The Diagnosis And Differential Diagnosis Value Of 64-slice Spiral Ct Perfusion Imaging In Small Hepatocellular Carcinoma

Backgroud and ObjectivesPrimary hcpatocellular carcinoma(PHC) is one of the most common malignant tumor in the word.Therefore,the early discovery,early diagnosis and early treatment of primary hepatocellular carcinoma,especially small hepatocellular carcinoma (SHCC) possess very important significances,which is the key point to prolong patient's life.The diagnosis and differential diagnosis imaging in hepatic tuberculum minus are always hotspot in imageology.Routine examinations such as tumor markers are not reliable in earlier period diagnosis of liver cancer.The conventional ultrasonography and radiological examination,for instance CT,nuclear magnetic resonance,arteriography arc limited in the diagnosis of small occupying lesions and hyperplastic nodules appear in liver cirrhosis.At present,the detection rate of small hepatic occupying lesions through imageology methods have changed,but it is still difficult to give correct diagnosis for the early parenchymatous lesser tubercles clinically.The specific signs of small lesions with different charactcrs are not obvious in imageology examination so that they arc difficult to discriminate,accordingly imageology examination is only able to achieve positioning examination but unable to determine the quality of these small affections.Along with development of imaging techniques and supporting software,CT pcrfusion imaging technique dcvelop quickly and used to diagnose and differential diagnose the liver tumors by analysing the hemodynamic status of the benign and the malignant tumor of liver,evaluating the hemodynamic status of tissues and organs.Dignosis mode of liver tumour has switch from morphological analysis only to a combination of morphological and functional imaging.The 64-CT peffusion imaging techniques aids were used to detect the influence of contrast dose on small hepatocellular carcinoma,diagnose and differential diagnose the hepatic tuberculum minus,investigate the clinical value of curvature analysis of time-density curves(TDC) from the first 20-40 second in Small hepatocellular carcinoma.Methods1.Twelve patients(6 male,6 femail;mean±SD,51.20±10.79) with suspected and later confirmed SHCC were selected for the study and were paired into 2 groups based on their age and body mass index and received either 50ml or 100ml dose of contrast for CT perfusion imaging.Firstly,the focus of infection were detected by plain scanning with 64 splice multi-slice spiral CT(GE Light Speed VCT),then 8 layers around the focus of infection were choosed to undertake perfusion scan; the layer with aorta portal vein and the focus of infection exhibit would be choosed,in which the select region of interest(ROI)of the aorta and portal vein would be setted,size of ROI would be controlled in the range of 2-6 Pix.Multi-layer axis scanning mode,0.6s per rot,120 KV voltage and 200mA tube, thickness is 5mm/8i,layer thickness 5mm,matrix 512×512.Using high-pressure syringe were used in perfusion imaging.(370mgl/ml),constrast medium was rapidly injected from ulnar vein,and injection rate is 5.0 ml/s,delay time is 10s. The results were transmitted to the AW4.3 workstations,then was analyzed with the CT perfusion 3 tumor perfusion analysis post-processing software.CT perfusion curves were generated on an Advanced Workstation(AW) and the ratio of the perfusion parameters between the lesion and normal liver were generated. These parameters included blood flow(BF),blood volume(BV),mean transit time(MTT),permeability surface(PS),and hepatic arterial fraction(HAF).In addition,the peak value(PV),and peak enhancement increase(PEI) of liver lesions were also analyzed.Statistical analysis was performed on the parameters obtained with the two sets of contrast dose.2.71 patients(42male,29 female;mean±SD,50.15±11.74) with determined liver lesions through clinical comprehensive diagnosis underwent perfusion imaging