摘要
目的利用64层螺旋CT全肝灌注模式观察肝细胞癌(HCC)的CT灌注特征以及在各种灌注图像上的影像表现。方法搜集32例经临床或手术病理证实诊断为HCC患者并以10例正常肝脏作为对照分析。用双筒高压注射器经肘前静脉以5ml/s的速率注入非离子型对比剂(370mgI/ml)和生理盐水,通过肝脏CT灌注软件得出TDC及HAP、HPP、TLP等灌注彩图,并分别测定相应的灌注参数值以评价正常肝脏与HCC的血流动力学状态。结果①正常肝实质TDC形态动脉期上升缓慢,门静脉期上升较快并达峰值,曲线走行自然;而HCC的TDC呈速升型,在动脉期迅速上升并在脾峰值附近达峰值,曲线峰值明显前移,而后可维持平衡或较快下降;②HCC组HAP、HPI明显高于正常组,HAP、HPI值分别为(46.6±16.6)ml/(min.100mg),(84.0±13.1)%,与正常对照有显著性差异(HAP:t=4.32,P<0.01;HPI:t=11.3,P<0.01);HCC组HAP、HPI值明显高于远处肝组织,二者统计学上亦有显著差异(HAP:t=2.08,P<0.05;HPI:t=4.8,P<0.01);③边缘模糊处瘤灶HPP>边缘清晰处瘤灶HPP,两者间统计学上有显著差异(t=9.52,P<0.01)。结论64层螺旋CT全肝灌注模式成像克服了以往灌注成像的不足,简单实用,具有一定的优势。能直观反映肝脏整体及HCC内部的血流灌注特征,从而为HCC的诊断、鉴别诊断和治疗提供重要的指导价值。
Objective To identify the characterization of hepatocellular carcinoma （HCC） perfusion and its images under the pattern of whole-liver perfusion with 64-slice spiral CT. Methods Thirty-two patients with HCC diagnosed by clinical data or pathological detections were employed. Ten normal persons acted as control group. Non-ion contrast medium （370 mgI/ml） and normal saline was injected through antecubital vein into the cases at 5 ml/s with double tubes high-pressure syringe. The colored pictures of time density curve （TDC）, hepatic arterial perfusion （HAP）, hepatic portal perfusion （HPP） and total liver perfusion （TLP） were harvested with special software of hepatic perfusion in CT. The parameters of perfusion were measured respectively. The condition of blood current dynamics in livers suffering HCC as well as those normal ones were evaluated based on the parameters. Results ①TDC of normal hepatic parenchyma raised slowly in arterial phase, whereas it raised fast and achieved the peaking in portal vein phase. The curve ran smoothly and softly. Contrastly, TDC of HCC performed as tachy-ascensus model. It ran fast in arterial phase and achieved the peaking near spleen peaking. The peaking of the curve presented earlier. Then the curve stayed unchanged for a time or descended quickly. ②The values of HAP and hepatic perfusion index （HPI） of HCC were （46.6±16.6） ml/（min · 100 mg） and （84.0±13.1）% respectively. They were bigger than those of the normal contrast by far, and the difference was significant （HAP： t = 4.32, P〈0.01 ; HPI： t= 11.3, P〈0.01）. Moreover, the values of HAP and HPI of HCC also exceeded those of distant part of hepatic parenchyma, and the difference is significant, too （HAP： t=2.08, P〈0.05; HPh t=4.8, P〈0.01）. ③The HPP of the circumferential part of the tumor with blurring edge is bigger than that of the tumor with sharp edge, the difference was significant （t=9. 52, P〈0.01）. Conclusion The whole-liver perfusion pattern with 64-slice spiral CT has some advantages, such as simplicity and practice. And the disadvantages of previous patterns of liver perfusion imaging are eliminated in this pattern. The characterization of blood current perfusion of the whole liver as well as the HCC can be identified. Thus, it can provide instructions to the diagnosis, differentiation and treatment of HCC.
出处
《中国医学影像技术》
CSCD
北大核心
2007年第5期707-710,共4页
Chinese Journal of Medical Imaging Technology
关键词
肝肿瘤
CT灌注成像
全肝灌注
Liver neoplasms
CT perfusion imaging
Whole-liver perfusion
