Department of Diagnostic Radiology, School of Medicine, University of Milano-Bicocca, H S. Gerardo, Via Pergolesi 33, 20052 Monza, Milan, Italy.
World J Gastroenterol. 2010 Dec 21;16(47):5993-6000. doi: 10.3748/wjg.v16.i47.5993.
To asses the value of computed tomography (CT)-perfusion in the detection of residual hepatocellular carcinoma (HCC) vascularization after transarterial chemoembolization (TACE).
Thirty-two consecutive patients were prospectively included in this study. All patients had liver cirrhosis and a confirmed HCC lesion which was treated with TACE. One month after treatment, perfusion measurements of treated lesions were carried out. The CT-perfusion (CT-p) protocol was performed with 16 slice multidetector computed tomography which included the following parameters: 8 dynamic slices/scan per 40 scans after iv injection of 50 mL of iodinated contrast (350 mg/mL) at a flow rate of 6 mL/s. Treated lesions were evaluated using dedicated perfusion software, which generated a quantitative colour map of perfusion. The following parameters were considered: hepatic perfusion (HP), arterial perfusion (AP), blood volume (BV), hepatic perfusion index (HPI), and time to peak (TTP). Perfusion parameters were described with quartile values of their distribution and statistically analyzed.
Perfusion parameters of the treated lesions could be quantitatively assessed using CT-p analysis. The presence of residual tumor tissue was observed in 13 of the 32 patients. The values of the perfusion parameters measured within the relapse tissue were: HP (mL/100 g per minute): median = 44.4 (1(st)qt = 31.3, 3(rd)qt = 55.8); BV (mL/100 g): median = 18.7 (1(st)qt = 11.5, 3(rd)qt = 22.5); AP (mL/min): median = 39.0 (1(st)qt = 36.5, 3(rd)qt = 61.3); HPI (%): median = 34.0 (1(st)qt = 30.4, 3(rd)qt = 38.9); TTP (s): median = 17.3 (1(st)qt = 15.8, 3(rd)qt = 26.5). With the use of the univariate paired Wilcoxon signed rank test, HP, AP and HPI were shown to be significantly higher (P < 0.001) in the relapse site than in the primary lesion. The BV and TTP parameters showed a tendency to be greater and lower, respectively, in the relapse site than in the primary lesion.
In patients with HCC treated with TACE, CT-p provides measurement of flow parameters related to residual arterial structures in viable tumor, thus helping in the assessment of therapeutic response.
评估 CT 灌注（CT-p）在经动脉化疗栓塞（TACE）后检测残留肝细胞癌（HCC）血管生成中的价值。
本研究前瞻性纳入 32 例连续患者。所有患者均患有肝硬化，且经证实存在 HCC 病变，采用 TACE 治疗。治疗 1 个月后，对治疗后的病变进行灌注测量。采用 16 层多排 CT 进行 CT-p 检查，包括以下参数：静脉注射 50ml 碘造影剂（350mg/ml）后 40 次扫描/次，流速为 6ml/s。使用专用灌注软件评估治疗后的病变，生成灌注的定量彩色图谱。考虑以下参数：肝灌注（HP）、动脉灌注（AP）、血容量（BV）、肝灌注指数（HPI）和达峰时间（TTP）。描述灌注参数的四分位值及其分布，并进行统计学分析。
通过 CT-p 分析可以对治疗后病变的灌注参数进行定量评估。在 32 例患者中，有 13 例观察到残留肿瘤组织。复发组织中测量的灌注参数值为：HP（mL/100g/min）：中位数=44.4（1st 四分位=31.3，3rd 四分位=55.8）；BV（mL/100g）：中位数=18.7（1st 四分位=11.5，3rd 四分位=22.5）；AP（mL/min）：中位数=39.0（1st 四分位=36.5，3rd 四分位=61.3）；HPI（%）：中位数=34.0（1st 四分位=30.4，3rd 四分位=38.9）；TTP（s）：中位数=17.3（1st 四分位=15.8，3rd 四分位=26.5）。采用单变量配对 Wilcoxon 符号秩检验，结果显示，复发部位的 HP、AP 和 HPI 均显著高于（P<0.001）原发部位。BV 和 TTP 参数在复发部位分别表现出较大和较小的趋势。
在接受 TACE 治疗的 HCC 患者中，CT-p 可提供与存活肿瘤中残留动脉结构相关的血流参数测量，有助于评估治疗反应。
