Singh Jagjeet, Sharma Sanjiv, Aggarwal Neeti, Sood R G, Sood Shikha, Sidhu Ravinder
Department of Radiodiagnosis and Intervention Radiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
Department of Imaging Sciences, University of Rochester Medical Center, New York, USA.
J Clin Imaging Sci. 2014 Feb 27;4:10. doi: 10.4103/2156-7514.127959. eCollection 2014.
The purpose of the study was to determine the role of computed tomography (CT) perfusion in differentiating hemangiomas from malignant hepatic lesions.
This study was approved by the institutional review board. All the patients provided informed consent. CT perfusion was performed with 64 multidetector CT (MDCT) scanner on 45 patients including 27 cases of metastasis, 9 cases of hepatocellular carcinoma (HCC), and 9 cases of hemangiomas. A 14 cm span of the liver was covered during the perfusion study. Data was analyzed to calculate blood flow (BF), blood volume (BV), permeability surface area product (PS), mean transit time (MTT), hepatic arterial fraction (HAF), and induced residue fraction time of onset (IRFTO). CT perfusion parameters at the periphery of lesions and background liver parenchyma were compared.
Significant changes were observed in the perfusion parameters at the periphery of different lesions. Of all the perfusion parameters BF, HAF, and IRFTO showed most significant changes. In our study we found: BF of more than 400 ml/100 g/min at the periphery of the hemangiomas showed sensitivity of 88.9%, specificity of 83.3%, positive predictive value (PPV) of 57.1%, and negative predictive value (NPV) of 96.7% in differentiating hemangiomas from hepatic malignancy; HAF of more than 60% at the periphery of hemangiomas showed sensitivity of 77.8%, specificity of 86.1%, PPV of 58.3% and NPV of 93.9% in differentiating hemangiomas from hepatic malignancy; IRFTO of more than 3 s at the periphery of hemangiomas showed sensitivity of 77.8%, specificity of 86.1%, PPV of 58.3%, and NPV of 93.9% in differentiating hemangiomas from hepatic malignancy.
Perfusion CT is a helpful tool in differentiating hemangiomas from hepatic malignancy by its ability to determine changes in perfusion parameters of the lesions.
本研究的目的是确定计算机断层扫描（CT）灌注成像在鉴别肝血管瘤与肝脏恶性病变中的作用。
本研究经机构审查委员会批准。所有患者均签署了知情同意书。使用64排多层螺旋CT（MDCT）扫描仪对45例患者进行CT灌注成像检查，其中包括27例转移瘤、9例肝细胞癌（HCC）和9例肝血管瘤。在灌注研究过程中覆盖肝脏14 cm的范围。分析数据以计算血流量（BF）、血容量（BV）、表面通透性乘积（PS）、平均通过时间（MTT）、肝动脉分数（HAF）和起始诱导残留分数时间（IRFTO）。比较病变周边和肝实质背景的CT灌注参数。
在不同病变周边的灌注参数中观察到显著变化。在所有灌注参数中，BF、HAF和IRFTO的变化最为显著。在我们的研究中发现：肝血管瘤周边BF大于400 ml/100 g/min时，在鉴别肝血管瘤与肝脏恶性肿瘤方面，敏感性为88.9%，特异性为83.3%，阳性预测值（PPV）为57.1%，阴性预测值（NPV）为96.7%；肝血管瘤周边HAF大于60%时，在鉴别肝血管瘤与肝脏恶性肿瘤方面，敏感性为77.8%，特异性为86.1%，PPV为58.3%，NPV为93.9%；肝血管瘤周边IRFTO大于3 s时，在鉴别肝血管瘤与肝脏恶性肿瘤方面，敏感性为77.8%，特异性为86.1%，PPV为58.3%，NPV为93.9%。
灌注CT能够确定病变灌注参数的变化，是鉴别肝血管瘤与肝脏恶性肿瘤的有用工具。
