CT全灌注成像在肝癌TACE介入术前肝储备功能评估中的价值

摘要/Abstract

摘要： 目的探讨CT全灌注成像在肝癌TACE介入术前肝储备功能评估中的价值。方法选取2016年1月至2018年12月原发性肝癌患者68例,均于TACE术前3 d进行CT全灌注成像,比较患者正常肝组织与肿瘤组织的HAP、PVP、TLP、HAPI及不同Child-Pugh分级患者的HAP、PVP、TLP、HAPI,分析灌注参数与Child-Pugh分级的相关性。结果正常肝组织的HAP与HAPI分别为(30.10±8.69)ml/(min·100 mL)、(22.01±5.03)%显著低于肿瘤组织(81.47±19.86)ml(min·100 mL)、(69.85±15.41)%,PVP与TLP分别为(0.52±18.27)、(148.10±31.11)ml(min·100 mL)显著高于肿瘤组织(40.01±9.88)、(123.10±26.49)ml(min·100 mL)(P<0.05)。Child-Pugh A级患者的HAPI显著低于B级患者,PVP与TLP显著高于B级患者(P<0.05)。Spearman相关性分析显示,HAP与Child-Pugh分级之间无明显相关性(r=0.119,P=0.367);HAPI与Child-Pugh分级呈明显正相关(r=0.442,P=0.002),PVP、TLP均与Child-Pugh分级呈显著负相关(r=-0.550、-0.489,P<0.01)。结论 CT灌注成像可定量反映不同Child-Pugh分级患者的血流动力学改变,评估患者肝储备功能,可为TACE术前评估、手术效果预测提供参考。

关键词: CT全灌注成像, 肝癌, 经肝动脉化疗栓塞, 肝储备功能

Abstract: Objective To investigate the value of computed tomographic (CT) perfusion imaging in the evaluation of liver reserve function before transcatheter arterial chemoembolization (TACE) intervention on liver cancer.Methods A total of 68 patients with primary liver cancer admitted to our hospital from January to February 2018 were enrolled. All patients underwent CT perfusion imaging 3 days before TACE. The hepatic arterial perfusion (HAP), portal venous perfusion (PVP), total liver perfusion (TLP) and hepatic arterial perfusion index (HAPI) were compared between normal liver tissue and tumor tissue, among patients with different Child-Pugh grades, and the correlation between perfusion parameters and Child-Pugh classification was analyzed. Results The HAP and HAPI of normal liver tissue were (30.10 ± 8.69) ml/min/100 ml and (22.01 ± 5.03)%, respectively, which were significantly lower than those of tumor tissue[(81.47 ± 19.86) ml/min/100 ml, (69.85 ± 15.41)%, P<0.05]. The PVP and TLP were (80.52 ± 18.27) ml/min/100 ml and (148.10 ± 31.11) ml/min/100 ml, respectively, which were significantly higher than those of tumor tissue [(40.01 ± 9.88) ml/min/100 ml, (123.10 ± 26.49) ml/min/100 ml, P<0.05]. The HAPI of Child-Pugh grade A patients was significantly lower than that of grade B patients, and the PVP and TLP of grade A patients were significantly higher than those of grade B patients (P<0.05). Spearman correlation analysis showed no significant correlation between the HAP and Child-Pugh classification (r=0.119, P=0.367). The HAPI was positively correlated with Child-Pugh classification (r=0.442, P=0.002). The PVP and TLP were negatively correlated with Child-Pugh classification (r=-0.550, P<0.001; r=-0.489, P<0.001).Conclusion CT perfusion imaging can quantitatively reflect the hemodynamic changes of patients with different Child-Pugh grades, and evaluate the liver reserve function of patients, which can provide reference for preoperative evaluation of TACE and prediction of surgical outcomes.

Key words: Computed tomographic perfusion imaging, Liver cancer, Transcatheter arterial chemoembolization, Liver reserve function

杨怀龙, 雷霆. CT全灌注成像在肝癌TACE介入术前肝储备功能评估中的价值[J]. 肝脏, 2020, 25(3): 270-272.

