肝癌介入诊疗中DSA血流动力学参数分析初步探讨

目的探讨肝癌TACE介入栓塞前肝动脉造影图像上癌灶、癌旁肝组织、背景肝组织之间血流动力学相关参数的差异性。方法本组共34例，男28例，女6例，均为经临床诊断原发性肝癌后第一次行介入诊疗。介入栓塞治疗前均先行肝固有动脉插管造影，采用高压注射器团注对比剂（370mgl／m1）15ml，流率5ml／s，注射后延时0．5s曝光，以4帧／s（fps）帧率持续采集图像15s，获取60（4x15）幅图像。图像处理采用自主开发的图像处理软件DSAanalysis1．0。分别在癌灶的肿瘤染色区、癌旁肝组织及背景肝组织等区域各选定兴趣区（ROI），并生成各区域ROI的时间一密度曲线（TDC），对各TDC进行定量分析，获得与血流动力学相关的参数并对比，相关的参数包括：视频密度增量峰值（AXPV）、达峰时间（TP）、显影持续时间（TD）、TDC升支及降支最大斜率（KmaxU及KmaxD）。结果癌灶、癌旁肝组织、背景肝组织的TD分别为12．97s±0．89、7．75s±0．89、4．99s±0．37；KmaxD分别为36．0s^-1±8．2、90．8s^-1±24．3和142．6S^-1±26．4s。癌灶、癌旁肝组织、背景肝组织的TD及KmaxD两两对比均具有显著性的差异（P〈0．01）。而其他参数三者之间差异无统计学意义（P〉0．05）。结论通过对DSAanalysis1．0软件获得的TDC进行分析，可获得与血流动力学相关参数值，其中TD、KmaxD可在一定程度上反映癌灶、癌旁肝组织及背景肝组织的血流动力学差异。

Preliminary hemodynamic quantitative analysis of hepatoceUular carcinomas using digital subtraction angiography

Objective To compare the hemodynamic parameters of hepatocellular carcinomas （HCCs）, para- tumoral and background liver parenchyma by digital subtraction angiography （DSA）. Methods 34 patients with primary HCCs （28 male, 6 female） were enrolled in the study. All patients underwent selective hepatic arteriography with a bolus injection of 15 mL of Iopamidol 370 at a flow rate of 5 mL/s. Image acquisition began at 0.5 s after the onset of injection at 4 frames/s for 15 s to obtain 60 images. Regions of interest （ROIs） were drawn in the tumors, para-tumoral liver parenchyma and background liver parenchyma on the DSA images. Time-density curves （TDCs） of the ROIs were generated using the DSA analysis Version 1.0 software. The hemodynamic parameters including peak increment of density value （APV）, time to reach the peak （TP）, time of developing duration （TD）, maximum slope of the descent （KmaxD） and maximum slope of the upslope （KmaxU） were compared among the different ROIs. Results TD was 12.97±0.89 s, 7.75±0.89 s and 4.99±0.37 s, and KmaxD was 36.0 ±8.2 s^-1, 90.8±24.3 s^-1 and 142.6±26.4 s^-1 for the tumors, para-tumoral liver parenehyma and background liver parenehyma, respectively. The differences of TD and KmaxD were statistically significant （P 〈 0.01 ） among the tumors, para-tumoral liver parenehyma and background liver parenchyma. The differences were not statistically significant （P 〉 0.05） for A PV, TP, and KmaxU among the tumors, para-tumoral liver and background liver. Conclusion TD and KmaxD may reflect the hemodynamic differences among hepatocellular carcinoma, para-tumoral liver parenchyma and background liver parenehyma.