肝脏CT灌注成像参数分析原发性肝癌TACE术后残余病灶的价值

肝脏 ›› 2025, Vol. 30 ›› Issue (9): 1230-1233.

肝脏CT灌注成像参数分析原发性肝癌TACE术后残余病灶的价值

葛敬军, 张嘉进, 柯炜炜, 顾凡, 葛晨梅, 黄晶晶

224200 东台东台市中医院影像科(葛敬军,张嘉进,顾凡,葛晨梅,黄晶晶) ;210003 南京东南大学附属中大医院介入科(柯炜炜)

收稿日期:2025-03-30 出版日期:2025-09-30 发布日期:2025-11-05
通讯作者: 黄晶晶,Email:15189297625@163.com
基金资助:
盐城市医学科技发展计划项目(YK2020013)

Value of CT perfusion imaging parameters in analyzing residual lesions of primary liver cancer after TACE

GE Jing-jun¹, ZHANG Jia-jin¹, KE Wei-wei², GU Fan¹, GE Chen-mei¹, HUANG Jing-jing¹

1. Department of Imaging, Dongtai Traditional Chinese Medicine Hospital, Yancheng 224200, China;
2. Department of Interventional Medicine, Affiliated Zhongda Hospital, Southeast University, Nanjing 210003, China

Received:2025-03-30 Online:2025-09-30 Published:2025-11-05
Contact: HUANG Jing-jing,Email:15189297625@163.com

摘要/Abstract

摘要： 目的探讨肝脏CT灌注成像参数分析原发性肝癌(PLC)患者TACE术后残余病灶的价值。方法回顾性分析2021年10月至2024年9月东台市中医院及南京中大医院介入科收治的95例PLC患者临床资料,比较TACE术前及术后完全灌注病灶、残余病灶CT灌注成像参数的变化,并分析它们对残余病灶的评价能力。结果 95例患者中,30例(31.6%)病灶完全缓解。与TACE前比,完全栓塞病灶TACE后感兴趣区血容量、栓塞区血容量、肝动脉灌注量及肝灌注指数明显降低(P<0.05),而灌注开始时间及门静脉灌注量显著增加(P<0.05)。与TACE前比,残余病灶TACE后门静脉灌注量明显降低(P<0.05),而肝动脉灌注量及肝灌注指数显著增加(P<0.05),而治疗前后感兴趣区血容量、栓塞区血容量及灌注开始时间比较差异无统计学意义(P>0.05)。以肝脏CT灌注成像参数作为预测因子,以TACE后是否存在肿瘤残余病灶作为二元结局变量,通过构建多CT灌注成像参数联合诊断模型进行术后疗效评估。经ROC曲线分析验证,该多参数诊断模型诊断曲线下面积、灵敏度及特异度分别为0.93、87.7%(57/65)及90.0%(27/30),均显著优于单一灌注参数(AUC 范围0.72～0.84)(Delong检验P<0.05),提示各灌注参数间存在互补的诊断信息。结论 CT灌注成像参数可灵敏地反映出PLC患者TACE术后病灶的血流变化特征,多参数联合诊断模型在术后疗效评估中表现出较高的诊断效能,具有良好的临床应用前景。

关键词: 原发性肝癌, 经导管动脉化疗栓塞术, CT灌注成像

Abstract: Objective To analyze the value of hepatic CT perfusion imaging parameters in evaluating residual lesions after transcatheter arterial chemoembolization (TACE) in patients with primary liver cancer (PLC). Methods The clinical data of 95 PLC patients admitted to the Interventional Departments of Dongtai Traditional Chinese Medicine Hospital and Nanjing Zhongda Hospital between October 2021 and September 2024 were retrospectively analyzed. This study compared the changes in CT perfusion imaging parameters between completely perfused lesions and residual lesions before and after TACE treatment, and further evaluated their capability in assessing residual lesions. Results Among the 95 patients, 30 cases (31.6%) achieved complete remission. Compared with pre-TACE values, completely embolized lesions showed significant post-TACE decreases in blood volume of the region of interest, embolized area blood volume, hepatic arterial perfusion, and hepatic perfusion index (P<0.05), while time to peak and portal venous perfusion increased significantly (P<0.05). In contrast, residual lesions exhibited significant reductions in portal venous perfusion (P<0.05) but increases in hepatic arterial perfusion and hepatic perfusion index (P<0.05) after TACE, with no significant difference in blood volume of the region of interest, embolized area blood volume, or time to peak before and after treatment (P>0.05). A multi-parameter diagnostic model combining CT perfusion imaging parameters was constructed to predict residual lesions (binary outcome) after TACE. ROC curve analysis confirmed that the area under the curve (AUC), sensitivity, and specificity of this multi-parameter diagnostic model were 0.93, 87.7% (57/65), and 90.0% (27/30), respectively. These values were significantly outperforming the individual parameters (AUC range: 0.72~0.84; Delong test, P<0.05), indicating complementary diagnostic information among parameters. Conclusion CT perfusion imaging parameters sensitively reflect hemodynamic changes in PLC lesions after TACE. The multi-parameter diagnostic model exhibits high efficacy for postoperative evaluation, demonstrating promising clinical utility.

Key words: Primary liver cancer, Transcatheter arterial chemoembolization, CT perfusion imaging

葛敬军, 张嘉进, 柯炜炜, 顾凡, 葛晨梅, 黄晶晶. 肝脏CT灌注成像参数分析原发性肝癌TACE术后残余病灶的价值[J]. 肝脏, 2025, 30(9): 1230-1233.

GE Jing-jun, ZHANG Jia-jin, KE Wei-wei, GU Fan, GE Chen-mei, HUANG Jing-jing. Value of CT perfusion imaging parameters in analyzing residual lesions of primary liver cancer after TACE[J]. Chinese Hepatolgy, 2025, 30(9): 1230-1233.

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