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目的探讨128层4DCT全肝灌注成像在肝肿瘤诊断中的价值。方法 45例原发性肝癌患者和40例肝血管瘤患者行128层CT全肝灌注扫描,所得数据经灌注软件处理后,自动生成灌注参数和4D-CTA图像:血流量(BF)、肝动脉灌注量(ALP)、门静脉灌注量(PVP)和肝动脉灌注指数(HPI)。根据各灌注图像及相关参数评价原发性肝癌病灶、肝血管瘤病灶及其周围1 cm内肝实质之间、肝血管瘤病灶及原发性肝癌病灶之间的血流动力学特点,观察肝肿瘤供应血管、肝内大血管阻断、狭窄及栓塞情况。结果①原发性肝癌病灶的BF、ALP、HPI高于周围1 cm内肝实质(P<0.01),原发性肝癌病灶的PVP显著降低(P<0.01);肝血管瘤病灶内的BF、ALP、HPI高于周围肝实质(P<0.05);肝血管瘤病灶的BF、ALP高于原发性肝癌病灶(P<0.05),而HPI低于原发性肝癌病灶(P<0.05)。原发性肝癌病灶的PVP降低,与肝血管瘤病灶相比差异有统计学意义(P<0.01)。②45例原发性肝癌中,肿瘤供血动脉28例,20例供血动脉增粗、僵直、扭曲,门静脉癌栓14例。40例肝血管瘤中,23例血管推压移位。17例血管正常。结论应用128层4DCT进行灌注检查,可准确反映原发性肝癌、肝血管瘤的血流动力学特征,为肝肿瘤的诊断、手术切除范围及判断预后提供可靠的依据。
Objective To investigate the value of 128-slice 4DCT whole liver perfusion imaging in the diagnosis of liver tumors. Methods Forty-five patients with primary hepatocellular carcinoma and 40 patients with hepatic hemangiomas underwent CT scan of whole liver with CT scan. The perfusion parameters and 4D-CTA images were automatically generated after the perfusion software was processed: blood flow (BF), hepatic artery Perfusion volume (ALP), portal vein perfusion (PVP) and hepatic artery perfusion index (HPI). The perfusion images and related parameters were used to evaluate the hemodynamic characteristics of primary hepatocarcinoma, hepatic hemangioma lesion and hepatic parenchyma within 1 cm, hepatic hemangioma lesion and primary hepatocellular carcinoma. Liver Tumor supply of blood vessels, large blood vessels in the liver, stenosis and embolism. Results ① The BF, ALP and HPI of primary hepatic carcinoma were significantly higher than those of hepatic parenchyma within 1 cm (P <0.01), while the PVP of primary hepatocellular carcinoma was significantly decreased (P <0.01) ALP and HPI were higher than those in the surrounding liver (P <0.05). BF and ALP in hepatic hemangioma were higher than those in primary hepatocellular carcinoma (P <0.05), while HPI was lower than that in primary hepatic carcinoma (P <0.05). The PVP of primary liver cancer lesion was lower than that of hepatic hemangioma (P <0.01). In 45 cases of primary hepatocellular carcinoma, there were 28 cases of tumor feeding artery, 20 cases of thickening of feeding artery, stiff, twisted and portal vein tumor thrombus in 14 cases. In 40 cases of hepatic hemangiomas, 23 cases were displaced by blood vessels. 17 cases of normal blood vessels. Conclusions The 128-layer 4DCT perfusion test can accurately reflect the hemodynamic characteristics of primary liver cancer and hepatic hemangioma and provide a reliable basis for diagnosis, surgical resection range and prognosis of liver tumors.