CT 灌注成像在 AFP 阴性及增强 CT 表现不典型的 HCC 诊断中的价值

摘要

Objective To explore the application of CT perfusion imaging in diagnosis and differential diagnosis of hepatocellular carcinoma (HCC)with negative AFP and/or atypical enhanced CT appearances.Methods Fourteen patients with hepatocellular carcinoma in our hospital from September 2011 to September 2013 were selected and underwent 64 slice spiral CT perfusion imaging.Results MTT of lesion areas in HCC group was 8.6±4.8s,PS was 28.8 ±19 mL·100 mL-1 ·min-1 ,while MTT and PS of the non-lesion areas were 14.5 ±8.1 s and 59.1 ±26 mL· 100mL-1 · min-1 ,respectively,the differences were statistically significant (all P < 0.05 ).The hepatic arterial perfusion fraction (HAF)of lesion areas in HCC group was 0.432 ±0.197,which was significant increased compared with non-lesion areas of 0.105±0.113 (P <0.05).There was no significant differences of HBV and HBF between lesion areas (30±20 mL/100 mL,232±170mL·100 mL-1 ·min-1 )and non-lesion areas (25±16 mL/100 mL,175±76 mL ·100 mL-1 ·min-1 )in HCC group,respectively (P >0.05 ).There was no obvious correlation between serum AFP and parameters of CT perfusion imaging in lesion areas,the results are as follows:PS (r=-0.1022,P =0.7520);HAF (r=-0.3138,P =0.2964);MTT(r=0.0416,P =0.8926);HBV (r = -0.2170,P =0.4765 );HBF (r = -0.2152, P =- 0.4801 ).Conclusion CT perfusion imaging has an important application value in diagnosis and differential diagnosis of HCC with negative AFP and/or atypical enhanced CT appearances.%目的探讨 CT 灌注成像在 AFP 阴性及增强 CT 表现不典型的肝细胞癌（HCC）诊断及鉴别诊断中的应用价值。方法从2011年9月至2013年9月收治的 HCC 患者中随机选择14例进行研究，均予以64层螺旋 CT 灌注成像扫描。结果HCC 组病灶的平均通过时间（MTT）为（8．6±4．8）s，血管表面通透性（PS）为（28．8±19）mL·100 mL-1·min-1，较之非病灶区的（14．5±8．1）s 和（59．1±26）mL·100 mL-1·min-1，均呈现出显著减少的情况；HCC组病灶的肝动脉灌注分数（HAF）为0．432±0．197，较之非病灶区的0．105±0．113，则呈现出显著增加的情况（均 P ＜0．05）。HCC 组病灶的肝血容量（HBV）（30±20）mL/100 mL 和肝血流量（HBF）（232±170）mL·100 mL-1·min-1较之非病灶区（25±16）mL/100 mL、（175±76）mL·100 mL-1·min-1差异均无统计学意义（均 P ＞0．05）。在 HBF方面，肝血管瘤组病灶与 HCC 组病灶之间存在显著差异。肝局灶性结节增生与非结节区的各灌注参数大小基本一致，但肝局灶性结节增生的 HAF 小于非结节区。HCC 组病灶灌注参数合患者血清 AFP 之间不存在明显的相关性，PS （r＝-0．1022，P ＝0．7520）；HAF（r＝-0．3138，P ＝0．2964）；MTT（r ＝0．0416，P ＝0．8926）；HBV（r ＝-0．2170，P ＝0．4765）；HBF（r＝-0．2152，P ＝-0．4801）。结论CT 灌注成像在 AFP 阴性及增强 CT 表现不典型的 HCC 诊断及鉴别诊断中具有重要的应用价值。