Hepatocellular carcinoma in cirrhotic liver disease: Functional computed tomography with perfusion imaging in the assessment of tumor vascularization
Hepatocellular carcinoma in cirrhotic liver disease: Functional computed tomography with perfusion imaging in the assessment of tumor vascularization
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DOI：
10.1016/j.acra.2008.02.005
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发表时间：
2008-07-01
影响因子：
4.8
通讯作者：
Fazio, Ferruccio
中科院分区：
文献类型：
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作者：
Ippolito, Davide;Sironi, Sandro;Fazio, Ferruccio
理由和目标。我们的目标是前瞻性地确定灌注计算机断层扫描（CT）在定量评估肝细胞癌（HCC）患者肿瘤相关血管生成中的价值。47例患者符合以下所有入选标准：1）Child-Pugh A级或B级肝硬化; 2）在筛选超声检查时存在疑似HCC的单个病灶; 3）病灶直径在1 - 3 cm之间。所有患者均接受了超声造影、造影前后三期CT和使用多排16层CT的灌注计算机断层扫描研究。分别测定了肝脏局灶性病变和肝实质的血流灌注（P）、组织血容量（BV）、肝脏灌注指数（HPI）、动脉灌注（AP）、门静脉灌注（PP）和达峰时间（TTP）。灌注参数用其分布的四分位值描述;单变量配对和非配对Wilcoxon符号秩检验用于统计学分析。47例患者中有21例被诊断为HCC;其余26例患者在超声造影和多排16层计算机断层扫描研究中未发现HCC。肿瘤组织内灌注参数测量值分别为：P（ml/s/ 100 g）：中位数= 47.0（第一四分位数36.0，第三四分位数= 61.4）; BV（ml/100 mg）：中位数= 24.0（第一四分位数= 18.7，第三四分位数= 29.3）; HPI（%）：中位数78.4（第一四分位数= 62.9，第三四分位数= 100）; AP（ml/min）：中位数= 45.9（第一四分位数= 39.0，第三四分位数= 60.1）; PP（ml/min）：中位数= 9.0（第一四分位数= 0.0，第三四分位数= 24.5）; TTP（秒）：中位数= 18.7（第一四分位数= 16.3，第三四分位数= 26.5）。在周围组织中计算的相应值为P（ml/s/100 g）：中位数= 11.5（第一四分位数= 9.4，第三四分位数13.9）; BV（ml/100 mg）：中位数= 10.7（第一四分位数= 7.1，第三四分位数= 14.2）; HPI（%）：中位数= 10.6（第一四分位数8.7，第三四分位数= 11.9）; AP（ml/min）：中位数= 13.2（第一四分位数= 10.1，第三四分位数= 15.5）; PP（ml/min）中位数55.2 TTP（秒）：中位数= 41.7（第一四分位数= 38.9，第三四分位数= 44.6）。与周围肝脏相比，HCC的P、BV、HPI和AP值较高（P < .001），而PP和TTP较低（P < .001）。肝细胞癌患者和非肝细胞癌患者的灌注参数值无显著差异（P > 0.001）。在HCC患者中，灌注CT技术可以提供肿瘤相关血管生成的定量信息。
Rationale and Objectives. Our goal was to prospectively determine the value of perfusion computed tomography (CT) in the quantitative assessment of tumor-related angiogenesis in cirrhotic patients with hepatocellular carcinoma (HCC).Materials and Methods. Forty-seven patients met all the following inclusion criteria: 1) Child-Pugh class A or B liver cirrhosis; 2) presence of a single lesion suspected as HCC at screening ultrasound examination; and 3) lesion diameter between I and 3 cm. All patients underwent contrast-enhanced ultrasound, pre- and post-contrast triple-phase CT, and perfusion computed tomographic study using multidetector 16-slice CT. Six parameters related to the blood microcirculation and tissue perfusion were measured for the focal liver lesion and cirrhotic parenchyma: perfusion (P), tissue blood volume (BV), hepatic perfusion index (HPI), arterial perfusion (AP), portal perfusion (PP), and time to peak (TTP). Perfusion parameters were described with quartile values of their distribution; univariate paired and unpaired Wilcoxon signed rank tests were used for statistical analysis.Results. HCC was diagnosed in 21 of the 47 patients; in the remaining 26, HCC was not found at contrast-enhanced ultrasound and multidetector 16-slice computed tomographic study. The values of perfusion parameters measured within tumor tissue were: P (ml/s/ 100 g): median = 47.0 (first quartile 36.0, third quartile = 61.4); BV (ml/100 mg): median = 24.0 (first quartile = 18.7, third quartile = 29.3); HPI (%): median 78.4 (first quartile = 62.9, third quartile = 100); AP (ml/min): median = 45.9 (first quartile = 39.0, third quartile = 60.1); PP (ml/min): median = 9.0 (first quartile = 0.0, third quartile = 24.5); and TTP (seconds): median = 18.7 (first quartile = 16.3, third quartile = 26.5). The corresponding values calculated in cirrhotic surrounding parenchyma were P (ml/s/100 g): median = 11.5 (first quartile =,9.4, third quartile 13.9); BV (ml/100 mg): median = 10.7 (first quartile = 7.1, third quartile = 14.2); HPI (%): median = 10.6 (first quartile 8.7, third quartile = 11.9); AP (ml/min): median = 13.2 (first quartile = 10.1, third quartile = 15.5); PP (ml/min) median 55.2 (first quartile = 40.1, third quartile = 79.5); and TTP (seconds): median = 41.7 (first quartile = 38.9, third quartile 44.6). P, BV, HPI, and AP values were higher (P < .001), whereas PP and TTP were lower (P < .001) in HCC relative to the surrounding liver. Values of perfusion parameters in the cirrhotic liver of patients with and without HCC were not significantly different (P > .001).Conclusion. In cirrhotic patients with HCC, perfusion computed tomographic technique can provide quantitative information about tumor-related angiogenesis.