Evaluation Of The Short-term Efficacy For Cryoablation In Hepatocellular Carcinoma With The Low Dose Perfusion Imaging Using Aquilion One640-slice CT

Background and Objective：Hepatocellular carcinoma (HCC) is the third common cause of the world ofthat death related to cancer, second to lung cancer and stomach cancer. But In China,the high mortality rate of liver cancer is in the second place, second to lung cancer.Because the onset is hiding, early symptoms are not obvious, doctors’ office visitingis late, liver function is poor due to liver cirrhosis or patients are not willing tosurgery and so on, surgical resection rate was only20%~30%. The options oftreatment for patients with advanced HCC are limited, only30~40%of patientsmay be able to try to cure.Currently, there are many kinds of non-surgical treatment of HCC: transcatheterarterial chemoembolization (TACE), radiofrequency ablation (RFA),cryoablation(CA), high intensity focused ultrasound(HIFU)therapy, radiation therapy,biological therapy, immunotherapy therapy or even gene therapy. For patients whoare inoperable or unwilling to surgery, they can take minimally invasive surgery, andstill get better treatment. Cryoablation has the obvious advantages, such as definiteand reliable therapeutic effect, accurate and controllable target therapy, flexibleconformal and so on. It is becoming an important therapeutic method and is focus ondeeply by the majority of patients and doctors. Because the recurrence rate of surgery excision about HCC is up to40~60%,timely and effective monitoring of tumor recurrence and early evaluation of treatmenteffect are especial necessary.In the early stage of HCC, the blood supply of hepatic artery and portal veinchanges gradually, it converts into the hepatic artery mainly form the portal veinmainly. However, the angiogenesis and metabolism of tumor are not reflected in theearly stage. CT perfusion imaging can reflect the microcirculation status of the lesion,and it can evaluate tumor angiogenesis indirectly and the efficacy of treatment.The subject research on clinical data of30cases about HCC and to investigate thesecurity of CT-guided cryoablation for hepatocellular carcinoma, meanwhile, throughthe analysis of the changes of AFP, CT perfusion parameters and partial responsebefore and after cryoablation, to explore the application value of the low-doseperfusion scanning using Aquilion ONE640-slice CT for evaluating the short-termtherapeutic effect of cryoablation for HCC.Materials and methods：30patients with HCC who confirmed by puncture pathology and will takecryoablation from February2012to December2013were collected. According toBCLC’s staging of2010, one patient was on the very early stage,28patients were onthe early stage, one patient was advanced stage. All patients underwent whole liverCT perfusion scanning at2-3days before cryoablation and4-6weeks (first review)after cryoablation, then they underwent conventional plain and enhanced CT scanningof upper abdomen at4months(second review) after cryoablation. All checks useToshiba’s Aquilion ONE scanner.The perfusion images were analyzed by body perfusion software, then we can getthe perfusion parameters, such as hepatic arterial perfusion (HAP), hepatic perfusionindex (HAPI)and portal venous perfusion (PVP).We can carry out cryoablation for patients using Cryo-Hit cryogenic refrigerationsystem which is produced by Israel Galileo (Galil Medical) in the guide of Brilliance16-slice CT scanner. After the successful puncture. The lesion was frozen10~15minwith argon firstly and rewarmed3min with helium secondly, to cycle twice. CT scansshould be regularly observed and monitored in time the area of hockey frozening during operation. The scope of cryoablation should go beyond peripheral1~2cm ofthe tumor.Specific observations indicators are as follows:1. the adverse reactions after cryoablation.2. the changes of AFP before and after cryoablation3. the partial response after cryoablation.4. the changes of HAP, PVP and HAPI of tumor tissue, peritumoral liver tissueand normal liver tissue changes before and after cryoablation.5. the radiation dose between perfusion scanning and conventional plain andenhanced CT scanning of upper abdomen.All the data were taken statistical analysis using SPSS version17.0, P <0.05wasconsidered statistically significant.Results：1. The cryoablation adverse reactions and treatment: in the30patients,10patientshad a fever,26patients were wound pain,5patients had cough,18patients hadpleural effusion,3patients were nausea and vomiting, one patient had slight degreefrostbite of skin and one patient had subcutaneous hemorrhage. All adverse reactionswere back to normal after symptomatic treatment.2. The changes of AFP before and after cryoablation: The positive rate of AFPwas86.7%(26/30) before the cryoablation and46.7%(14/30) after the cryoablation.The values of AFP significantly decreased, the difference was statistically significant(P <0.05).3. The partial response after cryoablation: CT plain scanning shows all lesionswere low-density and the diameters increased comparison of those of preoperation,The rate of hockey complete coverage was100%. After4months (second review) CTscanning show30lesions were complete remission and one lesion was partialprogress.4. The changes of perfusion parameters before and after cryoablation:(1) Before the cryoablation, the values of HAP and HAPI of tumor tissue werehigher than those of peritumoral liver tissue and normal liver tissue, and the values ofPVP of tumor tissue were lower than those of peritumoral liver tissue and normal liver tissue(P<0.05). No significant difference in the values of HAP, HAPI and PVPexisted between peritumoral liver tissue and normal liver tissue, with the P valuesbeing0.830,0.251and0.947respectively.(2) At4~6weeks after the cryoablation, the HAP and HAPI values of tumordecreased, and the difference was statistically significant (P <0.05), and PVP valuedecreased slightly without statistically significant (P=0.955); the HAP and PVPvalues of peritumoral liver tissue decreased, and the HAPI value slightly increased,the differences were significant difference(P<0.05); while the values of HAP, HAPIand PVP of normal liver tissue were no significant difference (P>0.05).5. The analysis of radiation dose: The doses of perfusion scanning were lowerthan those of conventional plain and enhanced scanning of upper abdomen, and thedifference was statistically significant (P<0.05).Conclusion：1. CT-guided cryoablation is safe and effective for hepatocellular carcinoma.2. Aquilion ONE640-slice CT perfusion imaging can quantitatively andobjectively reflect the short-term efficacy for cryoablation in HCC, and it can providean important reference about tumor recurrence and prognosis.3. The radiation doses of perfusion using Aquilion ONE640-slice CT are low.