计算机断层扫描灌注成像用于监测肝细胞癌的经动脉化疗栓塞术

Computed tomography perfusion imaging for monitoring transarterial chemoembolization of hepatocellular carcinoma.

作者信息

Marquez Herman P, Karalli Amar, Haubenreisser Holger, Mathew Rishi P, Alkadhi Hatem, Brismar Torkel B, Henzler Thomas, Fischer Michael A

机构信息

Institute of Diagnostic and Interventional Radiology, University Hospital Zurich and University of Zurich, CH-8091 Zurich, Switzerland.

Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, SE-14186, Stockholm, Sweden.

出版信息

Eur J Radiol. 2017 Jun;91:160-167. doi: 10.1016/j.ejrad.2017.03.014. Epub 2017 Mar 24.

DOI:10.1016/j.ejrad.2017.03.014

PMID:28629564

Abstract

PURPOSE

To prospectively monitor changes in tumor perfusion of hepatocellular carcinoma (HCC) in response to doxorubicin-eluted bead based transarterial chemoembolization (DEB-TACE) using perfusion-CT (P-CT).

METHODS AND MATERIALS

24 patients (54-79 years) undergoing P-CT before and shortly after DEB-TACE of HCC were prospectively included in this dual-center study. Two readers determined arterial-liver-perfusion (ALP, mL/min/100mL), portal-venous-perfusion (PLP, mL/min/100mL) and the hepatic-perfusion-index (HPI, %) by placing matched regions-of-interests within each HCC before and after DEB-TACE. Imaging follow-up was used to determine treatment response and to distinguish complete from incomplete responders. Performance of P-CT for prediction and early response assessment was determined using receiver-operating-characteristics curve analysis.

RESULTS

Interreader agreement was fair to excellent (ICC, 0.716-0.942). PLP before DEB-TACE was significantly higher in pre-treated vs non-treated lesions (P<0.05). Mean changes of ALP, PLP and HPI from before to after DEB-TACE were -55%, +24% and -27%. ALP and HPI after DEB-TACE were correlating with response-grades (r=0.45/0.48; both, p<0.04), showing an area-under-the-curve (AUC) of 0.74 and 0.80 respectively for identification of complete response.

CONCLUSION

High arterial and low portal-venous perfusion of HCC early after DEB-TACE indicates incomplete response with good diagnostic accuracy.

摘要

目的

使用灌注CT（P-CT）前瞻性监测肝细胞癌（HCC）在接受基于阿霉素洗脱微球的经动脉化疗栓塞术（DEB-TACE）后的肿瘤灌注变化。

方法和材料

本双中心研究前瞻性纳入了24例（年龄54 - 79岁）在HCC的DEB-TACE术前和术后不久接受P-CT检查的患者。两名阅片者通过在DEB-TACE术前和术后在每个HCC内放置匹配的感兴趣区域来确定动脉-肝脏灌注（ALP，mL/min/100mL）、门静脉灌注（PLP，mL/min/100mL）和肝脏灌注指数（HPI, %）。通过影像随访来确定治疗反应，并区分完全缓解和部分缓解者。使用受试者工作特征曲线分析来确定P-CT在预测和早期反应评估方面的性能。

结果

阅片者间一致性为中等至优秀（ICC，0.716 - 0.942）。DEB-TACE术前，预处理病变的PLP显著高于未处理病变（P<0.05）。DEB-TACE术前至术后ALP、PLP和HPI的平均变化分别为-55%、+24%和-27%。DEB-TACE术后ALP和HPI与反应分级相关（r = 0.45/0.48；均P<0.04），识别完全缓解的曲线下面积（AUC）分别为0.74和0.80。