Reiner Caecilia S, Morsbach Fabian, Sah Bert-Ram, Puippe Gilbert, Schaefer Niklaus, Pfammatter Thomas, Alkadhi Hatem
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland.
J Vasc Interv Radiol. 2014 May;25(5):747-59. doi: 10.1016/j.jvir.2014.01.025. Epub 2014 Mar 13.
To evaluate computed tomography (CT) perfusion for assessment of early treatment response after transarterial radioembolization of patients with liver malignancy.
Dynamic contrast-enhanced CT liver perfusion was performed before and 4 weeks after transarterial radioembolization in 40 patients (25 men and 15 women; mean age, 64 y ± 11; range, 35-80 y) with liver metastases (n = 27) or hepatocellular carcinoma (HCC) (n = 13). Arterial perfusion (AP) of tumors derived from CT perfusion and tumor diameters were measured on CT perfusion before and after transarterial radioembolization. Success of transarterial radioembolization was evaluated on morphologic follow-up imaging (median follow-up time, 4 mo) based on Response Evaluation Criteria in Solid Tumors (Version 1.1). CT perfusion parameters before and after transarterial radioembolization for different response groups were compared. Kaplan-Meier curves were plotted to illustrate overall 1-year survival rates.
Liver metastases showed significant differences in AP before and after transarterial radioembolization in responders (P < .05) but not in nonresponders (P = .164). In HCC, AP values before and after transarterial radioembolization were not significantly different in responders and nonresponders (P = .180 and P = .052). Tumor diameters were not significantly different on CT perfusion before and after transarterial radioembolization in responders and nonresponders with liver metastases and HCC (P = .654, P = .968, P = .148, P = .164). In patients with significant decrease of AP in liver metastases after transarterial radioembolization, 1-year overall survival was significantly higher than in patients showing no reduction of AP.
CT perfusion showed early reduction of AP in liver metastases responding to transarterial radioembolization; tumor diameter remained unchanged early after treatment. No significant early treatment response to transarterial radioembolization was found in patients with HCC. In patients with liver metastases, a decrease of AP after transarterial radioembolization was associated with a higher 1-year overall survival rate.
评估计算机断层扫描（CT）灌注成像在评估肝恶性肿瘤患者经动脉放射性栓塞术后早期治疗反应中的应用价值。
对40例肝转移瘤（n = 27）或肝细胞癌（HCC，n = 13）患者（25例男性，15例女性；平均年龄64岁±11岁；范围35 - 80岁）在经动脉放射性栓塞术前及术后4周进行肝脏动态对比增强CT灌注成像。在经动脉放射性栓塞术前及术后，通过CT灌注成像测量肿瘤的动脉灌注（AP）及肿瘤直径。根据实体瘤疗效评价标准（1.版），通过形态学随访成像（中位随访时间4个月）评估经动脉放射性栓塞术的疗效。比较不同反应组经动脉放射性栓塞术前、后的CT灌注参数。绘制Kaplan - Meier曲线以说明1年总生存率。
在有反应的肝转移瘤患者中，经动脉放射性栓塞术前、后的AP有显著差异（P < 0.05），而无反应者差异不显著（P = 0.164）。在HCC患者中，有反应者和无反应者经动脉放射性栓塞术前、后的AP值差异均不显著（P = 0.180和P = 0.052）。有反应和无反应的肝转移瘤及HCC患者经动脉放射性栓塞术前、后的CT灌注成像上肿瘤直径差异均不显著（P = 0.654，P = 0.968，P = 0.148，P = 0.164）。在经动脉放射性栓塞术后肝转移瘤AP显著降低的患者中，1年总生存率显著高于AP未降低的患者。
CT灌注成像显示，对经动脉放射性栓塞术有反应的肝转移瘤患者，其AP早期降低；治疗后早期肿瘤直径无变化。HCC患者经动脉放射性栓塞术后未发现明显的早期治疗反应。在肝转移瘤患者中，经动脉放射性栓塞术后AP降低与1年总生存率较高相关。
