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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。
Objective To investigate the value of CT perfusion imaging in the differential diagnosis of common liver tumors. Materials and Methods 61 patients with hepatocellular carcinoma were divided into hepatocellular carcinoma group, hepatic metastasis group and hepatic hemangioma group. The whole liver perfusion imaging was performed. The ROI was selected in the lesion (A point), focal lesion Peripheral 1 cm (point B) and normal liver parenchyma (point C), perfusion color maps, perfusion parameters and time-density curve (TDC) characteristics were analyzed. Results (1) In hepatocellular carcinoma, about 81% of liver metastases showed hyperinfarction in HAP, low perfusion in necrotic area and nonuniform hypoperfusion on the portal vein perfusion (HPP) ; Hepatic hemangioma marginal nodular-like enhancement area HAP map was significantly higher perfusion, HPP maps showed low perfusion in the early part of the non-enhanced area in the HAP and HPP showed low perfusion. (2) The TDC of hepatocellular carcinoma showed a rapid ascending and descending pattern and reached its peak before 30 s. The TDC of hepatic metastases reached its peak before 30 s, but the crest was not obvious at all. TDC of the cavernous hemangioma showed a rapid ascending and descending pattern , Usually reached the peak after 30s. (3) There was no significant difference between point B and point A in hepatocellular carcinoma and liver metastasis, while there was no difference between point B and point C in hemangiomas. Hepatic cell carcinoma group and liver metastasis group A HPP value was lower than that of hepatic hemangioma group, hepatic artery perfusion index (HPI) value was higher than that of hepatic hemangioma group. The value of HPP and total liver perfusion (TLP) at point B in hepatocellular carcinoma and liver metastasis group were lower than those in hepatic hemangioma group, and the HPI value was higher than that in hepatic hemangioma group. There was no significant difference in HPI between the two groups. (4) According to the ROC curves, the area under curve (AUC) of HPP, HPP, HPI and HPI perfusion parameters at point A were all between 0.7 and 0.9. Conclusion CT perfusion imaging has some value in the differential diagnosis of benign and malignant tumors in the liver. ROC curve analysis is expected to be used to evaluate the diagnostic efficacy of perfusion parameters in differentiating benign and malignant liver tumors and to select the appropriate diagnostic reference value.