Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany.
Department of Nuclear Medicine, Ulm University Hospital, Albert-Einstein-Allee 23, 89081 Ulm, Germany.
Tomography. 2022 Apr 15;8(2):1148-1158. doi: 10.3390/tomography8020094.
Contrast enhancement at the margins/rim of embolization areas in hepatocellular-carcinoma (HCC) lesions treated with transarterial chemoembolization (TACE) might be an early prognostic indicator for HCC recurrence. The aim of this study was to evaluate the predictive value of rim perfusion for TACE recurrence as determined by perfusion CT (PCT). A total of 52 patients (65.6 ± 9.3 years) underwent PCT directly before, immediately after (within 48 h) and at follow-up (95.3 ± 12.5 days) after TACE. Arterial-liver perfusion (ALP), portal-venous perfusion (PVP) and hepatic-perfusion index (HPI) were evaluated in normal liver parenchyma, and on the embolization rim as well as the tumor bed. A total of 42 lesions were successfully treated, and PCT measurements showed no residually vascularized tumor areas. Embolization was not entirely successful in 10 patients with remaining arterialized focal nodular areas (ALP 34.7 ± 10.1 vs. 4.4 ± 5.3 mL/100 mL/min, p < 0.0001). Perfusion values at the TACE rim were lower in responders compared to normal adjacent liver parenchyma and edges of incompletely embolized tumors (ALP liver 16.3 ± 10.1 mL/100 mL/min, rim responder 8.8 ± 8.7 mL/100 mL/min, rim non-responder 23.4 ± 8.6 mL/100 mL/min, p = 0.005). At follow-up, local tumor relapse was observed in 17/42, and 15/42 showed no recurrence (ALP 39.1 ± 10.1 mL/100 mL/min vs. 10.0 ± 7.4 mL/100 mL/min, p = 0.0008); four patients had de novo disseminated disease and six patients were lost in follow-up. Rim perfusion was lower compared to adjacent recurring HCC and not different between groups. HCC lesions showed no rim perfusion after TACE, neither immediately after nor at follow-up at three months, both for mid-term responders and mid-term relapsing HCCs, indicating that rim enhancement is not a sign of reactive hyperemia and not predictive of early HCC recurrence.
经动脉化疗栓塞 (TACE) 治疗的肝细胞癌 (HCC) 病变栓塞区边缘/边缘的对比增强可能是 HCC 复发的早期预后指标。本研究旨在评估 CT 灌注 (PCT) 确定的边缘灌注对 TACE 复发的预测价值。共有 52 名患者（65.6±9.3 岁）在 TACE 前、后即刻（48 小时内）和随访（95.3±12.5 天）时直接进行了 PCT 检查。在正常肝实质、栓塞边缘以及肿瘤床中评估了动脉-肝灌注 (ALP)、门静脉灌注 (PVP) 和肝灌注指数 (HPI)。42 个病灶成功治疗，PCT 检查无残留血管化肿瘤区。10 例患者存在残留动脉化局灶性结节区域，栓塞不完全（ALP 为 34.7±10.1 与 4.4±5.3 mL/100 mL/min，p＜0.0001）。与正常相邻肝实质和不完全栓塞肿瘤边缘相比，TACE 边缘的灌注值在反应者中较低（ALP 肝 16.3±10.1 mL/100 mL/min，边缘反应者 8.8±8.7 mL/100 mL/min，边缘非反应者 23.4±8.6 mL/100 mL/min，p=0.005）。随访时，42 例中有 17 例观察到局部肿瘤复发，15 例无复发（ALP 为 39.1±10.1 mL/100 mL/min 与 10.0±7.4 mL/100 mL/min，p=0.0008）；4 例患者出现新发播散性疾病，6 例患者失访。与复发 HCC 相比，边缘灌注值较低，且中期反应者与中期复发 HCC 之间无差异。TACE 后 HCC 病变即刻及随访 3 个月均无边缘灌注，无论是中期反应者还是中期复发者，均表明边缘增强不是反应性充血的标志，也不能预测 HCC 早期复发。
