Objective: To investigate the blood flow change status in early stage tumor-related areas of hepatocellular carcinoma and its clinical significance after radiofrequency ablation using multi-slice spiral CT whole-liver perfusion imaging technology. Methods: 21 cases of primary liver cancer that underwent CT-guided radiofrequency ablation were included. CT perfusion scans were divided into four groups according to the time points of CT scans (before surgery, immediately after surgery and 1 and 3 month after surgery), and then blood perfusion parameters of the corresponding areas of the tumor were measured. Statistical analysis was performed using two independent samples of non-parametric Wilcoxon rank-sum test. The differences of blood perfusion parameters between tumor or ablation lesion and background liver parenchyma, paratumor tissue or inflammatory response zone were compared before, immediately and 1 and 3 months after surgery, respectively. Results: (1) The hepatic arterial perfusion (HAP) and hepatic arterial perfusion index (HPI) of cancerous liver tumors and background liver parenchyma was significantly increased (P < 0.01). The total liver perfusion (TLP) was higher than the background liver parenchyma (P = 0.01 < 0.05). The time to peak (TTP) was significantly lower than background liver parenchyma (P < 0.01); (2) The perfusion parameters of HAP, PVP and TLP were lower than the background liver parenchyma in the complete ablation lesions immediately after radiofrequency ablation and 1 and 3 months after surgery, and the difference was statistically significant (P < 0.05); (3) The inflammatory response zone of ablation lesions of HAP, HPI, and TLP were gradually decreased with the extended postoperative time and TTP was gradually increased, while PVP did not change significantly; (4) HAP, HPI, and TTP were compared between the tumor and the tumor inflammatory response zone immediately after surgery, and 1 and 3 months after surgery, and the difference was statistically significant (P < 0.01). However, there was no statistically significant difference between PVP and TLP (P > 0.05). Conclusion: CT whole-liver perfusion imaging can precisely evaluate the early stage blood flow change status in peritumor and tumors before and after radiofrequency ablation and then objectively evaluate tumor's blood supply and therapeutic effect on hepatocellular carcinoma.
目的： 应用多层螺旋CT全肝灌注技术，探讨肝癌射频消融治疗术后早期肿瘤相关区域血流状态变化及其临床意义。 方法： 纳入21例原发性肝癌完成CT引导下射频消融治疗。均在术前、术后即刻、术后1个月及术后3个月分别进行CT灌注扫描；按CT扫描的时间点分4组，并测定肿瘤对应区域的血流灌注参数。使用非参数检验两独立样本Wilcoxon秩和检验进行统计学分析，分别比较术前、术后即刻、术后1个月及术后3个月瘤体或消融病灶与背景肝实质、瘤旁组织或炎性反应带与背景肝实质、瘤体与炎性反应带血流灌注参数的差异。 结果： （1）肝癌瘤体与背景肝实质比较肝动脉灌注量（HAP）、肝动脉灌注指数（HPI）明显升高（P < 0.01）；总灌注量（TLP）高于背景肝实质（P < 0.05）；达峰时间（TTP）明显低于背景肝实质（P < 0.01）；（2）射频消融术后即刻、术后1个月及术后3个月完全消融病灶的灌注参数HAP、PVP、TLP均低于背景肝实质，差异均有统计学意义（P < 0.05）；（3）消融病灶炎性反应带随术后时间延长，HAP、HPI、TLP逐渐降低，TTP逐渐上升，PVP无明显变化。（4）瘤体与术后即刻、术后1个月及术后3个月瘤周炎性反应带HAP、HPI、TTP比较，差异有统计学意义（P < 0.01)，PVP、TLP差异无统计学意义（P > 0.05）。 结论： CT全肝灌注成像可以准确评价肝癌射频消融术前后瘤体、瘤周早期血流灌注变化状况，进而客观评估肿瘤血供、评价治疗效果。.
Keywords: Hepatocellular carcinoma; Multi-slice spiral computed tomography; Perfusion imaging; Radiofrequency ablation.