Study Of 64 Slices Helical CT Perfusion Imaging In The Diagnosis Of Hepatic Focal Lesions

Objective1.To explore the characteristic of primary hepatocellular carcinoma (HCC), hepatic metastatis and hemoangiomas on hepatic CT perfusion imaging (CTPI) by 64 slices helical CT and to analyze hemodynamic features by measuring perfusion parametersvalue.2.To explore diferential value of CTPI in HCC, hepatic metastatis and HA and the ability of CTPI in evaluating adjacent parenchyma.3.To describe the hemodynamic characteristics of hepatic abscess, focal nodular hyperplasia(FNH), intrahepatic cholangiocellular carcinoma(ICC) by 64 slices helical CT perfusion imaging, to enlarge the application latitude of CTPI and to evaluate the value of CTPI in the diagnosis of uncommon hepatic focal lesions initially.MethodsHepatic CT perfusion imaging were performed in 86 patients in general hospital of Tianjin Medical University from May 2009 to December with axial shuttle mode, 120kv,400mas, Thickness 5mm,512×512 pixels, on a 64 slices helical CT scanner(GE light speed pro VCT). All the patient were fest for 8 hours or even longer, the contrast agent Omnipaque 350 50ml was injected into the median cubical vein at the rate of 4.5mlsec, delay time 10-12 s, scanning time 0.4s. time resolution 2.4s,17 scanning phase and 45.3s scanning time in total. The perfusion CT scan data was processed on GE Sun AW4.4 Advantage workstation, using service pack liver software package with undeconvolution method. The TDC were recorded and the perfusion parameters including BF, BV, MTT, PS, HAF was measured and statistically analyzed.Resultsl.The mean value of BF, BV, MTT, PS and HAF of HCC were 319.358±160.933 ml.min-1.100g-1,28.300±11.199ml.100g-1,8.048±2.028s,49.891±16.034 ml.min-1.100g-1,0.572±0.132. Comparing with the normal hepatic parenchyma, HCC had higher BF, BV, PS and HAF, lower MTT. The mean value of BF, BV, MTT, PS and HAF of hepatic metastasis were 231.059±73.824 ml.min-1.100 g-1,23.225±8.045ml.100g-1,8.378±2.598s,36.212±12.667ml.min-1.100g-1,0.460±0.181, comparing with the normal hepatic parenchyma, hepatic metastasis had higher HAF, the other perfusion parameters were no significant change. The mean value of BF, BV, MTT, PS and HAF of hemoangiomas were 287.166±102.835 ml.min-1.100g-1,43.019±16.125ml.100g-1,7.325±2.452s,44.261±19.407 ml.min-1.100g-1,0.378±0.103, Comparing with the normal hepatic parenchyma, HCC had higher BF, BV and HAF, lower MTT while PS was no significant change.2. The BF and HAF in the solid portion were significantly higher in HCC than that of hepatic metastasis and hemoangiomas, the BV of hemoangiomas was significantly higher than HCC and hepatic metastasis group; In the adjacent parenchyma, the BF and BV were significantly higher in hemoangiomas than HCC and hepatic metastasis group, while hepatic metastasis had higher HAF than HCC and hepatic metastasis group; In the parenchyma with normal appearance, the BV of HCC was significantly lower than hemoangiomas group.3. The mean value of BF,BV,MTT,PS,HAF of 5 untreated hepatic abscesses were 228.676±13.749 ml.min-1.100g-1,17.605±1.211 ml.100g-1,6.679±1.359s,38.140±7.346 ml.min-1.100g-1,0.453±0.089, the BF,BV,MTT and PS were decreased while HAF was increased comparing with the normal hepatic parenchyma; The mean value of BF,BV,MTT,PS,HAF of 7 treated hepatic abscesses were 185.490±26.824 ml.min-1.100g-1,16.683±6.109ml.100g-1,7.667±1.266s,37.124±9.929 ml.min-1.100g-1,0.433±0.084, the BF,BV,MTT and PS were slightly decreased while HAF was increased comparing with the normal hepatic parenchyma; The mean value of BF,BV,MTT,PS,HAF in the solid portion of 2 FNH were 409.866±70.295ml.min-1.100g-1,40.430±21.074ml.100g-1,7.896±0.264s 40.439±25.570 ml.min-1.100g-1,0.717±0.064, the BF, BV, HAF were significantly increased while the MTT and PS were slightly decreased comparing with the normal parenchyma; The mean value of BF,BV,MTT,PS,HAF of ICC were 183.258±32.393ml.min-1·100g-1,12.871±2.031ml.100g-1,6.350±0.418s 22.275±9.032ml.min-1.100g-1,0.458±0.085, the BF, BV, PS and MTT were decreased while HAF was significantly increased comparing with the normal hepatic parenchyma.Conclusion1. HCC is a malignant hypervascular tumor with high BF, BV and HAF and low MTT.; Hepatic metastases is a malignant tumor with high HAF; hemoangiomas is a hypervascular tumor with high BF, BV and HAF, low MTT.2. The change of CT perfusion imaging parameters of HCC, hepatic metastasis and, hemoangiomas are of great values in the differential diagnosis and the evaluation of adjacent invasion of hepatic malignancies.3. Hepatic abscess, FNH and ICC demonstrated distinctive features on CTPI; CTPI has a certain value and prospect in the diagnosis of hepatic abscess, FNH and ICC.