Evaluation Of Liver Reserve Function Of Primary Liver Cancer Before And After TACE By 320-row Dynamic Volume CT Perfusion Imaging

Objectives:To investigate the feature of hepatic perfusion parameters measured by 320-row Dynamic volume CT in patients with primary liver cancer complicated by cirrhosis, and the changes of perfusion parameters before and after Hepatic Arterial Chemoembolization(TACE). Explore the relationship between perfusion parameters and the Child-Pugh classification and the Model for end-stage liver disease (MELD score). While the final destination was to reveal the role of perfusion CT techniques in evaluation liver functional reserve and the evaluation value before and after TACE.Methods:58 cases of patients with primary hepatic carcinoma before TACE and 33 patients before and after TACE were enrolled to undego hepatic CT perfusion by 320-row Dynamic volume CT. Comparison the perfusion parameters differences between tumor tissue and normal liver tissue, Changes in perfusion parameters and liver function before and after TACE, Differences in perfusion parameters among Child-Pugh score and the MELD score. Analysis of the perfusion parameters, Child-Pugh classification and the MELD score by spearman’s correlation analysis. ROC curves be used to define the perfusion parameters determine Child-Pugh classification threshold.Results:(1)Hepatic arterial perfusion(HAP) and Total liver perfusion(TLP)of the tumor lobe below normal lobe simultaneously Portal vein perfusion (PVP) and Total liver perfusion (TLP) significantly reduced. (2)The HAP and TLP of tumor lobe below normal hepatic before TACE, After TACE 4-6 weeks HAP and TLP of the tumor lobe increased compared with the preoperative,While,the whole liver perfusion parameters no significant difference. (3) 5-7 days after TACE the liver function deteriorated, but it can return to the preoperative after 4-6 weeks.(4)The negative correlation was demonstrate between Child-pugh and PVP,TLP,while positive correlation was found between Child-pugh and HAPI, the coefficients were-0.542,-0.523,0.449,P<0.05. The negative correlation was demonstrate between MELD score and PVP,TLP,while positive correlation was found between MELD score and HAPI, the coefficients were -0.567,-0.557,0.595,P<0.05.However, there was no statistical significance for the correlation between Child-pugh and MELD score with HAP (P=0.075). (6) Based on ROC curve, when PVP is 75.94ml/min/100ml showed a sensitivity of 87.5% and a specificity of 76% for Grade C; when TLP is 137.58ml/min/100ml showed a sensitivity of 87.5% and a specificity of 70% for Grade C; when HAPI is 22.31% showed a sensitivity of 75.0% and a specificity of 76.0% for Grade C.Conclusions:(1) CT Perfusion Imaging can observe the tumor blood supply of Primary liver cancer, and quantitatively reflect the cirrhosis liver perfusion characteristics segmentlly before and after TACE, so it is valuable for the evaluation of segmental liver function reserve before and after TACE. (2) There is a good correlation between Liver CT perfusion parameters,Child-Pugh score and MELD score.Perfusion parameters in predicting Child-Pugh classification has high sensitivity and specificity, and the treatment is less affected, therefore it can be used as a supplementary means of assessment of liver reserve function. (3) TACE often cause short-term damage to liver function, and it can be restored after a period of time, but CT perfusion scan 4-6 weeks after TACE does not reflect the short-term damage to liver function.