肝癌TACE术前后CT灌注成像评估肝储备功能的应用价值

目的探讨肝脏CT灌注成像评估肝癌TACE术前后肝储备功能的应用价值。材料和方法49例原发性肝癌患者于TACE术前3天及术后4周行肝脏CT灌注成像,分析CT灌注参数与肝纤维化、肝功能Child-Pugh分级及术后并发症的关系。结果肝功能Child-Pugh分级与肝动脉灌注、门静脉灌注、肝动脉灌注分数有显着的统计学差异及相关性（r=0.447、0.442、-0.267,均P〈0.05）,随着Child-Pugh分级升高,PVP逐渐减低而HAP及HP逐渐升高。HAP、HPI与血清透明质酸呈高度正相关（r=0.701、0.651,均P〈0.05）。术前肝动脉灌注分数大于25%共17例中7例（41%）术后恢复不良,占TACE术后肝功能恶化组9例中的77.7%。结论肝脏CT灌注成像可作为评估肝储备功能的重要影像学指针,有很好的术前指导意义。

Application value of perfusion CT to assess liver functional reserve before and after TACE

Objective To evaluate the application value of perfusion CT in liver reserve function assessment before and after TACE. Materials and methods 49 patients with hepatocellular carcinoma were enrolled. Liver perfusion CT was performed 3 days before and 4 weeks after TACE,and Hepatic arterial perfusion （HAP）,portal perfusion （PVP） and hepatic arterial perfusion index （HPI） were measured. The correlation between hepatic parenchymal perfusion and liver function,Child-Pugh score and complications were analyzed. Result HAP,PVP,HPI were significantly correlated to Child-Pugh classification （r =0.447,0.442,-0.267,P〈0.05）. As Child-Pugh class went up,PVP decreased,HAP and HPI increased. HAP and HPI were highly correlated to serum hyaluronic acid （r =0.701,0.651,P〈0.05）. 41%（7/17）of patients got a HPI higher than 25% develop worsening liver function postoperatively and it was 77.7% （7/9） of totally 9 patients whose liver function worsen after TACE. Conclusion Liver perfusion CT is an important imageological index and of great value in evaluation of liver reserve function before operation.