320排CT上腹部一站式检查在肝癌TACE治疗中的价值.docVIP

320排CT上腹部一站式检查在肝癌TACE治疗中的价值 张晓宇，罗小平，罗银灯，倪卫国，彭 睿 （400010重庆，重庆医科大学附属第二医院放射科） [摘要] 目的 探寻320排CT上腹部一站式检查在肝癌经动脉插管化疗栓塞（transcatheter arterial chemoembolization，TACE)治疗中的临床应用价值。方法 收集30例肝癌患者TACE术前行320排CT上腹部灌注扫描病例，分析全肝灌注情况，与TACE术中数字减影血管造影（digital subtraction angiography，DSA）图像对比了解其血管成像能力，术后随访病灶灌注情况并与术前对比分析。对320排灌注容积扫描行辐射剂量分析。结果 TACE术前肝癌组织肝动脉灌注量（hepatic arterial perfusion,HAP）、门静脉灌注量(portal vein perfusion,PVP)及肝动脉灌注指数（hepatic arterial perfusion index,HAPI)与非癌组织相比，差异有统计学意义（P0.05）；术后肿瘤坏死组织无血流灌注；肿瘤活性组织的HAP、PVP较术前升高，HAPI则下降，较术后非癌组织其HAP及HAPI升高，而PVP则明显降低，差异有统计学意义（P0.05）。30次扫描中均能获得满意上腹部CT血管成像（computer tomography angiography,CTA)图像；对1～4级肝动脉CTA与DSA对比显示，差异无统计学意义（P0.05）,5级及以上肝动脉CTA与DSA比较，差异有统计学意义（P0.05）。剂量对比发现低参数（100 kV、100 mA）灌注扫描较常规上腹部增强扫描辐射剂量低，稍高参数灌注扫描方案（100 kV、200 mA）辐射剂量仅轻度增高。结论 320排CT上腹部一站式检查能很好的显示全肝灌注情况，尤其是肝癌组织的异常灌注情况及术后活性灶，血管成像能够从三维角度显示肝动脉及肿瘤滋养动脉，对TACE术前评估、术中操作及术后随访都具有重要的指导意义。 [关键词] 肝细胞癌；CT灌注；数字减影血管造影；栓塞；血管成像 [中图法分类号] [文献标志码] A Value of 320-row CT upper abdominal one-stop examination in the TACE treatment of HCC Zhang Xiaoyu,Luo Xiaoping,Luo Yindeng,Ni Weiguo,Peng Rui(Department of Radiology, Second Affiliated Hospital,Chongqing Medical University,Chongqing, 400010,China) [Abstract] Objective To explore the clinical application of 320-row CT upper abdominal one-stop examination in the TACE treatment of hepatocellular carcinoma(HCC). Methods Totally 30 patients with HCC underwent upper abdominal perfusion scan with 320-row CT before TACE.The whole liver perfusion was analyzed,and the angiography capability of 320-row CT was compared with DSA in TACE.Cancer tissues perfusion was compared with the preoperative’s in postoperative follow up.Radiation doses of 320--row CT perfusion scan were also analyzed. Results There were significant differences in HAP,PVP and HAPI of cancer tissues compared with non-cancerous tissues(P0.05).Cancer necrosis had no blood perfusion.Active cancer tissues had higher HAP、PVP and lower HAPI than the preoper