320排容积CT灌注成像在评价肝细胞肝癌TACE术后疗效中的应用价值

发布时间：2018-06-19 18:57

本文选题：CT灌注 + 肝细胞肝癌　；参考：《延边大学》2017年硕士论文

【摘要】：目的:探讨320排容积CT灌注(CT perfusion,CTP)成像技术在肝细胞肝癌经动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)后疗效评价中的应用价值。方法:收集2016年3月至2016年12月在本院经TACE治疗后的肝细胞肝癌患者,对符合标准的36例病人进行CT灌注检查、常规肝脏强化CT检查(动脉期及门脉期)和MRI检查。定量分析残留或复发病灶CT灌注参数与正常肝脏组织灌注参数之间的关系,包括肝动脉灌注量(arterial flow,AF)、门静脉灌注量(portal flow,PF)及灌注指数(perfusion index,PI),同时对比残留病或复发病灶与周围正常肝脏组织的时间-密度曲线(Time-density curve,TDC)趋势。结果:36例病人共评价47个病灶,CT灌注发现残留或复发病灶42个。1.术后病灶周围正常肝脏组织灌注参数AF为33.50±10.74(ml/min/100ml)、PF 为 130.05±36.70(ml/min/100ml)、PI 为 21.09±5.85;残留或复发病灶灌注参数AF 为 103.61±30.56(ml/min/100ml)、PF 为 35.67±24.09(ml/min/100ml)、PI为76.32±13.70,两组数据之间有显著性差异(P0.01),残留或复发灶AF及PI明显高于周围正常肝脏组织,PF明显低于周围正常肝脏组织。2.比较残留或复发病灶与周围正常肝脏组织时间-密度曲线强化峰值的时间和趋势,残留或复发灶强化峰值的时间为21.6±4.1(s),正常肝脏组织强化峰值时间为51.7± 6.0(s),两者比较有显著性差异(P0.05)。残留或复发灶TDC呈"速升速降"型,并在动脉期达到峰值,随后下降;正常肝脏组织呈"缓慢上升"型并且在静脉期达到峰值。3.以MRI评价的结果为标准,CT灌注对TACE术后疗效评价可靠性较高,Kappa值为0.69;敏感性为97.6%,特异性为66.7%。常规强化CT对TACE术后疗效评价可靠性较差,Kappa值为0.33;敏感性和特异性分别为73.2%、83.3%。4.CT灌注成像辐射剂量(10.2mSv)明显低于常规3期肝脏强化CT辐射剂量(28.34±5.9mSv),两组数据差异具有统计学意义(P0.05);CT灌注+常规2期肝脏强化CT辐射剂量(28.16±3.6mSv)与常规3期肝脏强化CT辐射剂量(28.34±5.9mSv)无统计学差异(P0.05)。结论:肝癌TACE术后,CT灌注参数能够客观的定量分析残留或复发病灶内微血管灌注情况;CT灌注图能够直观的发现残留或复发病灶;与常规肝脏强化CT比较,CT灌注成像平价具有较高的可靠性,对肝细胞肝癌TACE术后残留或复发检出率较高,同时CT灌注成像有效辐射剂量也较常规强化CT低。
[Abstract]:Objective: to evaluate the value of 320 slice CT perfusion CT (CT perfusionCT) imaging in evaluating the efficacy of transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods: 36 patients with hepatocellular carcinoma treated with TACE from March 2016 to December 2016 were examined with CT perfusion, conventional enhanced CT (arterial phase and portal phase) and MRI. The relationship between CT perfusion parameters of residual or recurrent lesions and normal liver tissue perfusion parameters was quantitatively analyzed. It included hepatic arterial perfusion volume, portal vein flow perfusion (PFF) and perfusion index (perfusion index). The time-density curves of residual or recurrent lesions were compared with those of adjacent normal liver tissues. Results A total of 47 lesions were evaluated in 36 cases. 42 residual or recurrent lesions were found by CT perfusion. The perfusion parameters of normal liver tissue around the lesion were 33.50 卤10.74 ml / min / 100 ml / 100 ml 路min / 100 ml 路min ~ (-1) PF = 130.05 卤36.70 min / 100 ml 路min ~ (-1) P = 21.09 卤5.85, respectively. The perfusion parameters of residual or recurrent lesions were 103.61 卤30.56 ml / min / 100 ml 路min ~ (-1) PF = 35.67 卤24.09 ml / min / 100 ml 路min ~ (-1) P = 76.32 卤13.70, respectively. There was a significant difference between the two groups (P 0.01). The residual or recurrent AF and Pi were significantly higher than those of the control group (P < 0.05). The PF in the surrounding normal liver tissue was significantly lower than that in the surrounding normal liver tissue. The time and trend of enhancement peak value of residual or recurrent focus and normal liver tissue were compared. The time of enhancement peak value of residual or recurrent focus was 21.6 卤4.1g / s, and that of normal liver tissue was 51.7 卤6.0 / s respectively. There was significant difference between the two groups (P 0.05). The residual or recurrent TDC showed "rapid ascending and rapid descending" type, and reached a peak value in arterial phase, then decreased, while normal liver tissue showed "slowly ascending" type and reached a peak value of .3in venous phase. According to the results of MRI evaluation, the reliability of CT perfusion in evaluating the curative effect after TACE was 0.69, the sensitivity was 97.6 and the specificity was 66.7. The reliability of conventional enhanced CT in evaluating the curative effect after TACE was poor. The Kappa value was 0.33; the sensitivity and specificity were 73.2and 83.3.4.The dose of CT perfusion imaging radiation was significantly lower than that of routine phase 3 liver enhanced CT radiation dose of 28.34 卤5.9 mSvn. The difference between the two groups was statistically significant. There was no significant difference in the dose of CT enhanced CT radiation between the two stages (28.16 卤3.6 mSv) and the conventional phase 3 (28.34 卤5.9 mSv). Conclusion: Ct perfusion parameters after TACE can be used to analyze the microvascular perfusion in residual or recurrent lesions objectively. Ct perfusion can directly detect residual or recurrent lesions. Compared with conventional enhanced CT, CT perfusion imaging is more reliable and has a higher detection rate of residual or recurrence after TACE, and the effective radiation dose of CT perfusion imaging is lower than that of conventional enhanced CT.
【学位授予单位】：延边大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7;R730.44

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