Tsushima Yoshito, Funabasama Shintaro, Aoki Jun, Sanada Shigeru, Endo Keigo
Department of Radiology, Motojima General Hospital, 3-8 Nishi-Honcho, Ohta, Gunma 373-0033, Japan.
Acad Radiol. 2004 Feb;11(2):215-23. doi: 10.1016/s1076-6332(03)00578-6.
To apply perfusion computed tomography (CT) technique to variable malignant liver tumors, and to define the usefulness of quantitative color mapping.
Perfusion CT images were created for 36 malignant liver tumors in 28 patients (age, 66.4 +/- 10.1 years; range, 48-85) with metastatic liver tumors (n = 17; nine colorectal carcinomas, eight other malignant tumors) and hepatocellular carcinomas (n = 11). A single-slice dynamic CT was performed after an intravenous bolus injection of 40 mL of contrast material (320 mgI/mL) with 8 mL/sec. The parameters were calculated pixel-by-pixel using maximum slope method, and quantitative maps of arterial and portal perfusion were created. In four patients who underwent transcatheter arterial chemoembolization, perfusion CT was performed before and after transcatheter arterial chemoembolization.
In all patients, liver tumors were shown as hypervascular lesions on arterial perfusion CT. The average arterial perfusion value of the metastatic tumors from the colorectal carcinomas was 0.67 +/- 0.33 mL/min/mL, and that of hepatocellular carcinomas was 0.94 +/- 0.26 mL/min/mL (P = .03). The other metastatic tumors from various primary tumors showed a wide range (0.19-1.45 mL/min/mL) of arterial perfusion. Arterial perfusion of the liver tumors was obviously decreased after successful transcatheter arterial chemoembolization. In 12 of 15 tumors, in which portal perfusion CT images could be created, region-of-interest analysis showed no portal perfusion in the tumors. In two cases, decreased portal perfusion in the segments, which malignant tumors involved, was demonstrated.
Perfusion CT can provide quantitative information about arterial and portal perfusion of liver tumors, combined with good anatomic detail in one image. This technique has a potential to evaluate the angiogenesis of liver tumors, to show secondary changes in perfusion, such as decreased portal perfusion in apparently normal liver adjacent to metastases, and to monitor the therapeutic response in vivo.
将灌注计算机断层扫描（CT）技术应用于不同类型的肝脏恶性肿瘤，并确定定量彩色成像的实用性。
对28例患者（年龄66.4±10.1岁，范围48 - 85岁）的36个肝脏恶性肿瘤进行灌注CT成像，其中包括转移性肝癌（n = 17；9例结直肠癌转移，8例其他恶性肿瘤转移）和肝细胞癌（n = 11）。静脉团注40 mL造影剂（320 mgI/mL），注射速度为8 mL/秒后进行单层动态CT扫描。使用最大斜率法逐像素计算参数，并生成动脉灌注和门静脉灌注的定量图像。对4例行经动脉化疗栓塞术的患者，在术前和术后进行灌注CT检查。
在所有患者中，肝脏肿瘤在动脉灌注CT上均表现为高血供病变。结直肠癌转移瘤的平均动脉灌注值为0.67±0.33 mL/min/mL，肝细胞癌的平均动脉灌注值为0.94±0.26 mL/min/mL（P = 0.03）。来自各种原发肿瘤的其他转移瘤的动脉灌注范围较广（0.19 - 1.45 mL/min/mL）。成功的经动脉化疗栓塞术后，肝脏肿瘤的动脉灌注明显降低。在15个可生成门静脉灌注CT图像的肿瘤中，12个肿瘤的感兴趣区分析显示肿瘤内无门静脉灌注。2例显示恶性肿瘤累及节段的门静脉灌注降低。
灌注CT可在一幅图像中提供肝脏肿瘤动脉灌注和门静脉灌注的定量信息，并具有良好的解剖细节。该技术有可能评估肝脏肿瘤的血管生成，显示灌注的继发性改变，如转移灶附近看似正常的肝脏中门静脉灌注降低，并在体内监测治疗反应。
