本文選題：CT灌注 + 肝細(xì)胞肝癌�。� 參考：《延邊大學(xué)》2017年碩士論文

【摘要】：目的:探討320排容積CT灌注(CT perfusion,CTP)成像技術(shù)在肝細(xì)胞肝癌經(jīng)動脈化療栓塞術(shù)(transcatheter arterial chemoembolization,TACE)后療效評價(jià)中的應(yīng)用價(jià)值。方法:收集2016年3月至2016年12月在本院經(jīng)TACE治療后的肝細(xì)胞肝癌患者,對符合標(biāo)準(zhǔn)的36例病人進(jìn)行CT灌注檢查、常規(guī)肝臟強(qiáng)化CT檢查(動脈期及門脈期)和MRI檢查。定量分析殘留或復(fù)發(fā)病灶CT灌注參數(shù)與正常肝臟組織灌注參數(shù)之間的關(guān)系,包括肝動脈灌注量(arterial flow,AF)、門靜脈灌注量(portal flow,PF)及灌注指數(shù)(perfusion index,PI),同時(shí)對比殘留病或復(fù)發(fā)病灶與周圍正常肝臟組織的時(shí)間-密度曲線(Time-density curve,TDC)趨勢。結(jié)果:36例病人共評價(jià)47個(gè)病灶,CT灌注發(fā)現(xiàn)殘留或復(fù)發(fā)病灶42個(gè)。1.術(shù)后病灶周圍正常肝臟組織灌注參數(shù)AF為33.50±10.74(ml/min/100ml)、PF 為 130.05±36.70(ml/min/100ml)、PI 為 21.09±5.85;殘留或復(fù)發(fā)病灶灌注參數(shù)AF 為 103.61±30.56(ml/min/100ml)、PF 為 35.67±24.09(ml/min/100ml)、PI為76.32±13.70,兩組數(shù)據(jù)之間有顯著性差異(P0.01),殘留或復(fù)發(fā)灶A(yù)F及PI明顯高于周圍正常肝臟組織,PF明顯低于周圍正常肝臟組織。2.比較殘留或復(fù)發(fā)病灶與周圍正常肝臟組織時(shí)間-密度曲線強(qiáng)化峰值的時(shí)間和趨勢,殘留或復(fù)發(fā)灶強(qiáng)化峰值的時(shí)間為21.6±4.1(s),正常肝臟組織強(qiáng)化峰值時(shí)間為51.7± 6.0(s),兩者比較有顯著性差異(P0.05)。殘留或復(fù)發(fā)灶TDC呈"速升速降"型,并在動脈期達(dá)到峰值,隨后下降;正常肝臟組織呈"緩慢上升"型并且在靜脈期達(dá)到峰值。3.以MRI評價(jià)的結(jié)果為標(biāo)準(zhǔn),CT灌注對TACE術(shù)后療效評價(jià)可靠性較高,Kappa值為0.69;敏感性為97.6%,特異性為66.7%。常規(guī)強(qiáng)化CT對TACE術(shù)后療效評價(jià)可靠性較差,Kappa值為0.33;敏感性和特異性分別為73.2%、83.3%。4.CT灌注成像輻射劑量(10.2mSv)明顯低于常規(guī)3期肝臟強(qiáng)化CT輻射劑量(28.34±5.9mSv),兩組數(shù)據(jù)差異具有統(tǒng)計(jì)學(xué)意義(P0.05);CT灌注+常規(guī)2期肝臟強(qiáng)化CT輻射劑量(28.16±3.6mSv)與常規(guī)3期肝臟強(qiáng)化CT輻射劑量(28.34±5.9mSv)無統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:肝癌TACE術(shù)后,CT灌注參數(shù)能夠客觀的定量分析殘留或復(fù)發(fā)病灶內(nèi)微血管灌注情況;CT灌注圖能夠直觀的發(fā)現(xiàn)殘留或復(fù)發(fā)病灶;與常規(guī)肝臟強(qiáng)化CT比較,CT灌注成像平價(jià)具有較高的可靠性,對肝細(xì)胞肝癌TACE術(shù)后殘留或復(fù)發(fā)檢出率較高,同時(shí)CT灌注成像有效輻射劑量也較常規(guī)強(qiáng)化CT低。
[Abstract]:Objective: to evaluate the value of 320 slice CT perfusion CT (CT perfusionCT) imaging in evaluating the efficacy of transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). Methods: 36 patients with hepatocellular carcinoma treated with TACE from March 2016 to December 2016 were examined with CT perfusion, conventional enhanced CT (arterial phase and portal phase) and MRI. The relationship between CT perfusion parameters of residual or recurrent lesions and normal liver tissue perfusion parameters was quantitatively analyzed. It included hepatic arterial perfusion volume, portal vein flow perfusion (PFF) and perfusion index (perfusion index). The time-density curves of residual or recurrent lesions were compared with those of adjacent normal liver tissues. Results A total of 47 lesions were evaluated in 36 cases. 42 residual or recurrent lesions were found by CT perfusion. The perfusion parameters of normal liver tissue around the lesion were 33.50 鹵10.74 ml / min / 100 ml / 100 ml 路min / 100 ml 路min ~ (-1) PF = 130.05 鹵36.70 min / 100 ml 路min ~ (-1) P = 21.09 鹵5.85, respectively. The perfusion parameters of residual or recurrent lesions were 103.61 鹵30.56 ml / min / 100 ml 路min ~ (-1) PF = 35.67 鹵24.09 ml / min / 100 ml 路min ~ (-1) P = 76.32 鹵13.70, respectively. There was a significant difference between the two groups (P 0.01). The residual or recurrent AF and Pi were significantly higher than those of the control group (P < 0.05). The PF in the surrounding normal liver tissue was significantly lower than that in the surrounding normal liver tissue. The time and trend of enhancement peak value of residual or recurrent focus and normal liver tissue were compared. The time of enhancement peak value of residual or recurrent focus was 21.6 鹵4.1g / s, and that of normal liver tissue was 51.7 鹵6.0 / s respectively. There was significant difference between the two groups (P 0.05). The residual or recurrent TDC showed "rapid ascending and rapid descending" type, and reached a peak value in arterial phase, then decreased, while normal liver tissue showed "slowly ascending" type and reached a peak value of .3in venous phase. According to the results of MRI evaluation, the reliability of CT perfusion in evaluating the curative effect after TACE was 0.69, the sensitivity was 97.6 and the specificity was 66.7. The reliability of conventional enhanced CT in evaluating the curative effect after TACE was poor. The Kappa value was 0.33; the sensitivity and specificity were 73.2and 83.3.4.The dose of CT perfusion imaging radiation was significantly lower than that of routine phase 3 liver enhanced CT radiation dose of 28.34 鹵5.9 mSvn. The difference between the two groups was statistically significant. There was no significant difference in the dose of CT enhanced CT radiation between the two stages (28.16 鹵3.6 mSv) and the conventional phase 3 (28.34 鹵5.9 mSv). Conclusion: Ct perfusion parameters after TACE can be used to analyze the microvascular perfusion in residual or recurrent lesions objectively. Ct perfusion can directly detect residual or recurrent lesions. Compared with conventional enhanced CT, CT perfusion imaging is more reliable and has a higher detection rate of residual or recurrence after TACE, and the effective radiation dose of CT perfusion imaging is lower than that of conventional enhanced CT.
【學(xué)位授予單位】：延邊大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7;R730.44

