The Blood Supply Feature Of Hepatic Metastases And The Evaluation Post TACE By Using CT Perfusion Imaging

Objective The purpose of our study is to analyze hemodynamics characteristics of metastatic carcinoma by CTPI, to research perfusion parameter change of non lipiodol deposition area(including residual tumor and relapse,necrotic tissure were excluded) after TACE, and to study whether perfusion parameter of tuomor issue before TACE is associative with lipiodol deposition or not for guiding treatment of metastatic carcinoma.Materials and Methods CT perfusion scans were performed 2-4 days in 25 cases before transhepatic arterial chemoembolization treatment and 30-40 days in 20 cases after TACE with metastatic carcinoma. The perfusion parameters of tumor issue and peripheral liver parenchyma before TACE, non lipiodol deposition area post-operation(including residual tumor and relapse,necrotic tissure were excluded) and peripheral liver parenchyma after TACE were measured, including the values of hepatic blood flow(HBF), hepatic blood volume(HBV),mean transit time(MTT), permeability(PS),hepatic arterial fraction(HAF), and calculate hepatic arterial perfusion(HAP) and portal vein perfusion(PVP). All perfusion parameters were recoreded, and the time-density curve(TDC) and perfusion parameters characteristics of hypervasular as well as hypovascular metastases were analyzed. Meanwhile, the changes of hepatic metastasis parameter in tumor tissue before and after TACE as well as non lipiodol deposition area after TACE( including ecurrence and residual tumor with exception of necrosis) should be recorded and the relativity between preoperative TACE tumor tissue perfusion parameters and aggradation of LPD should be analyzed.Results In the hypervasular metastases, the TDC is fast risen and slowly fallen, the tumor issue is hypertransfusion obviously in HBF images. HBF,PS,HAF and HAP are superior to peripheral liver parenchyma while HBV, MTT and PVP are inferior to peripheral liver parenchyma.The differents of all parameters are ststistically significant(P<0.05). In the hypovascular metastases, the TDC is slowly risen and slowly fallen, the tumor issue is hypotransfusion obviously in HBF images. HBF,HBV,MTT and PVP are inferior to peripheral liver parenchyma while PS and HAF are superior to peripheral liver parenchyma, in which HBF,HBV,MTT,HAF and PVP are ststistically significant(P<0.05). 15 patients (with 3 hypervasular metastases and 12 hypovascular metastases) have changed perfusion parameter values in non lipiodol deposition area (including ecurrence and residual tumor with exception of necrosis) before and after TACE, among which HBF, HBV, HAP descended remarkably (P<0.05) after TACE, being statistically significant. Although MTT, PS, HAF, PVP descended after TACE too, there are no statistical significance(P>0.05). In the above 15 patients, HBF, HBV, MTT and PVP in non lipiodol deposition area (including ecurrence and residual tumor with exception of necrosis) are inferior to peripheral liver parenchyma, PS, HAP and PVP were superior to peripheral liver parenchyma, in which HBF, HBV, MTT, HAF and PVP have marked differences and are statistically significant(P<0.05). The other 5 hypovascular metastases have no lipiodol deposits after TACE. By separated analyzing, we could see HBF, HAF and HAP increased while HBV, MTT, PS and PVP decline inconspicuously,and HBF,HBV,MTT,PS and PVP are inferior to peripheral liver parenchyma while HAF and HAP are superior to peripheral liver parenchyma after TACE. Meanwhile, according to analysis of differences above and relativity, we could get the conclusion that the lipiodol deposits of hepatic metastases after TACE had connection with CT perfusion parameters HAF and HAP. Conclusions CT perfusion imaging, which can reflect hemodynamic traits of hepatic metastases as well as evaluate the blood supply transformation before and after TACE objectively, has a great bearing on guiding the interventional therapy to hepatic metastases.