Research On The Evaluations On The Hepatic Function Reserve Of Primary Hepatic Carcinoma By320-row Dynamic Volume CT Perfusion Imaging

[Objectives] To study the characters of CT perfusion for patients with hepatitis B cirrhosis accompanied by primary hepatic carcinoma, and to explore the clinical value of the evaluation by 320-row dynamic volume CT perfusion imaging on hepatic function reserve of patients with primary hepatic carcinoma resulting from hepatitis B cirrhosis.[Materials and methods] 35 cases of patients with primary hepatic carcinoma accompanied by different degrees of hepatitis hepatocirrhosis were collected during the period from December,2013 to December 2014. The patients were divided into three grades, that is, Grade A, Grade B, and Grade C, according to the Child-pugh classification standard (including 14 cases of Grade A,11 cases of Grade B, and 10 cases of Grade C). The Toshiba "Aqualion One" 320-row dynamic volume CT was taken to conduct CT perfusion scanning on the 35 patients, and the abdominal perfusion software was taken to obtain the perfusion pseudo color map of hepatic aterial perfusion (HAP), poetal venous perfusion (PVP), and hepatic artierial perfusion index (HAPI). In addition, three Ranges of Interest (ROI) were selected within the liver tissue areas having no carcinoma at the anterior right lobe of liver, the posterior right lobe of liver, the leftintrahepatic lobe, and the left extrahepatic lobe, and the caudate lobeas well as the caudate loberespectively, and the average values were figured out after the corresponding perfusion values were obtained. The above post-treatment works were all achieved by the two doctors from the Department of Radiology respectively. Finally, comparison was conducted on the three perfusion values obtained by the measurement of the two doctors as well as the perfusion values (HAP, PVP, and HAPI) of the patients graded according to Child-pugh so as to see whether there was of statistical differences, and analysis had been conducted on the spearman correlation between all the perfusion values and Child-pugh classification.[Results]1.There was no significant statistical differences between the two groups of perfusion values measured by the two doctors from the Department of Radiology (P>0.05, See Table 3).2.There was no significant statistical differences among the HAPs of the patients at Grade A, Grade B, and Grade C (P>0.05), but there were significant statistical differences among the PVPs and HAPIs of the patients at Grade A, Grade B, and Grade C (P<0.05). Then S-N-K analysis were conducted on PVP, HAPI, and TLP of the patients at Grade A, Grade B, and Grade C, and the results included that there was no statistical difference between Grade B and Grade C (P>0.05) but there were statistical differences between Grade A and Grade B and between Grade A and Grade C (P<0.05).3.The analysis on the correlations between the perfusion values of the three groups of Grade A, Grade B, and Grade C and the three Grades of C-P:There was no significant correlation between the HAP changes and the Child-pugh classification but there was significant correlations among PVP, HAPI, and C-P classifications, among which there was significant negative correlation between PVP and the C-P classification with the correlation coefficients as r=-0.773 (P<0.001).while there was significant positive correlation between PVP and HAPI with the correlation coefficient as r=0.676(P< 0.001).[Conclusion]l.The CT perfusion values PVP and HAPI were of good correlation to the Child-pugh classification, the PVP tended to decrease with the gradual increasing of Child-pugh classification,both showed a negative correlation relationship, while the HAPI tended to increase with the gradual increasing of Child-pugh classification, both were positively related; and PVP and HAPI could be act as the important indexes for the evaluation of hepatic function reserve of patients with hepatic carcinoma resulting from hepatitis B cirrhosis, but in this research it has been proved that it was of no great meaning to take HAP to evaluate the hepatic function reserve.2.The320-row dynamic volume CT perfusion imaging perfusion value measurement was of rather high repeatability, and there were differences among the perfusion values though taking ROI from the five lobes of the liver due to the differences of the operators (based on the premise of avoiding the large blood vessels, neoplastci foci, and the edge of the liver);3.The 320-row dynamic volume CT perfusion imaging was able to reflect the hepatic function reserve in a quick, safe, and correct way;4.This research had obtained the CT perfusion parameters of different hepatic function reserves before the TACE operation, thus laying foundation for future researches on the evaluation on the predication of the effects of the operations by the hepatic function reserve of patients with hepatic carcinoma before the TACE operation.