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 陶鈞;張勇;楊大勇;;原發(fā)性肝癌5支供血動脈1例[J];中國臨床醫(yī)學(xué)影像雜志;2016年03期

2 呂婷婷;劉愛蓮;汪禾青;李葉;陳麗華;韓錚;;多模態(tài)磁共振成像對結(jié)節(jié)型肝細(xì)胞癌TACE+RFA術(shù)后復(fù)發(fā)灶評估的價(jià)值[J];磁共振成像;2016年02期

3 許俊鋒;王劍華;董文英;;磁共振擴(kuò)散加權(quán)成像在肝細(xì)胞癌肝動脈化療栓塞術(shù)后療效監(jiān)測中的價(jià)值[J];中國現(xiàn)代醫(yī)學(xué)雜志;2015年31期

4 王豪;蔣婷;付唆林;宋嫣;劉婷婷;;超聲引導(dǎo)下注射聚桂醇硬化治療單純性肝囊腫臨床分析[J];中外醫(yī)學(xué)研究;2015年29期

5 魏礦榮;彭俠彪;梁智恒;岑惠珊;;全球肝癌流行概況[J];中國腫瘤;2015年08期

6 胡金妹;楊偉斌;;CT灌注成像診斷肝細(xì)胞癌的臨床價(jià)值分析[J];醫(yī)學(xué)影像學(xué)雜志;2015年04期

7 毛景松;王勝強(qiáng);梁茂全;蘇洪英;;碘油沉積類型與巨塊型肝癌肝動脈栓塞化療術(shù)療效的關(guān)系[J];中華臨床醫(yī)師雜志(電子版);2015年06期

8 李海波;耿麗莉;郭群;;旋轉(zhuǎn)DSA三維重建技術(shù)在肝臟腫瘤介入治療中的應(yīng)用[J];中國臨床研究;2015年01期

9 次旦旺久;盧再鳴;林坤;王曉明;;增強(qiáng)MRI對肝癌TACE術(shù)后殘余癌及復(fù)發(fā)癌診斷的Meta分析[J];中國臨床醫(yī)學(xué)影像雜志;2014年08期

10 宋紅俊;姚之豐;胡四龍;張光遠(yuǎn);付怡;章英劍;;~(18)F-脫氧葡萄糖PET/CT顯像在肝細(xì)胞癌經(jīng)導(dǎo)管肝動脈化療栓塞術(shù)后殘留病灶診斷和預(yù)后判斷中的價(jià)值[J];腫瘤影像學(xué);2014年01期

相關(guān)碩士學(xué)位論文 前1條

1 趙冬梅;磁共振DWI評價(jià)原發(fā)性肝癌TACE術(shù)療效的價(jià)值[D];瀘州醫(yī)學(xué)院;2012年

，

本文編號：2040928