CT灌注轨道减影成像对原发性肝癌经导管动脉化疗栓塞术后疗效评估的临床价值研究
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摘要
目的研究CT灌注轨道减影成像技术评价原发性肝癌经导管肝动脉化疗栓塞术后疗效的临床价值。方法连续选入2013年1月至2017年6月在我院诊断为原发性肝癌、经肝动脉化疗栓塞术(Transcatheter Arterial Chemoembolization,TACE)治疗、一个月后成功随访的患者98例,分别行肝脏动态增强MRI扫描、320排容积CT灌注扫描,并应用轨道减影成像获得CT减影图像,两项检查间隔时间不超过一周。评估两种影像学方法判断残留动脉期强化区的一致性。结果两种影像学方法对判断残留强化区(Kappa=0.5)以及对肿瘤动脉期强化区最长径的测量(t=1.895,P=0.068)具有较好的一致性,对肿瘤动脉期强化最短径的测量具有统计学差异(t=2.298,P=0.033)。结论 CT灌注轨道减影技术对评价原发性肝癌TACE术后疗效、指导后续治疗有较高的临床价值。
Objective To evaluate the clinical value of CT perfusion orbital subtraction imaging in the treatment of primary hepatocellular carcinoma after transcatheter arterial chemoembolization(TACE). Methods A total of 98 patients with primary liver cancer who underwent TACE were successfully followed up in our hospital from January 2013 to June 2017. Liver dynamic enhancement MRI scan and 320-row volume CT perfusion scan were performed one month after surgery, and CT orbital subtraction imaging were used to obtain CT subtraction images. The interval between the two examinations was less than one week. Two imaging methods were evaluated to determine the consistency of the residual area of the residual arterial phase. Results The two imaging methods had a good agreement on the determination of the residual enhancement zone(Kappa=0.5) and the measurement of the maximum diameter of the tumor in the arterial phase(t=1.895,P=0.068), and the measurement of the shortest diameter of the tumor arterial phase was statistically different(t=2.298, P=0.033). Conclusion CT perfusion orbital subtraction technique can effectively evaluate the tumor residual tissue and its enhancement after TACE, and it has certain clinical value for guiding follow-up treatment.
Objective To evaluate the clinical value of CT perfusion orbital subtraction imaging in the treatment of primary hepatocellular carcinoma after transcatheter arterial chemoembolization(TACE). Methods A total of 98 patients with primary liver cancer who underwent TACE were successfully followed up in our hospital from January 2013 to June 2017. Liver dynamic enhancement MRI scan and 320-row volume CT perfusion scan were performed one month after surgery, and CT orbital subtraction imaging were used to obtain CT subtraction images. The interval between the two examinations was less than one week. Two imaging methods were evaluated to determine the consistency of the residual area of the residual arterial phase. Results The two imaging methods had a good agreement on the determination of the residual enhancement zone(Kappa=0.5) and the measurement of the maximum diameter of the tumor in the arterial phase(t=1.895,P=0.068), and the measurement of the shortest diameter of the tumor arterial phase was statistically different(t=2.298, P=0.033). Conclusion CT perfusion orbital subtraction technique can effectively evaluate the tumor residual tissue and its enhancement after TACE, and it has certain clinical value for guiding follow-up treatment.
引文
[1]梁宏元,卢再鸣.原发性肝癌综合介入治疗现状与困惑[J].临床肝胆病杂志,2016,(1):44-48.
[2]Su JY.A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world:2010-2016[J].Clin Mol Hepat,2016,22(1):7-17.
[3]Piscaglia,Ogasawara S.Patient selection for transarterial chemoembolization in hepatocellular carcinoma:importance of benefit/risk assessment[J].Liver Cancer,2018,7(1):104-119.
[4]Lencioni R.Chemoembolization for hepatocellular arcinoma[J].Semin Oncol,2012,39(4):503-539.
[5]Cheng BQ,Jia CQ,Liu CT,et al.Chemoembolization combined with radiofrequency ablation for patients with hepatocellular carcinoma larger than 3 cm:a randomized controlled trial[J].JAMA,2008,299(14):1669-1677.
[6]Wang Y,Ma L,Yuan Z,et al.Percutaneous thermal ablation combined with TACE versus TACE monotherapy in the treatment for liver cancer with hepatic vein tumor thrombus:Aretrospective study[J].PLoS One,2018,13(7):e0201525.
[7]Endo K,Kuroda H,Oikawa T,et al.Efficacy of combination therapy with transcatheter arterial chemoembolization and radiofrequency ablation for intermediate-stage hepatocellular carcinoma[J].Scand J Gastroenterol,2018,53:1575-1583.
[8]冯峰,施裕新,夏淦林.TACE术后残留肝癌的影像学研究进展[J].国际医学放射学杂志,2009,32(3):250-254.
[9]斯兴无,周红俐,陈华平,等.MRI与CT对原发性肝癌TACE术后的疗效评估[J].西部医学,2017,29(8):1150-1153.
[10]侯毅斌,王忠富,施裕新,等.磁共振弥散加权成像联合动态增强在评估肝癌TACE术后病灶残留及随访中的应用价值[J].中国CT和MRI杂志,2018,16(1):108-110.