YANG Huai-long, LEI Ting.. The value of CT perfusion imaging in the evaluation of liver reserve function before TACE intervention on liver cancer[J]. Chinese Hepatolgy, 2020, 25(3): 270-272.

参考文献 19

[1]	潘克华,曹国全,孙厚长,等.肝脏CT灌注成像中不同算法对灌注参数的影响.中华放射学杂志,2016,50:537-541.
[2]	李梦迪,陈勇,高知玲,等.多层螺旋CT全肝灌注成像对肝脏常见肿瘤血流状态的评价.中华肿瘤杂志,2015,37:904-908.
[3]	梁长华,毛华杰,岳军艳,等.肝细胞肝癌CT全肿瘤灌注值与瘤体体积、Child-Pugh分级相关性分析.实用放射学杂志,2018,34:378-381.
[4]	李珊玫,高知玲,吕茜婷,等.全肝CT灌注成像定量评估肝癌经肝动脉化疗栓塞术后血流状态变化的价值.中华肝脏病杂志,2018,26:429-435.
[5]	吴国华,殷允娟,侯海燕,等.256层CT全肝灌注评估肝硬化段性功能储备.中国医学计算机成像杂志,2015,21:246-250.
[6]	中华人民共和国卫生部. 原发性肝癌诊疗规范(2011年版). 中华肝脏病杂志, 2012, 20:929-946.
[7]	钟井松,胡春洪,曹阳,等.320排容积CT全肝灌注成像评价小肝癌血供的临床价值.中华肿瘤防治杂志,2015,22:696-698,703.
[8]	喻朋辉,赵香田.双源CT全肝灌注成像用于原发性肝细胞癌患者动脉导管化疗栓塞术后疗效评估研究.中西医结合肝病杂志,2018,28:307-309.
[9]	徐璐,褚志强,于文娟,等.CT灌注成像评价兔肝不同程度热缺血再灌注损伤的研究.中华器官移植杂志,2018,39:164-170.
[10]	陈大治, 谭辉, 樊秋菊, 等. 乙肝肝硬化患者全肝及各肝段体积与肝功能Child-Pugh分级的相关性研究. 宁夏医科大学学报, 2017,39:1286-1288.
[11]	黄宇峰,陈建新,张同华,等.CT 灌注值分析及 CT 灌注成像鉴别肝细胞癌和肝局灶性结节增生的诊断价值.肝脏,2016,21:626-629.
[12]	庞玉花,马晓明,王金环, 等.CT肝容量测量联合CTP分级评价原发性肝癌合并肝纤维化患者肝储备功能的临床价值.河北医科大学学报,2018,39:1197-1200.
[13]	梁伟强,王猛.术前肝脏储备功能评估的最新研究进展.新医学,2019,50:229-233.
[14]	吴杨,施丽丽,房海燕, 等.原发性肝癌的CT灌注参数特征及肝脏储备功能评估价值.中国现代普通外科进展,2018,21:309-310.?
[15]	李丹,刘建滨,李文政.多层螺旋CT测算肝脾体积及其之间比值评估肝硬化患者肝功能储备的初步研究.当代医学,2018,24:49-53.
[16]	金良红,李兴杰,关红博, 等.双能量CT碘定量结合动态对比增强MRI评估肝硬化患者肝脏血流动力学和肝功能临床价值研究.实用肝脏病杂志,2019,22:712-715.
[17]	王梅,尉从新,杨贵华, 等.肝硬化CT分级评估肝癌介入治疗肝储备功能及预后的临床价值.中国老年学杂志,2017,37:2197-2198.
[18]	贾济波,杨文广,朱全新, 等.64排螺旋CT肝脏灌注对血吸虫性肝硬化分级及肝储备功能的研究.中国社区医师,2017,33:106-108.
[19]	汤秋月,向述天,张洪, 等.320排容积CT灌注成像对原发性肝癌肝储备功能评价的研究.中国CT和MRI杂志,2017,15:88-91.