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Diagnostic value of computed tomographic perfusion imaging of whole liver for quantitative assessment of blood flow state in liver cancer after transcatheter arterial chemoembolization



Diagnostic value of computed tomographic perfusion imaging of whole liver for quantitative assessment of blood flow state in liver cancer after transcatheter arterial chemoembolization



Zhonghua Gan Zang Bing Za Zhi 26(6): 429-435



目的: 探讨全肝CT灌注成像对肝癌经肝动脉化疗栓塞(TACE)术前、术后瘤灶及瘤旁血流状态变化的定量评估价值。 方法: 收集行TACE的肝癌患者26例,分别于术前2~3 d及术后1个月完成全肝CT灌注成像,分别对瘤体、瘤旁1 cm及背景肝实质进行肝动脉灌注量(HAP)、门静脉灌注量(PVP)、总肝灌注量(TLP)、肝动脉灌注指数(HPI)及达峰时间(TTP)的测量。据资料不同分别采用方差分析、t检验或秩和检验进行统计学分析。 结果: 共检出34个病灶,根据TACE术后碘油沉积情况分为碘油密实组(21个)和碘油稀疏组(13个)。肝癌TACE术后病灶长径较术前总体上呈缩小趋势,密实组病灶缩小程度大于稀疏组,术前术后长径比较分别为(3.12±0.58)cm对比(1.93±0.79)cm、(2.98±2.01)cm对比(2.58±2.00)cm,差异有统计学意义(t值分别为15.1、8.65,P < 0.05)。碘油密实组术前瘤区HAP及HPI最高,瘤旁1 cm高于背景肝实质,背景肝实质PVP、TLP及TTP最高,瘤旁1 cm高于瘤区,对应灌注参数总体上及两两比较差异均有统计学意义(P < 0.05);术后瘤旁1 cm的HAP及HPI高于背景肝实质,PVP、TLP及TTP低于背景肝实质,差异有统计学意义(P < 0.05);TACE术前术后对应区域的比较,碘油沉积区无血流灌注,术后瘤旁1 cm HAP和HPI下降,PVP、TLP及TTP上升,与术前比较差异有统计学意义(P < 0.05),背景肝实质术后血流灌注变化差异无统计学意义(P > 0.05)。碘油稀疏组瘤区术后HAP及HPI下降,PVP及TTP上升,差异有统计学意义(P < 0.05),其他两区域变化差异无统计学意义(P > 0.05)。 结论: 肝癌TACE术后碘油沉积区无血流灌注,瘤旁1 cm及碘油稀疏组残余灶肝动脉灌注量下降,门静脉灌注量上升。CT灌注成像能量化评价血流灌注状态,对肝癌TACE术前治疗方案的确定及术后疗效的评价具有重要意义。.

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PMID: 30317756


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