cardiac catheterization were −0.07 [–0.37 to 0.24], 0.03 [−0.49 to 0.55], 0.12 [−0.39 to 0.63] cm², respectively. Differences in AVA among CT and TEE or cardiac catheterization did not differ systematically over the range of measurements and were not correlated with aortic valve calcium mass score.

Conclusion

Planimetric aortic valve area measurements from 256-slice CT agree well with those derived from TEE and cardiac catheterization in high-risk subjects with known high-grade calcified aortic stenosis.     

Radiation dose reduction by using 100-kV tube voltage in cardiac 64-slice computed tomography: A comparative study

Objective

To evaluate a 100-kilovoltage (kV) tube voltage protocol regarding radiation dose and image quality, in comparison with the standard 120 kV setting in cardiac computed tomography angiography (CCTA).

Methods

103 patients undergoing retrospective ECG-gated helical 64-slice CCTA were enrolled (100 kV group: 51 patients; 120 kV group: 52 patients). Inclusion criteria were: (1) BMI <28 kg/m²; (2) weight <85 kg; (3) coronary calcium score <300 Agatston Units (AU). Quantitative image quality parameters were calculated [image noise, contrast-to-noise ratio (CNR), intracoronary CT-attenuation (HU)]. Each coronary artery segment (AHA/ACC-16-segments-classification) was evaluated for image quality on a 4-point scale.

Results

There was no statistical difference in age, gender, BMI and eff. tube current (mA s), and the use of ECG-tube current modulation (50.9% vs. 50% of patients) between both groups. 84.2% of patients in the 100 kV group had zero calcium score or less than100 AU, the remaining had between 100 and 300 AU.The effective radiation dose was significantly lower in the 100 kV group with mean 7.1 mSv ± 2.4 (range, 3.4-11.1) compared to the 120 kV group with 13.4 mSv ± 5.2 (range, 6.3-22.7) (p < 0.001) (dose reduction, 47%).In the 100 kV group, the use of ECG-dependent tube current modulation reduced the radiation exposure (by 44.8%) to 5.3 mSv ± 1.1 (range, 3.4-8.5 mSv) (p < 0.001), the dose without was 9.6 mSv ± 1.1 (range, 6.3-11.1).Image noise in the coronary arteries was not different between both groups with 29.8 and 30.5 SD [HU], respectively. CNR in the 100 kV group was with 20.9 ± 6.8 for the coronary arteries and with 19.9 ± 5.9 for the aorta similar to the 120 kV group.Intraluminal CT-attenuation (HU) of the coronary arteries were higher in the 100 kV group (p < 0.001).Image quality on 100 kV scans was excellent in 86.3%, good in 9.2%, acceptable in 3.1% of coronary segments; 1.4% were non-interpretable (in 1/4 due to increased image noise because of BMI >25 kg/m²).

Conclusions

The 100 kV protocol significantly reduces the radiation dose in CCTA in patients with a low BMI <25 kg/m² and a low calcium load while maintaining high image quality and the advantages of helical scan algorithm.     

Lipiodol retention and massive necrosis after lipiodol-chemoembolization of hepatocellular carcinoma: Correlation between computed tomography and histopathology

This retrospective study examined the computed tomography (CT) criteria for judging the effectiveness of transcatheter arterial Lipiodolchemoembolization (Lp-chemo-TAE) in 35 cases with hepatocellular carcinoma (HCC). Massive necrosis, defined as involving 97% or more of the HCC nodule, was observed in 15 cases after Lp-chemo-TAE, whereas nonmassive necrosis, defined as involving ≤96% of the HCC nodule, was observed in the remaining 20 cases. In 12 of 15 cases (80%) with massive necrosis, uniform dense retention of Lipiodol (Lp) was observed throughout the HCC nodule on CT images 3–4 weeks after Lp-chemo-TAE as opposed to only one (5%) of 20 cases with nonmassive necrosis (p<0.01). Eight of nine cases (89%) with massive necrosis had tumor attentuation values of 365 Hounsfield units (HU) or greater on CT images 3–4 weeks after embolization, as opposed to only four (27%) of 15 cases with nonmassive necrosis (p<0.01). We conclude that the effectiveness of the Lp-chemo-TAE can be judged on CT from the degree and duration of Lp retention in the HCC nodule and the measurement of the attenuation value of the HCC nodule.     

Liver perfusion CT during hepatic arteriography for the hepatocellular carcinoma: Dose reduction and quantitative evaluation for normal- and ultralow-dose protocol

Objectives

The purpose of this study was to investigate whether substantial reduction of the computed tomography (CT) dose is possible in liver CT perfusion imaging by comparing the results of ultralow-dose CT perfusion imaging with those of conventional CT perfusion imaging the same patients and under the same conditions.

