CT灌注成像在肝癌诊断中的临床应用

摘要

目的：探讨肝脏CT灌注成像在早期肝癌诊断中的价值。方法对60例肝癌患者的病灶及肝实质进行肝脏多层螺旋CT灌注扫描，测量肝癌病灶和肝硬化实质的CT灌注值，包括血管表面通透性（PS）、平均通过时间（MTT）、肝动脉灌注分数（HAF）、血容量（BV）、血流量（BF）和对比剂到达时间，并获得相应灌注伪彩图。结果大小不同的肝癌病灶间灌注值差异无显著性（P＞0.05），60例患者中15例病灶≤3 cm，肝癌病灶的HAF、BV、BF值均明显高于肝硬化实质（P＜0.05）；ROC曲线分析，BF临界值为140.363时，灵敏度为86.10%，特异度为60%；BV临界值为28.163时，灵敏度为79.30%，特异度为100%；HAF临界值为0.3026时，灵敏度为100%，特异度为90%。结论 CT灌注成像可早期检出肝癌患者，肝动脉分数的测定适用于早期肝癌测定，当临界值为0.3026时，对早期肝癌的灵敏度为100%，特异度为90%。%Objective To discuss the value of liver CT perfusion imaging in diagnosis of early hepatocellular carcinoma. Method Hepatic MSCT perfusion scanning of the lesion and liver parenchyma in 60 cases of HCC patients, CT perfusion of HCC lesions and hardening liver parenchymameasurements, including vascular permeability surface (PS), mean transit time(MTT), hepatic arterial fraction (HAF), blood volume (BV), blood lfow (BF) andtime of arrival contrast agent, and got the corresponding perfusion maps. Result Different size of HCC lesions between the perfusion values were not statistically different (P>0.05), 60 patients with lesions in 15 patients with lesions≤3 cm, HAF, BV, BF values were signiifcantly higher than that in cirrhosis of the liver parenchyma (P<0.05);ROC curve analysis, the critical value of BF was 140.363, sensitivity was 86.10%, speciifcity was 60%, the critical value of BV was 28.163, the sensitivity was 79.30%, speciifcity was 100%;the critical HAF value was 0.3026, sensitivity was 100%, speciifcity was 90%. Conclusion CT perfusion imaging can detect early HCC patients suitable for early HCC, the determination of hepatic arterial fraction, when the critical value of 0.3026 for early HCC, sensitivity is 100%, speciifcity was 90%.