The Value Of Dual Source On Evaluation On Effect Of Chemotherapy Of Liver Metastasis

Objective: The disease rate of hepatic metastases is1.2times that ofprimary liver cancer,, which is due to the liver physiological function andanatomical structure, and confined by the number of metastases, major volumeof the metastases and so on, only there are a small number of patients suitablefor surgery. Traditional chemotherapy drugs are prone to take mutation anddrug resistance and side effects. So in recent years, antiangiogenic treatmentwhich to consider as one kind of new treatment for patients of liver metastasesdevelop quickly, but still faces many challenges, how to effectively monitorand evaluate its efficacy is one of them. This study aimed to analyzehemodynamic characteristics of liver metastases by CT perfusion imaging andto study liver metastases perfusion parameters change after four period ofantiangiogenic drug therapy, and compared with the traditional morphologymaximum diameter, at last obtained CT perfusion imaging whether can be toevaluate the efficacy of antiangiogenic drugs in order to guide furthertreatment.Methods:There were30cases of patients with liver metastases before theantiangiogenic therapy to take dual-source CT perfusion imaging scanexamine, then26patients with dual-source CT perfusion imaging scan againwithin the week after four period the antiangiogenic chemotherapy. Then wemeasure the CT perfusion parameters of liver metastases tumor andsurrounding liver parenchyma before chemotherapy and after chemotherapy,including blood flow (BF), hepatic blood volume (BV) and permeabilitysurface (PS), hepatic artery perfusion (HAP) flow and portal vein filling (PVP)and hepatic perfusion index (HPI). Record of the perfusion parameters, andanalysis perfusion parameters of liver metastases before chemotherapycompared with the surrounding liver parenchyma, liver metastases after chemotherapy compared with the surrounding liver parenchyma, changes ofperfusion parameters liver metastases before and after chemotherapy.Application of traditional maximum diameter measurements use to measurethe liver metastases if there are changes in tumor morphology before and afterchemotherapy.Results:26cases of liver metastases before chemotherapy in CTPIperformance: ALP map showed high hepatic arterial perfusion, significantlyhigher than the surrounding normal liver parenchyma, central necrosis have noperfusion, the PVP map showed low perfusion, significantly lower thesurrounding liver parenchyma. Before chemotherapy, the mean and varianceof the liver metastases BF, BV, PS, HAP, PVP, HPI were72.34±14.86,15.35±4.74,47.61±11.41,54.79±19.32,99.81±25.67,60.24±9.73; the normalliver parenchyma BF, BV, PS, the ALP, PVP, HPI were43.22±9.51,10.31±6.32,74.18±15.10,29.17±8.43,124.64±16.35,30.63±8.35. Livermetastases compare with normal liver parenchyma: BF, BV HAP and HPIgreater than the normal liver parenchyma, PS and PVP is less than thesurrounding liver parenchyma, the parameter BF, PS HAP, PVP, HPI, therewere significant differences (P <0.05), have statistically significant, while BVhave no significant difference differences (P>0.05), not statisticallysignificant.Average and variance of liver metastases after chemotherapy, BF,BV, PS, HAP, PVP, the HPI was57.82±21.33,11.51±8.43,42.77±27.86,37.60±24.34,94.37±35.19,56.39±22.15; normal liver parenchymaBF, BV, PS, the ALP, PVP, the HPI was40.32±19.27,10.23±10.40,49.64±26.21,27.22±10.47,117.88±48.74,27.21±8.07. Average and variance ofliver metastases after chemotherapy, BF, BV, PS, HAP, PVP, the HPI was57.82±21.33,11.51±8.43,42.77±27.86,37.60±24.34,94.37±35.19,56.39±22.15; normal liver parenchyma BF, BV, PS, the ALP, PVP, the HPI was40.32±19.27,10.23±10.40,49.64±26.21,27.22±10.47,117.88±48.74,27.21±8.07. The perfusion parameters of the26cases of livermetastases before and after chemotherapy: the BF, BV HAP, HPI reducedafter chemotherapy, BF HAP HPI have significant difference (P <0.05) take statistically significant, but BV have no significant difference (P>0.05), nostatistical significance; PS and PVP were increased after chemotherapy, PVPthere was a significant difference (P <0.05), statistically significant, while thePS was no significant difference (P>0.05), not statistically significant.Theaverage and variance of the maximum diameter of metastatic tumors beforeand after chemotherapy were6.34±5.31,5.72±4.77, no significantdifference (P>0.05), not statistically significant.Conclusion:1CT perfusion imaging can reflect the hemodynamic characteristics ofliver metastases, and infer the biood-supply of liver metastases come form thehepatic artery.2CT perfusion imaging can reflect the metastases of liver metastasesafter four chemotherapy did not complete ablation, there is still residual, thisresult can provide direction for the follow-up treatment.3CT perfusion imaging can reflect the hemodynamic change of livermetastases before and after four period chemotherapy, showingantiangiogenic therapy for liver metastases have a certain effect, and alsoworkers can better to assess the efficacy of anti-angiogenic drugs by CTperfusion imaging medical, and carry out the next treatment.4The maximum diameter in the traditional morphological methodsmeasuring the changes of four chemotherapy of liver metastases, livermetastases before and after chemotherapy, the maximum diameter slightlyreduce, but not statistically significant. Blood flow changes of metastasesearlier than morphological changes, and CT perfusion imaging in theevaluation of the efficacy of chemotherapy is superior to the traditional senseof the morphological measurements.