Materials and methods

The study was composed following two parts: computer simulation and patients study. In computer simulation, noise was added to the images so that the standard deviation (SD) of the CT values in the liver parenchyma became various values using ImageJ. Time density curves (TDCs) were created from the simulated data, and the influence of difference in the SDs on the shapes of the TDCs was investigated. In the patient study, CT perfusion during intra-arterial injection was performed in 30 consecutive patients undergoing transcatheter arterial chemoembolization. CT perfusion images were acquired twice, at 100 mA (CTDI_vol, 300 mGy) for normal and at 20 mA (CTDI_vol, 60 mGy) for the ultralow radiation doses, under the same conditions.

Results

No change was observed in the shape of the TDCs and peak values in the analysis of simulation images. A very good correlation was observed between the normal- and ultralow-dose CT images for all analyzed values (R² = 0.9885 for blood flow, 0.9269 for blood volume, and 0.8424 for mean transit time).

Conclusions

Our results demonstrated that there was no significant difference in the analysis results of perfusion CT between ultralow-dose CT performed using 20% of the conventional dose and normal-dose CT perfusion.     

Value of multidetector computed tomography evaluation of myocardial perfusion in the assessment of ischemic heart disease: comparison with nuclear perfusion imaging

MDCT-derived myocardial perfusion has not yet been validated against accepted standards. We developed a technique for quantification of myocardial perfusion from MDCT images and studied its diagnostic value against SPECT myocardial perfusion imaging (MPI). Ninety-eight patients were studied. Abnormal perfusion was detected by comparing normalized segmental x-ray attenuation against values obtained in 20 control subjects. Disagreement with resting MPI was investigated in relationship to MDCT image quality, severity of MPI abnormalities, and stress MPI findings. Resting MPI detected mild or worse abnormalities in 20/78 patients. MDCT detected abnormalities in 15/20 patients (sensitivity of 0.75). Most abnormalities missed by MDCT analysis were graded as mild on MPI. Additional abnormalities found in 16/78 patients were not confirmed on resting MPI (specificity of 0.72). However, 8 of these 16 apparently false positive MDCT perfusion tests had abnormal stress MPI; of these 8 patients, 7 had optimal MDCT image quality, while in 6/8 remaining patients, image quality was suboptimal. When compared with resting MPI, MDCT detected perfusion abnormalities with high accuracy. Moreover, half of MDCT perfusion abnormalities not confirmed by resting MPI were associated with abnormal stress MPI. Importantly, this information can be obtained without additional radiation dose or contrast agent.     

Dynamic contrast-enhanced CT imaging of hepatocellular carcinoma in cirrhosis: feasibility of a prolonged dual-phase imaging protocol with tracer kinetics modeling

Dynamic contrast-enhanced (DCE) CT imaging of four patients with hepatocellular carcinoma (HCC) was performed using a dual-phase imaging protocol designed with initial rapid dynamic imaging to capture the initial increase in contrast medium enhancement in order to assess perfusion, followed by a delayed imaging phase with progressively longer intervals to monitor subsequent tissue enhancement behaviour in order to assess tissue permeability. The DCE CT images were analysed using a dual-input two-compartment distributed parameter model to yield separate estimates for blood flow and permeability, as well as fractional intravascular and extravascular volumes. The HCCs and surrounding cirrhotic liver tissues were found to exhibit enhancement curves that can be appropriately described by two distinct compartments separated by a semipermeable barrier. Early contrast arrival was also found for HCC as compared with background liver. These findings are consistent with the current understanding of sinusoidal capillarization and hepatocarcinogenesis.     

肝细胞癌CT灌注成像的诊断和临床应用

近年来,随着CT硬件与软件技术的发展,CT灌注成像在肝脏疾病诊断中取得了较大进步。本文就其基本原理、成像技术、诊断、临床应用等作一综述,重点在于CT灌注成像对肝细胞癌治疗的疗效评估及监测具有指导意义。     

