肝细胞癌的CT灌注与可重复性研究

摘要

Objective To prospectively assess computed tomographic (CT) perfusion for evaluation of tumor vascularity of advanced hepatocellular carcinoma (HCC) and to correlate CT perfusion parameters with tumor grade and serum markers. Methods Total of 30 patients with unresectable HCC and hepatic metastatic (25 cases of HCC, 5 cases of hepatic metastases) were accept dynamic by CT perfusion scan for the first time after intravenous contrast agent. CT perfusion parameters (tumor tissue, hepatic tissue blood flow, blood volume, mean transit time, permeability surface area product) were collected. Repeat examination was performed in four patients within 30 hours to test reproducibility of CT perfusion. CT perfusion parameters were compared among tumors of different grades, with presence or absence of portal vein invasion, with presence or absence of cirrhosis, and of various extrahepatic metastases. Parameters were correlated with HCC serum markers. One-way analysis of variance was used to calculate variations in CT perfusion parameters. Results Good correlation (r = 0.9, P < 0.01) was observed between repeat examination results and first CT examination results. There was a significant difference (P < 0.05) in CT perfusion parameters between primary HCC and background liver parenchyma. Well-differentiated HCC showed significantly higher perfusion values (P < 0.05) than other grades. There was no significant difference in tumor perfusion between presence or absence of portal vein invasion or cirrhosis. CT perfusion value of lymph node metastasis demonstrated was lower than that of other extrahepatic metastasis. There was no significant correlation between CT perfusion parameters and serum markers (P > 0.05). Conclusions CT perfusion is a feasible and, from the limited data, reproducible technique for quantifying tumor vascularity and angiogenesis in advanced HCC.%目的：应用CT灌注成像前瞻性研究进展期肝细胞癌（HCC）的肿瘤血管，并评估CT灌注参数与肿瘤分级及肿瘤标记物的相关性。方法手术不能切除的HCC及肝转移患者30例（HCC组25例、肝转移组5例）静脉注射造影剂后，接受动态首次通过CT灌注扫描。收集数据计算CT灌注参数（肿瘤组织和肝组织的血流量、血容量、平均通过时间、表面通透性）。其中有4例患者在30小时内再行1次CT灌注扫描，以检验本研究的可重复性。CT灌注参数在不同级别的肿瘤、有无门静脉癌栓、肝硬化、无肝外转移患者中进行比较，并且评估CT灌注参数与AFP的相关性。应用单向方差分析来统计处理CT灌注参数在各个比较中的差异。结果本研究的可重复性检验良好（r =0.9，P ＜0.01）。在肝细胞肝癌组织与肝实质的CT灌注参数比较，差异有统计学意义（P ＜0.05）。高分化的HCC-CT灌注值高于低分化肿瘤（P ＜0.05）。有或无门静脉癌栓、有或无肝硬化患者的CT灌注值差异无统计学意义。淋巴结转移的CT灌注值低于其他肝外转移。CT灌注参数与AFP比较，差异无统计学意义（P ＞0.05）。结论 CT灌注成像是一项可行的、可重复性定量分析进展期肝癌肿瘤血供与肿瘤血管生成的检查手段。