Guyennon Aurélie, Mihaila Marius, Palma John, Lombard-Bohas Catherine, Chayvialle Jean-Alain, Pilleul Frank
Aurélie Guyennon, Marius Mihaila, John Palma, Frank Pilleul, Department of Gastrointestinal Radiology, University Hospital Edouard Herriot, 5 Place d'Arsonval 69437 Lyon, France.
World J Radiol. 2010 Nov 28;2(11):449-54. doi: 10.4329/wjr.v2.i11.449.
To assess prospectively parameters of computed tomography perfusion (CT p) for evaluation of vascularity of liver metastases from neuroendocrine tumors.
This study was approved by the hospital's institutional review board. All 18 patients provided informed consent. There were 30 liver metastases from neuroendocrine tumors. Patients were divided into three groups depending on the appearance of the liver metastases at the arterial phase of morphological CT (hyperdense, hypodense and necrotic). Sequential acquisition of the liver was performed before and for 2 min after intravenous injection of 0.5 mg/kg contrast medium, at 4 mL/s. Data were analyzed using deconvolution analysis to calculate blood flow (BF), blood volume (BV), mean transit time (MTT), hepatic arterial perfusion index (HAPI) and a bi-compartmental analysis was performed to obtain vascular permeability-surface area product (PS). Post-treatment analysis was performed by a radiologist and regions of interest were plotted on the metastases, normal liver, aorta and portal vein.
At the arterial phase of the morphological CT scan, the aspects of liver metastases were hyperdense (n = 21), hypodense (n = 7), and necrotic (n = 2). In cases of necrotic metastases, none of the CT p parameters were changed. Compared to normal liver, a significant difference in all CT p parameters was found in cases of hyperdense metastases, and only for HAPI and MTT in cases of hypodense metastases. No significant difference was found for MTT and HAPI between hypo- and hyperdense metastases. A significant decrease of PS, BV and BF was demonstrated in cases of patients with hypodense lesions PS (23 ± 11.6 mL/100 g per minute) compared to patients with hyperdense lesions; PS (13.5 ± 10.4 mL/100 g per minute), BF (93.7 ± 75.4 vs 196.0 ± 115.6 mL/100 g per minute) and BV (9.7 ± 5.9 vs 24.5 ± 10.9 mL/100 g).
CT p provides additional information compared to the morphological appearance of liver metastases.
前瞻性评估计算机断层扫描灌注（CT p）参数，以评价神经内分泌肿瘤肝转移灶的血管情况。
本研究经医院机构审查委员会批准。所有18例患者均签署知情同意书。共有30个神经内分泌肿瘤肝转移灶。根据形态学CT动脉期肝转移灶的表现（高密度、低密度和坏死）将患者分为三组。在静脉注射0.5mg/kg造影剂前及注射后2分钟内，以4mL/s的速度对肝脏进行序列采集。采用去卷积分析计算血流量（BF）、血容量（BV）、平均通过时间（MTT）、肝动脉灌注指数（HAPI），并进行双室分析以获得血管通透性-表面积乘积（PS）。由放射科医生进行治疗后分析，并在转移灶、正常肝脏、主动脉和门静脉上绘制感兴趣区。
在形态学CT扫描动脉期，肝转移灶表现为高密度（n = 21）、低密度（n = 7）和坏死（n = 2）。在坏死性转移灶中，所有CT p参数均无变化。与正常肝脏相比，高密度转移灶的所有CT p参数均有显著差异，低密度转移灶仅HAPI和MTT有显著差异。低密度和高密度转移灶的MTT和HAPI无显著差异。与高密度病变患者相比，低密度病变患者的PS、BV和BF显著降低；PS（23±11.6mL/100g每分钟）、BF（93.7±75.4对196.0±115.6mL/100g）和BV（9.7±5.9对24.5±10.9mL/100g）。
与肝转移灶的形态学表现相比，CT p可提供更多信息。
