| Part OneTechnical Analyses of whole liver perfusion with128-MSCTObjective:To optimize protocol of whole liver CT perfusion (CTP) with128-MSCTMaterials and Methods:With128-MSCT, the whole liver CTP of two pigs were undertaken to observe the features of blood flow and to reveal the characteristic, single and non-overlapping porcine liver blood flow could be visualized. The whole liver CTP of ninety patients (average,52.1y°), were randomly divided into3groups with30cases in each and the crosscheck analyses of image quality with different tube electric voltage (120kV versus100kV), different contrast media injection rate (5ml/s versus8ml/s), different contrast media concentration (300mgI/ml versus370mgI/ml) and with or without motion correction and filtration. The comparative study among different group were carried out, liver artifact, tissue noise, TDC peak time, TDC peak value under different protocol were evaluated statistically. Finally, Interobserver did repeatability of data measurement.Results:After injection, the volume-rendered images revealed only the hepatic arterial tree at16s; the area supplied by capillaries could be observed at21s; the hepatic arterial tree totally disappeared and the hepatic venous tree appeared at28s. Different tube electric voltage, artifact, tissue noise processing two-way analysis of variance (ANOVA), P>0.05; there was no significant difference statistically. Comparing contrast media concentration300mgI/ml with370mgI/ml, ANOVA revealed peak value T between two groups were8.011for hepatic artery,9.106for portal vein,8.809for spleen, P<0.001,with significant differences. Paired t-test displayed significant statistical difference before and after motion correction and filtration. Comparing the injection rates of contrast media(5ml/s versus8ml/s) for hepatic artery, portal vein and spleen parenchyma, the peak value T were9.909,7.842and5.776respectively,.P<0.0001,outcoming with statistical difference. There was no significant difference during different time measurement of CTP parameter of interobserver. Conclusions:1. Whole liver CTP could be underwent by128-MSCT.2. With100kVp versus120kVp, provide good images with lower dosage,8ml/s injection rate and370mgI contrast media concentration could set more correct and sensitive TDC, increase the contrast between liver and lesion with motion correction and filtration.3、Decrease of artifact and correct data measurement could be obtained with motion correction and filtration. There was good repeatability of data measurement of interobserver. Part TwoThe Correlative Study Whole Liver CT Perfusion Parameter and Underlying Pathology of liver fibrosis/cirrhosis with128-slice CTObjective:Quantitative analyses of whole-liver CT perfusion with128-MSCT were performed prospectively to identify the relationship between CT perfusion parameter and severity of liver fibrosis/cirrhosis.Materials and Methods:Fifty-one clinical cases, average age53.9Y°, divided by Scheuer pathological standard into five stages, including5cases in S0,5cases in S1,9cases in S2,9cases in S3,23cases in S4.One month before operation all cases were undergone whole-liver CT perfusion with128MSCT. CT perfusion data of different sites were analyzed statistically for the right posterior lobe, right anterior lobe, left medial lobe, left lateral lobe and the caudate, and furthermore the relationship between pathological grades and CT perfusion data.Results:Analysis of variance(ANOVA) demonstrated, that SO CT perfusion data including BF、BV、AUP、PVP、HPL、P of the right posterior lobe, right anterior lobe, left medial lobe, left lateral lobe and caudate had statistic difference, P<0.05. In S2CT perfusion data including BV、ALP、P of different lobes had no statistic difference, P>0.05, but CT perfusion data including BF、PVP、HPI of different lobes had statistic difference, P<0.05. In S1、S3、S4CT perfusion data of different lobes had no statistic difference, P>0.05. Analysis of linear trend test manifested that from S1to S4of liver fibrosis/cirrhosis. Perfusion data including BF、BV、PVP and P of different lobes had a linear downward tendency;in most lobes (except right anterior lobe) CT perfusion data HPI had a linear upward tendency. BF、BV、 PVP、HPI and P had a difference between reversible liver fibrosis/cirrhosis (S1and S2) and irreversible liver fibrosis/cirrhosis (S3and S4),.Conclusions:1、Whole-liver perfusion CT imaging may be useful to evaluate quantitatively liver fibrosis/cirrhosis.2、From S1to S4of liver fibrosis/cirrhosis, CT perfusion data BV、BF、PVP、P and HPI may have a linear correlation with BV、BF、PVP and P in positive correlation and HPI in negative correlation.3、CT perfusion data BV、BF、PVP、HPI and P showed significant difference statistically in reversible liver fibrosis/cirrhosis (S1and S2) from irreversible liver fibrosis/cirrhosis (S3and S4). Part ThreeThe Quantitative Analyses of Whole-liver Perfusion for Staging of Hepatocellular Carcinoma in clinical study with128-MSCTObjective:Quantitative analyses of whole-liver CT perfusion of hepatocellular carcinoma with128-MSCT may feasible to prospectively identify the relationship between CT perfusion parameter, different pathologic grades and micro vessel density.Materials and Methods:Thirty-nine patients with surgical pathologically proved HCC were enrolled from Zhongshan hospital, Shanghai. They were undertaken CT perfusion with128-MSCT2weeks before operation without any previous treatment. The whole liver CT perfusion with Siemens Definition AD128-MSCT, and then the VPCT Body-tumor Soft were postprocessor provided the perfusion curve and the correlative parameter including blood flow, blood volume, mean transit time, and permeability of the internal structure and the peripheral background of HCC. All parameter including tissue blood flow, blood volume, mean transit time, and permeability by using VPCT body-tumor software package. All parameters were statistically compared among tumors of different grades, background liver and micro vessel density CD31\CD34. Results:Two-way analysis of variance(ANOVA) was used to calculate variations in CT perfusion parameters. While liver perfusion BF in HCC compared with background liver, F=105.21, P<0.001;in different pathologic grades, F=2.83, P=0.00445; BV in HCC compared with background liver, F=89.11, P<0.0001; in different pathologic grades, F=5.10, P=0.0029; PMB in HCC compared with background liver, F=0.22, P=0.6392, in different pathologic grades, F=0.19, P=0.9046; MTT in HCC compared with background liver, F=23.78, P<0.0001, in different pathologic grades, F=6.83, P=0.0004.There were positive correlation between BF and CD34,BV and CD31,BF and CD31(r=0.40719,0.71335,0.44656); there was negative correlation between MTT and CD34(r=-0.33901) by Spearman test,P<0.05. CD34、CD31had significant difference in different pathologic grades by Kruskal-Wallis Test, p<0.05.Results:1、There was significant difference in CTP parameter BV, BF, MTT between HCC and background liver, the cutoff values were51.4ml.100mg-1.min-1、10.9ml.100mg-1、14.3S respectively.2、There was also difference in CTP parameters between different pathologic grades with BV、MTT lying down associated with simultaneous elevating pathological grade.3、There was close relationship between CTP data and MVD showing linear positive correlation between BF and CD31, BF and CD34, BV and CD31;and linear negative correlation between MTT and CD31, MTT and CD34.4、There was a linear positive trend correlation between CD34and pathologic grades in HCC. |
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