Kaufmann S, Horger T, Oelker A, Beck S, Schulze M, Nikolaou K, Ketelsen D, Horger M
University of Tübingen, Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str.3, 72076 Tübingen, Germany.
Technische Universität München, M2-Lehrstuhl für Numerische Mathematik, Boltzmannstraße 3, 85748 Garching, Germany.
Eur J Radiol. 2015 Dec;84(12):2548-54. doi: 10.1016/j.ejrad.2015.09.009. Epub 2015 Sep 11.
Response monitoring of transarterial chemoembolization (TACE) with the help of volume perfusion computed tomography (VPCT) at day one post-TACE and analysis of TACE-impact on tumor and uninvolved liver parenchymal perfusion by using different particles sizes and epirubicin dose.
Institutional review board approved this prospective study. VPCT was performed in the baseline, post-interventional (FU1; 24 h post-TACE) and at follow-up (FU2; median, 81 days) in 45 consecutive patients. 100-300 μm (n=17) and 300-500 μm (n=28) drug eluting beads (DEB) using an epirubicin dose of (<=25 vs. >25) were administered. VPCT was performed for 40-s using 80 kV, 100/120 mAs, 64×0.6 mm collimation, 26 consecutive measurements, IV injection (50 ml iodinated contrast), flow rate (5 ml/s). Blood flow (BF), blood volume (BV) and k-trans were registered as average and max values in the tumor. Arterial liver perfusion (ALP), portal-venous perfusion (PVP) and the hepatic perfusion index (HPI) were registered both in tumor and non-involved liver parenchyma. Response to TACE was classified by VPCT as complete (CR), partial (PR) or no response (NR).
A significant reduction of viable tumor tissue was found in all patients between baseline and FU1 (p<0.001) being independent on particle size and epirubicin dose (p>0.05). PPV/NPV/sensitivity/specificity of post-interventional VPCT (FU1) results for prediction of the mid-term tumor course (FU2) were 100%/70%/76%/100%. There was generally a significant increase of the ALP between baseline and FU1 in the liver parenchyma coupled by a significant subsequent decrease (normalization) of ALP and HPI between FU1 and FU2.
VPCT accurately measures impact of TACE on liver tumor and hepatic parenchymal perfusion. The former proved not to be significantly dependent on particle size and epirubicin dose. There was no persistent perfusion deficit in the liver after TACE.
借助容积灌注计算机断层扫描（VPCT）在经动脉化疗栓塞（TACE）术后第1天监测其反应，并通过使用不同粒径和表柔比星剂量分析TACE对肿瘤及未受累肝实质灌注的影响。
机构审查委员会批准了这项前瞻性研究。对45例连续患者在基线期、介入治疗后（FU1；TACE术后24小时）及随访期（FU2；中位数81天）进行VPCT检查。使用表柔比星剂量（<=25 vs. >25），分别给予100 - 300μm（n = 17）和300 - 500μm（n = 28）的药物洗脱微球（DEB）。VPCT检查采用80 kV、100/120 mAs、64×0.6 mm准直、连续26次测量、静脉注射（50 ml碘化造影剂）、流速（5 ml/s），持续40秒。记录肿瘤内血流（BF）、血容量（BV）和k转运的平均值及最大值。记录肿瘤及未受累肝实质的动脉肝灌注（ALP）、门静脉灌注（PVP）和肝灌注指数（HPI）。根据VPCT将TACE反应分为完全缓解（CR）、部分缓解（PR）或无反应（NR）。
在所有患者中，基线期与FU1之间可见存活肿瘤组织显著减少（p < 0.001），且与粒径和表柔比星剂量无关（p > 0.05）。介入治疗后VPCT（FU1）结果预测中期肿瘤病程（FU2）的阳性预测值/阴性预测值/敏感度/特异度分别为100%/70%/76%/100%。肝实质中，基线期与FU1之间ALP通常显著升高，随后在FU1与FU2之间ALP和HPI显著下降（恢复正常）。
VPCT可准确测量TACE对肝肿瘤及肝实质灌注的影响。前者被证明与粒径和表柔比星剂量无显著相关性。TACE术后肝脏无持续性灌注不足。
