The Evaluation For The Whole Liver CT Perfusion In The Interventional Therapy Of Hepatocellular Carcinoma

[Objective] To investigate the whole liver CT perfusion clinicalapplication in the hemodynamics changes analysis of large hepatocellularcarcinoma during the treatment.[Methods](1) To compare the perfusion parameters before and afterTACE in patients with small hepatocellular carcinoma, and analyze thehemodynamic changes.12SHCC patients were collected fromdepartment of interventional radiology in our hospital since2008,9to2012,12who underwent TACE treatment. All patients were examined bythe whole liver CT perfusion(CTP)1~2days before operation and4weeks after operation in the first intervention, and parameters were alsoobtained including hepatic blood flow (BF), hepatic blood volume (BV),mean transit time (MTT), probability of surface (PS), hepatic arterialfraction (HAF).(2) To compare the perfusion parameters before and afterTACE in patients with large hepatocellular carcinoma, and analyze thehemodynamic changes.12SHCC patients were collected fromdepartment of interventional radiology in our hospital since2008,9to2012,12who underwent TACE treatment. All patients were examined bythe whole liver CTP1~2days before operation and4weeks afteroperation in the first intervention, and parameters were also obtainedincluding BF, BV, MTT, PS, HAF.(3) Total36lesions in18patients withhepatocellular carcinoma after TACE through DSA and CTP review, with the results of DSA as the "gold standard", the whole liver CTPIexamination results were evaluated.(4) We analyze the survival timebased on the long-term follow-up of patients with hepatocellularcarcinoma.[Results](1) Comparing SHCC tumor tissues to normal tissues before TACE:there were statistical difference in BF, MTT, PS HAF(P<0.05), and theyall had significant difference；the parameters between preoperative andpostoperative of SHCC BF, BV, PS,HAF had statistical difference andamong them BF, BV, HAF had significant difference(P<0.01).(2) Comparing large HCC tumor tissues to normal tissues before TACE:there were statistical difference in BF, MTT, PS, HAF(P<0.05), andamong them BF, HAF had significant difference(P<0.01)；the parametersbetween preoperative and postoperative of large HCC of BF, BV,PS,HAF(P<0.05) had statistical difference and all of them hadsignificant difference(P<0.01).Through the analysis of both SHCC and large HCC, the differences ofperfusion parameter HAF is the most significant in the carcinoma tissuesand normal tissues, followed by perfusion parameter BF.(3) In the evaluation of residual lesion activity after TACE, with theresults of DSA as the "gold standard", the result of whole liver CTPIexamination results consistency test were: Kappa value=0.719, CTPI diagnostic sensitivity was96.55%, specificity was71.43%, the positivepredictive value was93.33%, the negative predictive value was83.33%;activity lesions compared with normal liver tissue after TACE, BF, BV,PS, HAF differences were statistically significant (P<0.05).(4) Through the long-term follow-up to both large and small HCCpatients, the median survival period of large hepatocellular carcinomapatients was16months, median survival of patients with small HCC was49months, the median survival of small HCC patients was obviouslybetter than that of large HCC patients.[Conclusion] CT perfusion imaging of large and small hepatocellularcarcinoma shows higher clinical application value in diagnosis and liverhemodynamics assessment after treatment of TACE and postoperativeresidual active lesion.