with 64-slice helical CT(MSCT).Facilities and scanning methods weres similar to that of part one,adding portal vein phase(PVP) at 80s and lag periods range from 180s to 20min.There were 22 SHCC,10 metastatic tumors(Mets),26 cavernous hemangiomas(CH),7 liver abscesses(LA),6 focal hepatic adipose infiltrations(FFL).Perfusion parameters included blood flow(BF),blood volume (BV),mean transit time(MTT),permeability surface(PS),and hepatic arterial fraction(HAF) were analysed.Parameters were analysed by one-factor analysis of variance.3.83 patients with determined liver lesions through clinical comprehensive diagnosis underwent perfusion imaging with 64-slice helical CT(MSCT). Facilities and scanning methods weres similar to that of part one,adding PVP at 80s and Delay phase ranged from 180s to 20min.There were 22 SHCC,10 Mets, 26 CH,7 LA,6 FFL,7 regenerating nodules(RN),and 5 hepatic cysts(HC).We analyzed the perfusion data from 20s to 40s on the TDC.Region-of-interests were drawn on both tumors and liver parenchymal(LP) to generate two TDCs for comparison.These curves were then fitted with binomials to identify their shapes and curvatures.TDC for the lessons can be separated into three types by binomial coefficients:whose negative coefficient for the square term were binomial with convex upward(BCU);whose positive coefficient for the square term were binomial with concave downward(BCD);whose horizontal line,showing less change of CT value.Results1.(1)The BF,BV,and HAF with the use of 100ml significantly higher than the normal liver,The BF,and HAF with the use of 50ml significantly higher than the normal liver.(2)However,the PV value was(80.92HU±17.80) with the use of 100ml,significantly higher than(36.51HU±13.25) with the use of 50ml(t = 3.765,p = 0.013).The PEI values demonstrated similar results at(2.09±0.57) and(0.76HU±0.37) for the 100ml and 50ml groups,respectively,with statistical significant difference(t = 3.665,p = 0.015).(3)There was no statistical difference for the lesion-to-normal liver ratios for the normal perfusion parameters(BF,BV, MTr,PS,and HAF) with either 100ml or 50ml.2.(1)The value of BF,BV,HAF in small hepatic carcinoma were significantly higher than the edge and the normal liver tissue(P＜0.05);but the value of MTT and PS non-statistics significance(P＞0.05).Parameters among the edge and the normal liver tissue were no statistics significance(P＞0.05).(2)The normal perfusion parameters(BF,BV,MTr,PS,and HAF) among the SHCC,Mets,CH non-statistics significance(P＞0.05).(3)The value of BF between SHCC and LA have statistics significance(P＜0.05).The value of BF,BV,HAF in SHCC were significantly higher than the FFL(P＜0.05).(4) BF,BV,MTT and HAF among malignant lesson groups(including SHCC and Mets,32 total) and benign lesson groups(including LA and FFL,besides CH,13 total) had statistical difference (P＜0.05).3.(1)TDC for the 83 tumors can be separated into three types:①22 SHCC,10 Mets, 2 LA whose binomial with convex upward(BCU,negative coefficient for the square term).②26 CH,5 LA,6 FFL,7 RN whose binomial with concave downward(BCD,positive coefficient for the square term).③5 HC whose horizontal line,showing no blood supply.TDCs for LP were all BCD types, suggesting its main blood supply coming from portal vein.(2) However benign or malignant lesson,enhancement characteristers were useful for further diagnosing the hepatic tuberculum minus.Conclusions1.100ml contrast dose provided stronger enhancement for the liver lesion and maybe advantageous in the detection of SHCC and more informationfor further qualitative diagnosis of SHCC. 2.BF,BV and HAF of SHCC,Mets and CH were significantly higher than the normal liver tissue;but perfusion parameters(BF,BV,MTT,PS,HAF) had no difference among SHCC,Mets,CH.BF,BV,MTT and HAF were helpful of differentiating benign and malignant lesions(CH besides).3.Curvature analysis from the 20s-40s perfusion TDC suggesting its clinical values in diagnosing and differential diagnosing the hepatic tuberculum minus.