CT灌注成像在原发性肝癌化疗疗效评价中的应用价值

摘要

[目的]探讨多层螺旋CT灌注成像(CT perfusion imaging,CTPI)在原发桂肝癌(primary hepatic carcinoma,PHC)化疗疗效评价中的应用价值.[方法]对33例PHC患者于联合化疗前1～3d和化疗第2疗程后1～3d分别行血清甲胎蛋白(alpha fetoprotein,AFP)检测和CT灌注扫描,经肝脏CT灌注软件获得时间密度曲线(time-density curve,TDC),从而得到肝动脉灌注量(hepatic artery perfusion,HAP)、门静脉灌注量(Portalvenous perfusion,PVP)、肝动脉灌注指数(Hepatic arterial perfusion index,HAPI)和总肝灌注量(total liver perfusion,TLP)及毛细血管通透性(permeability surface,PS)及相关的彩色灌注图,比较化疗前肿瘤组织及周围正常肝组织的血流灌注,观察化疗前后肿瘤组织的血流灌注变化；分别分析化疗前后HAP、PVP、HAPI、TLP及PS差值与AFP差值的相关性.应用统计软件包对化疗前肿瘤组织与周围正常肝组织的血流灌注采用独立样本t检验;对化疗前后肿瘤组织的血流灌注变化采用配对样本￡检验进行显著性分析；对化疗前后HAP、PVP、HAPI、TLP和PS的差值分别与AFP的差值进行相关性分析.[结果]原发性肝癌患者33例,化疗前肿瘤组织较周围正常肝组织,HAP、HAPI和TLP升高差异有统计学意义(P＜0.05),PS和PVP改变差异无统计学意义(P＞0.05)；化疗第2疗程治疗后,肿瘤HAP、HAPI和TLP下降差异有统计学意义(P＜0.05),PS和PVP改变差异无统计学意义(P＞0.05); HAP、HAPI、TLP与AFP呈正相关(P＜0.05),而与PVP和PS与AFP相关性差异无统计学意义(P＞0.05).[结论]CTPI能准确地反映原发性肝癌化疗前后的血流动力学改变,可用于临床治疗反应的监测和治疗方案的选择.%[Objective]To discuss the clinical value of CTP1 on postchemotherapy of primary hepatocelluar carcinoma. [Methods]CTPl was applied to 33 patients with primary hepatocelluar carcinoma 1~3 days before the chemotherapy and 1~3 days after second course of the chemotherapy .With the help oi perfusion software,the IDC,HAP,PVP,HAPI and PS of all HCC lesions were measured,and the relevant perfusion color images were obtained.Tht parameters of all HCC lesions obtained before chemotherapy was compared to those of normal lesions and those of all HCC lesions after chemotherapy, and the differences were statistically analyzed. AFP in serum was examined 1 days before the chemotherapy and 1 ~3 days after second course of the chemotherapy.The correlation of CTPI and AFP in serum was analysed with statistic software. [ResultsJThe negative correlation between the decrease percentage of AFP in serum and CTPI was found.The positive correlation decreased percentage of AFP in serum and CTPI. The HAP.HAPI and TLP ol HCC lesions before chemotherapy were significantly lower than those of normal lesions; While the PVP and PS before chemotherapy showed no significant change when compared to those of normal lesions; In all patients the HAP.HAPI and TLP of HCC lesions after chemotherapy were significantly lower than that measured before chemotherapy;While the PVP and PS after chemotherapy showed no significant change when compared to that before chemotherapy. [Conclusion]CTPI can directly and quantitatively reflect the hemodynamic situation of HCC lesions both before and after chemotherapy,which is very helpful for estimating the therapeutic efficacy of chemotherapy