【摘要】 目的评价CT灌注成像结合全肝增强扫描在中晚期肝癌患者行导管动脉化疗栓塞术(TACE)疗效的价值。方法 41例中晚期肝癌患者行TACE术后4周再行CT灌注扫描,计算肝血流量、肝血容量、平均通过时间、肝动脉分数及表面通透性等参数及基线图像,并于灌注扫描后即行全肝增强扫描。结果根据肝癌行TACE术后基线图像显示碘油在肿瘤区域的沉积形态,观察到在41患者中,碘油完全填充型1例、缺损型或环形10例、簇集型25例及稀少型5例;与肝癌再次行TACE治疗时肝动脉数字减影血管造影结果比较,两者诊断吻合率100%。各灌注参数显示碘油沉积区域肝癌组织血流灌注消失;非碘油沉积区域与正常肝组织比较,肝血流量、肝血容量及平均通过时间等参数差异均有统计学意义(P<0.01),而肝动脉分数及表面通透性等参数差异无统计学意义(P>0.05)。观察结果显示,全肝增强扫描可弥补CT灌注成像覆盖范围较小,无法全面了解全肝碘油填充情况的缺点;全肝增强扫描可提供肝癌及子灶大小、形态、密度、强化程度以及扫描范围其他脏器有无异常,是否有腹腔淋巴结转移等详细的临床资料。结论 CT灌注成像结合全肝增强扫描可判断中晚期肝癌患者行TACE疗效,对进一步治疗中晚期肝癌具有重要的临床指导价值。更多还原

【Abstract】 Objective To evaluated the value of perfusion imaging combined with enhancement scanned of whole liver in patients with harbored mid advanced stage liver cancer after transarterial chemoembolization( TACE) treatment. Methods 41 patients with harbored mid advanced stage liver cancer underwent CT perfusion imaging and whole liver enhancement scan before and 4 weeks after TACE treatment. Hepatic blood flow( HBF),Hepatic blood volume( HBV),Mean transit time( MTT),Hepatic artery fraction( HAF),Permeability of surface( PS) parameters,and the baseline image( BI) of CT were analyzed. Results According to the BI of CT scan after performed TACE indicated iodized oil deposition in lesions,the iodized oil deposition configuration appeared entireness filling in 1 case,ring form or incomplete filling in 10 cases,cluster in 25 cases,and sparsity in 5 cases. CT Perfusion parameters showed that the blood flow disappeared in iodized oil deposition in all the patients. HBF、HBV and MTT reduced significantly in non iodized oil deposited region compared with normal liver tissue( P < 0. 01),while HAF and PT has no difference between non iodized oil deposited region and normal liver tissue( P > 0. 05). Enhancement scan of whole liver might compensate the disadvantages of CT perfusion, such as lesser of coverage area. Enhancement scan of whole liver also provided advantage to observe the region,shape, density and strengthen degree of primary and secondary carcinoma,to observe invasion to visceral organs and lymphatic me-tastasis. Conclusion CT perfusion imaging combined with enhancement scan of whole liver could evaluate the curative effect of TACE,which has clinical guide value in optimizing therapy of mid-advanced liver cancer patients.更多还原