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层螺旋CT脑灌注成像与颈内动脉狭窄的相关性研究

目的：应用256层螺旋CT探讨颈内动脉狭窄和闭塞与脑灌注降低的相关性。方法：对76例患者进行CTA和CTP联合检查,根据CTA图像选出颈内动脉无狭窄者为对照组,其余患者进行颈内动脉狭窄分级,分轻、中、重三级,每级独立分析研究。所有患者均选择感兴趣区进行脑灌注成像CBV、CBF、MTT、TTP测量,单侧颈内动脉狭窄者病变侧与健侧对比,进行配对t检验。双侧颈内动脉狭窄者与对照组对比,进行独立样本t检验。结果：颈内动脉无狭窄者共15例,CBV CBF MTT TTP值分别为（分水岭区2.5±0.6;38±12;5.4±0.6;21±6。基底节区5.5±0.4;95±15;3.2±1.1;20±5）。单侧颈内动脉狭窄者共33例,其中轻中度狭窄者各为12例,且CBV、CBF、MTT、TTP四项差异均无统计学意义（P〉0.05）,重度狭窄者9例,分水岭区CBF、MTT差异有高度统计学意义（P〈0.01）,TTP差异有统计学意义（P〈0.05）,CBV差异无统计学意义（P〉0.05）。基底节区MTT差异有高度统计学意义（P〈0.01）,CBF差异有统计学意义（P〈0.05）,CBV、TTP差异无统计学意义（P〉0.05）。双侧颈内动脉狭窄者共28例,重度狭窄者11例,CBF、MTT差异有统计学意义（P〈0.05）。结论：受侧枝循环等多种因素影响,颈内动脉重度狭窄或闭塞与脑内血流灌注降低有相关性,轻中度狭窄与脑灌注降低无明显相关性。     

Hyperperfusion on perfusion computed tomography following revascularization for acute stroke

Purpose: To describe the findings of hyperperfusion on perfusion computed tomography (CT) in four patients following revascularization for acute stroke.

Material and Methods: In 2002-2003, among a series of 6 patients presenting with an acute stroke and treated with intra-arterial thrombolysis, we observed the presence of hyperperfusion in 3 patients on the follow-up CT perfusion. We included an additional patient who was treated with intravenous thrombolysis and who had hyperperfusion on the follow-up CT perfusion. We retrospectively analyzed their CT perfusion maps. Cerebral blood volume (CBV) and cerebral blood flow (CBF) maps were compared between the affected territory and the normal contralateral hemisphere.

Results: In the four patients, the mean CBV and CBF were 3.6±2.0 ml/100 g and 39±25 ml/100 g/min in the affected territory compared to the normal side (mean CBV = 2.7±2.1 ml/100 g, mean CBF = 27±23 ml/100 g/min). There was no intracranial hemorrhage in the hyperperfused territories. At follow-up CT, some hyperperfused brain areas progressed to infarction, while others retained normal white to gray matter differentiation.

Conclusion: CT perfusion can demonstrate hyperperfusion, which can be seen in an ischemic brain territory following recanalization.     

128层4D CT全肝灌注成像在肝细胞癌中的初步应用

目的:探讨128层4D CT全肝灌注成像在原发性肝癌(HCC)灌注中的参数特征及其初步临床应用价值。方法:对20例正常对照组、40例经临床或手术病理证实为HCC的患者行128层4D CT灌注扫描,获得灌注参数血流量(BF)、肝动脉灌注量(ALP)、门静脉灌注量(PVP)、肝动脉灌注指数(HAPI)。根据各灌注图像及相关参数评价正常组织与恶性肿瘤、高分化HCC与低分化HCC的血流动力学状态。同时获得270mm扫描覆盖范围内动态4D CTA图像,动态观察对比剂流入及流出情况,判断肿瘤供血动脉的增粗、僵直、门静脉癌栓等。结果:①HCC患者ALP、HAPI、BF明显高于正常组(P<0.01),PVP明显降低(P<0.01)。②高分化HCC患者灌注参数ALP、HAPI低于低分化HCC,PVP明显升高,二者差异有统计学意义(P<0.01)。灌注参数从一方面反映了肿瘤的恶性程度。③40例HCC中,4D CTA显示肿瘤供血动脉25例,13例供血动脉增粗、僵直,门静脉癌栓15例。结论:128层4D CT灌注成像可以通过一次注射对比剂,获得全肝灌注信息及动态的4DCTA,肝灌注模式成像克服了以往灌注成像的不足,简单实用,具有一定的优势。此技术能很好地反映HCC的血流动力学变化,为HCC的早期诊断、指导临床治疗及判断预后提供可靠的依据,具有重要的临床应用价值和广阔的应用前景。     

CT灌注成像在肝癌TACE术后疗效评价中的应用价值

目的 探讨双源CT灌注成像(CTPI)在HCC TACE术后疗效评价中的价值.方法 对24例HCC患者于TACE术前1～3 d、术后6～8 d和30～40 d分别行双源CT灌注扫描,经肝脏CT灌注软件得到肝动脉灌注量(HAP)、门静脉灌注量(PVP)、肝动脉灌注指数(HPI)等彩色灌注图,在图像上分别测定相应的灌注参数值,观察TACE治疗前后肿瘤组织的血流灌注变化及肿瘤的大小改变,评价TACE治疗肿瘤的疗效.结果 TACE术前9例肿瘤呈均匀高灌注,15例呈不均匀高灌注.术后8例瘤灶内碘油沉积密实,16例碘油沉积不均.灌注图像显示碘油沉积区域无血流灌注,碘油稀疏及缺乏区域仍有血流灌注.所有患者术前、术后6～8 d及肿瘤残留患者复发前后的肿瘤组织HAP、HPI差异均有统计学意义(P＜0.05),而PVP则差异无统计学意义(P＞0.05).术前、术后6～8 d肿瘤最大径以及肿瘤残留患者复发前后肿瘤最大径均无明显变化(P＞0.05).TACE术后,16例残瘤组织及正常肝组织HAP、PVP、HPI差异均有统计学意义(P＜0.01).结论 CT灌注成像能直观和定量地反映肝癌TACE前后的血流动力学变化,有助于TACE疗效的评价.     

