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目的评价CT灌注成像结合全肝增强扫描在中晚期肝癌患者行导管动脉化疗栓塞术(TACE)疗效的价值。方法 41例中晚期肝癌患者行TACE术后4周再行CT灌注扫描,计算肝血流量、肝血容量、平均通过时间、肝动脉分数及表面通透性等参数及基线图像,并于灌注扫描后即行全肝增强扫描。结果根据肝癌行TACE术后基线图像显示碘油在肿瘤区域的沉积形态,观察到在41患者中,碘油完全填充型1例、缺损型或环形10例、簇集型25例及稀少型5例;与肝癌再次行TACE治疗时肝动脉数字减影血管造影结果比较,两者诊断吻合率100%。各灌注参数显示碘油沉积区域肝癌组织血流灌注消失;非碘油沉积区域与正常肝组织比较,肝血流量、肝血容量及平均通过时间等参数差异均有统计学意义(P<0.01),而肝动脉分数及表面通透性等参数差异无统计学意义(P>0.05)。观察结果显示,全肝增强扫描可弥补CT灌注成像覆盖范围较小,无法全面了解全肝碘油填充情况的缺点;全肝增强扫描可提供肝癌及子灶大小、形态、密度、强化程度以及扫描范围其他脏器有无异常,是否有腹腔淋巴结转移等详细的临床资料。结论 CT灌注成像结合全肝增强扫描可判断中晚期肝癌患者行TACE疗效,对进一步治疗中晚期肝癌具有重要的临床指导价值。
Objective To evaluate the value of CT perfusion imaging combined with whole liver enhanced scan in the treatment of advanced hepatocellular carcinoma undergoing transcatheter arterial chemoembolization (TACE). Methods Forty-one patients with advanced hepatocellular carcinoma (HCC) underwent four-week follow-up of TACE and CT perfusion scan. Liver perfusion, hepatic blood volume, mean transit time, hepatic arterial fraction, surface permeability and other parameters and baseline images were calculated. Whole liver enhanced scan. Results According to the baseline images of liver cancer after TACE, the deposition patterns of lipiodol in the tumor area were observed. Among the 41 patients, 1 was completely filled with lipiodol, 10 were defects or 10 rings, 25 were clustered and 5 were rare For example, compared with the results of digital subtraction angiography of hepatic artery treated with TACE in liver cancer again, the diagnostic coincidence rate of the two was 100%. The perfusion parameters showed that the perfusion of HCC tissue disappeared in the lipiodol deposition area. There was significant difference between the non-lipiod deposition area and the normal liver tissue (P <0.01), such as hepatic blood flow, hepatic blood volume and mean passage time , While there was no significant difference in parameters of hepatic artery and surface permeability (P> 0.05). The results show that the enhanced whole liver scan can make up for CT perfusion imaging coverage is small, can not fully understand the shortcomings of liver filling situation; liver enhanced scan can provide liver cancer and size, shape, density, degree of enhancement and scanning Range of other organs with or without abnormalities, whether there is abdominal lymph node metastasis and other detailed clinical data. Conclusion CT perfusion imaging combined with whole liver enhanced scan can determine the efficacy of TACE in patients with advanced liver cancer, and has important clinical value in further treatment of advanced liver cancer.