Application Of Ct Perfusion Imaging In Perfusion Characteristics And Evaluation Of Differentiation Degree Of Hepatocellular Carcinoma

Objective:To study the value of 320-detector row volume CT perfusion imaging in perfusion characteristics and evaluation of differentiation degree of hepatocellular carcinoma.Methods:79 patients with hepatocellular carcinoma were diagnosed during December,2015 to December,2017 in our hospital.There were diagnosed by clinical,imaging,pathological,and biochemical examinations as 36 cases of small hepatocellular carcinoma,18 cases of nodular liver cancer,23 cases of solitary large hepatocellular carcinoma.320-detector row volumes CT perfusion imaging and routine CT scans with three-phase contrast enhancement scans were performed.And there were 2 patients who failed to check.① Perfusion parameters including hepatic arterial flow(HAF),hepatic portal flow(HPF),and hepatic arterial perfusion index(HP I)in the tumor area and peri tumoral tissue and distal normal tissue were quantitatively analyzed.②The difference of perfusion parameters of hepatocellular carcinoma in different histopathological groups was compared.③The relationship between tumor diameter,differentiation and perfusion parameters in small hepatocellular carcinoma was analyzed.④ The detection rates of small hepatocellular carcinoma with two methods including routine three-phase contrast-enhanced CT scans and CT perfusion imaging and the the radiation effective dose received by the patient were compared.Results:1.The HAF(77.51±7.70 mL/(min·100ml))and HPI(58.78±4.79%)of tumor area in the small hepatocellular carcinoma group were significantly higher than that of the peritumoral tissues(35.29±7.74 ml/(min·100ml)),(16.62±9.07%)and the distal liver tissues(33.24±3.83 ml/(min·100ml)),(17.58±4.06%)),while the HPF(53.29±17.74 ml/(min·100ml))of tumor area was significantly lower than that of the peritumoral tissues(176.82±12.63 ml/(min·100ml))and the distal liver tissues(156.45±10.57 ml/(min·100ml)).There was statistically significant difference among the tumor area and the tumor tissue and distal liver tissue(P<0.05).There was no significant difference between the peritumoral tissue and the distal liver tissue(P>0.05).2.The HAF(119.01 ± 19.14 ml/(min·100ml))and HPI(78.81 ± 11.24%)of the tumor area in the nodular hepatocellular carcinoma group were significantly higher than that of the peritumoral tissues(66.12±19.21 ml/(min·100ml)),(37.71 ± 15.84%)and the distal liver tissues(37.34±6.20 ml/(min·100ml)),(18.05±10.34%),while the HPF(32.26± 15.51 ml/(min·100ml))of the tumor area was significantly lower than that of the peritumoral tissues(109.34±32.10 ml/(min·100ml))and the distal liver tissues(162.73±28.19 ml/(min·100ml)).There were statistical differences among different regions(P<0.05).3.The HAF(102.23± 10.68 100ml))and HPI(72.23±9.47%)of the tumor area in the solitary large hepatocellular carcinoma group were significantly higher than that of the peritumoral tissues(57.81 ±4.23 ml/(min·100ml)),(30.81 ±9.44%)and the distal liver tissues(40.81 ±6.96 ml/(min·100ml)),(19.045±5.37%),while the HPF(38.88±6.83 ml/(min·100ml))of the tumor area was significantly lower than that of the peritumoral tissues(128.63± 5.36 ml/(min·100ml))and the distal liver tissues(169.46±7.43 ml/(min·100ml)).There was a statistically significant difference among the regions(P<0.05).4.Comparison of perfusion parameters in tumor areas among small hepatocellular carcinoma,nodular hepatocellular carcinoma and solitary large hepatocellular carcinoma:The HAF and HPI values of the small hepatocellular carcinoma group were significantly lower than those of the nodular hepatocellular carcinoma group and the solitary large hepatocellular carcinoma group,and the HPF values were significantly higher than the latter two groups.The difference was statistically significant(P<0.05).There was no significant statistical difference that comparison of the perfusion parameters HAF,HPF,and HPI values between the nodular hepatocellular carcinoma and solitary large hepatocellular carcinoma(P>0.05).Comparison of the peritumoral tissue among the three groups:The HAF and HPI values of the nodular hepatocellular carcinoma and the solitary large hepatocellular carcinoma were significantly higher than those of the small hepatocellular carcinoma,and the HPF values were correspondingly lower(P<0.05).However,there was no statistical difference in perfusion parameters between the nodular hepatocellular carcinoma and the solitary large hepatocellular carcinoma(P>0.05).There was no significant difference in perfusion parameters among the three groups of the distal liver tissue(P>0.05).5.The linear relationship between HPI value and tumor diameter of small hepatocellular carcinoma.As the tumor diameter increases,the HPI value increases.6.Analysis of perfusion parameters in 36 patients with different pathological types of small hepatocellular carcinoma showed that the HAF values of highly differentiated,moderately differentiated and poorly differentiated hepatocellular carcinoma were 62.35± 12.09,102.33± 18.35 and 133.68±8.31 ml/(min·100 ml).The HPF values were 73.19±3.47,65.42±4.10 and 39.93±3.05 ml/(min·100ml).The HPI values were 45.63±1.23,60.67±5.57 and 77.34±5.72(%).The HAF and HPI values of the three groups gradually increased,and the HPF values gradually decreased(P<0.05).7.The detection rate of small hepatocellular carcinoma was about 86.11%(31/36)under CT perfusion scan,while the detection rate of small hepatocellular carcinoma was about 55,56%(20/36)during routine three-stage enhancement(arterial phase).There was a statistical difference(χ2=8.13,P=0.004).8.The radiation effective dose of the conventional three-phase enhanced scan(28.37±5.65 mSv)was significantly higher than that of CT perfusion scan(12.41 ±3.05 mSv),which was statistically significant(t=15.12,P=0.000).Conclusion:The 320-detector row volume CT perfusion imaging could be used to quantitatively analyze the hemodynamic characteristics of small hepatocellular carcinoma,isolated hepatocellular carcinoma and diffuse hepatocellular carcinoma,and correspondingly evaluate and guide treatment for different hemodynamic changes of HCC.CT perfusion imaging could be used to improve the early detection rate of small hepatocellular carcinoma and predict the degree of differentiation of small hepatocellular carcinoma.Quantitative analysis of the peritumoral tissue could also be performed to roughly assess hepatic tumor infiltration.The 320-detector row volume CT perfusion imaging was significantly reduced in radiation dose compared with the conventional three-phase enhanced scan.