Comparison of whole-body 64-slice multidetector computed tomography and conventional radiography in staging of multiple myeloma

This study compares the sensitivity of whole-body multidetector CT (MDCT) and conventional radiography (CR) in the staging of multiple myeloma (MM). Twenty-nine patients with MM underwent a staging examination both by MDCT and CR. CT examination was performed with a collimation of 64×0.6 mm, a tube potential of 100 kVp, an effective tube current-time product of 100 mAs and automatic dose modulation as low-dose protocol. Number, size and diagnostic confidence of osteolytic lesions were determined and compared. The effective dose of MDCT and CR was assessed. Using MDCT, the detection of osteolysis was increased seven-fold concerning the spine. Ninety-seven lesions in 18 patients were detected exclusively by MDCT. The detection rate concerning the spine, pelvic skeleton and thoracic cage was significantly higher (p≤0.001), and diagnostic confidence was increased by MDCT (p<0.02) compared to CR. Therapy was changed after MDCT in 18.2% of the patients with a clinical suspicion of progressive disease. The estimated effective dose of MDCT (4.8 mSv) and CR (1.7 mSv) was comparable. In conclusion, MDCT has a significantly higher sensitivity and reliability in the detection of osteolysis than CR and can be recommended as standard imaging method in the staging of MM.     

经导管肝动脉栓塞化疗联合华蟾素门静脉灌注治疗中期原发性肝癌疗效研究

目的探讨经导管肝动脉栓塞化疗(TACE)联合华蟾素门静脉灌注治疗中期原发性肝癌患者的临床疗效与预后。方法选取自2011年2月至2013年11月收治的中期原发性肝癌患者79例,其中,单独应用TACE的患者40例(单独组),联合应用TACE与华蟾素门静脉灌注的患者39例(联合组)。比较两组患者存活与门静脉侵犯情况,并分析其影响因素。结果单独组与联合组患者的1年存活率分别为62.5%(25/40)与82.1%(32/39),2年存活率分别为22.5%(9/40)与35.9%(14/39),3年存活率分别为7.5%(3/40)与17.9%(7/39);中位存活时间分别为15.0个月与18.0个月;门静脉癌栓发生率分别为82.5%(33/40)与61.5%(24/39)。两组比较,差异均有统计学意义(P<0.05)。华蟾素门静脉灌注、ChildPugh分级、甲胎蛋白水平及肿瘤大小是影响患者预后的独立危险因素。结论 TACE联合华蟾素门静脉灌注治疗可明显改善中期原发性肝癌患者的预后,值得临床推广。     

128层螺旋CT全脑灌注对浸润性星形细胞瘤的分级评估

目的:评价128层螺旋CT全脑灌注(CTP)对浸润性星形细胞瘤分级定性诊断的价值。方法:选择我院90例脑肿瘤患者进行CTP检查,经手术和病理学证实为浸润性星形细胞瘤(Ⅱ~Ⅳ级)者46例纳入本研究对象。CTP采用SOMATOM Definition AS型128层螺旋CT机进行灌注扫描,应用后处理工作站对原始数据进行后处理,获得时间-密度曲线(TDC),测定肿瘤区和对侧正常组织的脑血流量(CBF)、脑血容量(CBV)、毛细血管表面通透性(PS)及对比剂达峰值时间(TTP),并对灌注参数进行统计学分析。结果:在所有病例中,全脑灌注图像平均视觉评价分数明显高于传统灌注图(P<0.01),且对病变定位更为精确。星形细胞肿瘤高级别组的CBF、CBV和PS值均显著高于低级别组(P<0.01),而TTP值的差异无统计学意义(P>0.05)。ROC曲线分析表明,CBF、CBV和PS值对鉴别高、低级别星形细胞肿瘤的ROC曲线下面积分别为0.925、0.897和0.954,采用CBF≥72.052ml/min/100g,CBV≥4.293ml/100g和PS≥6.337ml/min/100g作为分界点对鉴别高低级别星形细胞肿瘤的敏感性均为87.2%,特异性分别是83.5%、83.5%和93.0%。结论:128层螺旋CT全脑灌注有利于脑肿瘤的术前整体评估和精确定位;CTP参数CBF、CBV及PS值及TDC曲线对鉴别高、低级别星形细胞肿瘤具有较高的敏感性和特异性。