应用全肝CT灌注技术评价原发性肝癌血流灌注特点及其相关因素分析

摘要

目的：应用全肝 CT 灌注技术探讨肝癌组织及瘤周组织血流灌注特点及其相关因素。方法：采用全肝 CT 灌注技术对56例原发性肝癌病例进行扫描，对扫描结束获得的多时相动态增强扫描图像应用最大斜率法的数学模型进行后处理，可以获得肝动脉灌注量（eAP）、肝动脉灌注指数（ePI）等灌注参数。在动态增强扫描图像中选择肿瘤最大直径平面，测量肿瘤直径（D）及坏死直径（d），计算肿瘤坏死程度指标 R（R ＝ d/ D ×100%）。在肿瘤最大直径平面，分别选择肿瘤组织、肿瘤周缘1-2cm 区域、远离肿瘤组织的无瘤区域划定感兴趣区，分别测量瘤体、瘤周及无瘤区域的 eAP、ePI。分析肿瘤瘤内灌注参数与瘤体坏死程度的相关性及瘤体直径、瘤体坏死与瘤周组织灌注值的相关性。结果：原发性肝癌瘤内 eAP、ePI 分别高于无瘤组织，有显著性差异（P ﹤0.05）。瘤体 eAP 与瘤体坏死程度呈显著负相关（r ＝-0.721，P ﹤0.05），而 ePI 与瘤体坏死程度无相关性（P ＝0.244）。原发性肝癌瘤周组织 eAP、ePI 分别高于无瘤组织，其统计学上有显著性差异（P﹤0.05）。肿瘤直径与瘤周组织 eAP、ePI 成正相关（r ＝0.489、0.544，P ﹤0.05），且与肿瘤坏死因素有协同作用。结论：全肝 CT 灌注技术通过灌注参数可以全面反映原发性肝癌瘤体及瘤周血流灌注情况，并且可以体现瘤体直径、瘤体坏死程度对瘤周血流灌注的影响情况。%Objective:To investigate hePatocellular carcinoma and Peritumoral tissue Perfusion characteristics and related factors by the total liver Perfusion CT. Methods:All 56 Patients diagnosed with Primary hePatic carcinoma had accePted the total liver CT Perfusion scanning. eePatic artery Perfusion(eAP)and hePatic Perfusion index(ePI)of the Perfusion Pseudo - color Pictures were obtained. Target images showing maximum diameter of the tumor surface were selected in dynamic enhanced CT images. By measuring tumor diameter(D)and necrosis diameter(d),the de-gree of tumor necrosis index R(R = d/ D × 100% )was calculated. In the target images,ROIs were set on tumor tissue, Peritumoral tissue of 1 - 2cm area,non - tumor tissue. The eAP,ePI of different ROIs were obtained,which were used to analyze the correlation between tumor Perfusion Parameters and the degree of tumor necrosis,the correlation between tumor size,tumor necrosis and Peritumoral tissue Perfusion Parameters. Results:The eAP,ePI of tumor tis-sue was higher than non - tumor tissue in cases of PeC(P ﹤ 0. 05). The eAP of tumor tissue was significantly nega-tively correlated(r = - 0. 721,P ﹤ 0. 05)with the tumor necrosis index,while there was no correlation between the ePI and the tumor necrosis index(P = 0. 244). The eAP,ePI of Peritumoral tissue was higher than non - tumor tis-sue(P ﹤ 0. 05). The eAP,ePI of tumor tissue was significantly Positive correlated(r = 0. 489,0. 544,P ﹤ 0. 05)with the tumor diameter,and tumor necrosis factor showed synergistic effect. Conclusion:Total liver Perfusion imaging with MSCT is valuable to evaluate the Perfusion characteristics of hePatocellular carcinoma,and may reflect the imPact of tumor diameter,tumor necrosis to the Peritumoral tissue Perfusion.