320排容积CT灌注成像在原发性肝癌TACE术后局部活性灶评估中的临床应用

Clinical application of 320-detector row CT perfusion imaging in evaluating the activity of residual hepatocellular carcinoma after TACE

摘要:

目的：评价320排容积CT灌注在原发性肝癌经动脉插管化疗栓塞（transcatheter arterial chemoembolization，TACE）术后活性灶评估中的临床应用价值。方法：36例原发性肝癌TACE术后1~3月行上腹部灌注扫描，并于1周内行数字减影血管造影（digital subtraction angiography，DSA）检查对照。以 CT灌注分析软件获得全肝灌注参数，将DSA结果作为标准，评估其对肝癌TACE术后活性灶的发现情况。对320排容积CT灌注扫描行辐射剂量分析。结果：36例TACE术后患者扫描36次，评估病灶43个，CT灌注发现活性病灶34个，诊断正确率约为95.35%，灵敏度100.00%，特异度约81.80%，阳性预测值约94.12%，阴性预测值100.00%，阳性似然比5.5，阴性似然比约为0，约登指数约81.80%。TACE术后活性灶肝动脉血流量、门静脉血流量及肝动脉灌注指数与正常肝脏组织相比，差异有统计学意义（P<0.05）。剂量对比发现低参数（100 kV、100 mA）灌注扫描较常规上腹部增强扫描辐射剂量低，稍高参数灌注扫描方案（100 kV、200 mA）辐射剂量仅轻度增高。结论：320排容积CT灌注扫描可很好显示TACE术后活性病灶，在肝癌TACE术后随访中具有很高的临床实用价值。

Abstract:

Objective：To assess clinical value of 320-detector row CT perfusion imaging（CTPI） in evaluating the activity of residual hepatocellular carcinoma（HCC） within 1-3 months after transcatheter arterial chemoembolization（TACE）. Methods：Totally 36 pa－tients with HCC underwent upper abdominal perfusion scan after receiving TACE and digital subtraction angiography（DSA） within one week after CT perfusion scan. Hepatic perfusion parameters were acquired by CT perfusion analysis software. Effects of CTPI on activity of residual HCC after TACE were evaluated by using DSA as a golden standard. Radiation doses of 320-detector row CT per－fusion scan were analyzed. Results：CT perfusion scan was conducted for 36 times and 43 lesions were assessed. Totally 34 active le－sions were detected by CT perfusion scan，with diagnosis accuracy of 95.35％ approximate，sensitivity of 100.00％，specificity of 81.80％ approximate，positive predicative value of 94.12% approximate，negative predicative value of 100.00%，positive likelihood ra－tio of 5.5，negative likelihood ratio of approximate 0 and Youden’s index of approximate 81.80％ in detecting the residual blood sup－plies. There were differences in active focal hepatic arterial flow，portal flow and hepatic arterial perfusion index of tissues after TACE compared with those of normal hepatic tissues. Perfusion scan with lower parameter（100 kV，100 mA） had lower radiation dose than the conventional upper abdomen enhanced scan while that with higher parameter（100 kV，200 mA） only had slightly higher radiation dose. Conclusions：320-detector row CTPI can well display the activity of residual HCC after TACE. It is very useful for postoperative follow-up after TACE.