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目的探讨原发性肝癌(HCC)的双源CT灌注成像(CTPI)特征及其临床价值。方法对30例HCC患者行CT灌注扫描,获得肝动脉灌注量(ALP)、门静脉灌注量(PVP)、肝动脉灌注指数(HPI)、灌注流量(BF)、血管通透性(P)、patlak血容量(pBV)等灌注参数,以评价HCC的CT灌注特点。结果 (1)HCC的时间-密度曲线(TDC)在动脉期迅速上升至峰值,而后维持平衡或较快下降;(2)30例肿瘤组织在ALP、HPI、BF、P、pBV图上均表现为高灌注,其中的10例ALP图呈均匀高灌注,20例呈不均匀高灌注,坏死区无血流灌注;(3)肿瘤组织ALP、HPI、BF、pBV明显高于瘤旁肝组织和正常肝组织(P<0.05),PVP明显低于瘤旁肝组织和正常肝组织(P<0.05);(4)边缘模糊的瘤灶周围肝组织ALP、BF高于边缘清晰的瘤灶周围肝组织(P<0.05);(5)CT灌注图像测得HCC病灶面积较原始图像所测得的面积大。结论双源CTPI能很好的反映HCC的血流灌注特点,对HCC的诊断和治疗有重要的临床应用价值。
Objective To investigate the characteristics of dual-source CT perfusion imaging (CTPI) in primary hepatocellular carcinoma (HCC) and its clinical value. Methods Totally 30 patients with HCC underwent CT perfusion scan. Hepatic artery perfusion (ALP), portal vein perfusion (PVP), hepatic artery perfusion index (HPI), perfusion flux (BF), vascular permeability Blood volume (pBV) and other perfusion parameters to evaluate the CT perfusion characteristics of HCC. Results (1) The time-density curve (TDC) of HCC increased rapidly to the peak at the arterial phase and then maintained the equilibrium or rapidly decreased. (2) The tumor tissues of all the 30 cases showed ALP, HPI, BF, P, 10 cases of ALP showed high perfusion, 20 cases of non-uniform perfusion, no perfusion in necrotic area; (3) The tumor tissue ALP, HPI, BF, pBV was significantly higher than the para-tumor liver tissue and (P <0.05). PVP in normal liver tissue was significantly lower than that in para-tumor liver tissue and normal liver tissue (P <0.05). (4) ALP and BF in peripheral edge of hepatic tissue with fuzzy margin were higher than those in clear margin (P <0.05). (5) The area of HCC lesions measured by CT perfusion images was larger than the original image. Conclusions Dual-source CTPI can well reflect the characteristics of perfusion of HCC and has important clinical value for the diagnosis and treatment of HCC.