[11]Katoh T,Mitani M,Noma K,et al.Delayed enhancement of hepatocellular carcinoma on dynamic CT:sign of extrahepatic collaterals after transcatheter arterial chemoembolization or transcatheter arterial chemoinfusion[J].Abdom Imaging,2002,27(1):34-39.
[12]邹文远,张自力,石思李.多层螺旋CT灌注成像对肝癌TACE前后血供化的价值探讨[J].医学影像学杂志,2010,20(7):1003-1005.
[13]李珊玫,高知玲,吕茜婷,等.全肝CT灌注成像定量评估肝癌经肝动脉化疗栓塞术后血流状态变化的价值[J].中华肝脏病杂志,2018,26(6):429-435.
[14]黄丽娜,倪衡建,姜建威,等.256层CT全肝灌注成像在原发性肝癌肝动脉化疗栓塞术中的价值[J].中华肝胆外科杂志,2015,21(8):512-516
[15]石朋,王坤,沈俊春,等.CT检查在原发性肝癌患者经肝动脉化疗栓塞术后疗效评估中的应用价值分析[J].实用肝脏病杂志,2018,21(2):253-256.
[16]Ippolito D.Bonaffini PA,Ratti L,et al.Hepatocellular carcinoma treated with transarterial chemoembolization:dynamic perfusion-CT in the assessment of residual tumor[J].World J Ga stroenterol,2010,16:5993-6000.
[17]Yang L,Zhang XM,Tan BX,et al.Computed tomographic perfusion imaging for the therapeuticres ponse of chemoembolization for hepatocellular carcinoma[J].J Comput assist Tomorg,2012,36:226-230.
[18]朱宇航.320排容积CT轨道减影成像对原发性肝癌TACE术后疗效评估的临床价值研究[D].吉林:吉林大学,2014.
[2]Su JY.A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world:2010-2016[J].Clin Mol Hepat,2016,22(1):7-17.
[3]Piscaglia,Ogasawara S.Patient selection for transarterial chemoembolization in hepatocellular carcinoma:importance of benefit/risk assessment[J].Liver Cancer,2018,7(1):104-119.
[4]Lencioni R.Chemoembolization for hepatocellular arcinoma[J].Semin Oncol,2012,39(4):503-539.
[5]Cheng BQ,Jia CQ,Liu CT,et al.Chemoembolization combined with radiofrequency ablation for patients with hepatocellular carcinoma larger than 3 cm:a randomized controlled trial[J].JAMA,2008,299(14):1669-1677.
[6]Wang Y,Ma L,Yuan Z,et al.Percutaneous thermal ablation combined with TACE versus TACE monotherapy in the treatment for liver cancer with hepatic vein tumor thrombus:Aretrospective study[J].PLoS One,2018,13(7):e0201525.
[7]Endo K,Kuroda H,Oikawa T,et al.Efficacy of combination therapy with transcatheter arterial chemoembolization and radiofrequency ablation for intermediate-stage hepatocellular carcinoma[J].Scand J Gastroenterol,2018,53:1575-1583.
[8]冯峰,施裕新,夏淦林.TACE术后残留肝癌的影像学研究进展[J].国际医学放射学杂志,2009,32(3):250-254.
[9]斯兴无,周红俐,陈华平,等.MRI与CT对原发性肝癌TACE术后的疗效评估[J].西部医学,2017,29(8):1150-1153.
[10]侯毅斌,王忠富,施裕新,等.磁共振弥散加权成像联合动态增强在评估肝癌TACE术后病灶残留及随访中的应用价值[J].中国CT和MRI杂志,2018,16(1):108-110.
[11]Katoh T,Mitani M,Noma K,et al.Delayed enhancement of hepatocellular carcinoma on dynamic CT:sign of extrahepatic collaterals after transcatheter arterial chemoembolization or transcatheter arterial chemoinfusion[J].Abdom Imaging,2002,27(1):34-39.
[12]邹文远,张自力,石思李.多层螺旋CT灌注成像对肝癌TACE前后血供化的价值探讨[J].医学影像学杂志,2010,20(7):1003-1005.
[13]李珊玫,高知玲,吕茜婷,等.全肝CT灌注成像定量评估肝癌经肝动脉化疗栓塞术后血流状态变化的价值[J].中华肝脏病杂志,2018,26(6):429-435.
[14]黄丽娜,倪衡建,姜建威,等.256层CT全肝灌注成像在原发性肝癌肝动脉化疗栓塞术中的价值[J].中华肝胆外科杂志,2015,21(8):512-516
[15]石朋,王坤,沈俊春,等.CT检查在原发性肝癌患者经肝动脉化疗栓塞术后疗效评估中的应用价值分析[J].实用肝脏病杂志,2018,21(2):253-256.
[16]Ippolito D.Bonaffini PA,Ratti L,et al.Hepatocellular carcinoma treated with transarterial chemoembolization:dynamic perfusion-CT in the assessment of residual tumor[J].World J Ga stroenterol,2010,16:5993-6000.
[17]Yang L,Zhang XM,Tan BX,et al.Computed tomographic perfusion imaging for the therapeuticres ponse of chemoembolization for hepatocellular carcinoma[J].J Comput assist Tomorg,2012,36:226-230.
[18]朱宇航.320排容积CT轨道减影成像对原发性肝癌TACE术后疗效评估的临床价值研究[D].吉林:吉林大学,2014.
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