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64-slice Spiral CT Stage-4 Enhanced and Perfusion Scans in the Diagnosis of Small Hepatocellular Carcinoma

Author: WangJunWei
Tutor: GaoJianBo
School: Zhengzhou University
Course: Medical Imaging and Nuclear Medicine
Keywords: Liver cells Cancer Perfusion imaging Tomography X - ray computed
CLC: R735.7
Type: Master's thesis
Year: 2009
Downloads: 35
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Abstract

Background and Purpose: Hepatocellular carcinoma is one of the common liver malignancy with poor prognosis and short survival time of patients with advanced hepatocellular carcinoma survival of untreated 0.7-3 months. Survival in patients with small hepatocellular carcinoma (Small HepatocellularCarcinoma, SHCC) significantly improved domestic reports of small hepatocellular carcinoma after 5-year survival rate of up to 60% or more, and therefore early detection and diagnosis of small hepatocellular carcinoma become one of the hot research. Application of 64-slice volume CT of the subject by the following, in order to get more small hepatocellular carcinoma imaging to improve diagnostic accuracy and guide clinical treatment. ① explore the 64-slice spiral CT scan and perfusion imaging in the diagnosis of small hepatocellular carcinoma four enhanced scanning methods and considerations. The ② calculated small liver cancer, the adjacent liver cancer and control liver perfusion parameters, and compare the differences. ③ to explore the small HCC different pathological grade between CT features and differences perfusion parameters. Materials and Methods: Clinical data collected from May 2008 to March 2009 menstrual 64-slice spiral CT the four enhanced scan and CT perfusion (CTP) diagnosis for small hepatocellular carcinoma, and subsequently confirmed by pathology or clinical cases 30 patients, 28 males and 2 females, age 32-76 years, mean 53 years. Contains 34 small HCC lesions in 30 cases, two cases of recurrent lesions after surgery. Another two cases the SHCC radiofrequency ablation CT perfusion data collection. Scanning method 2.1 liver four enhanced scan method of fasting, drinking water for 800-1000ml supine on the scanning bed, conventional whole liver unenhanced, and then using the U.S. company GE 64 rows of light-speed VCT machine line four enhanced scan (early arterial and late portal phase, equilibrium phase or delayed phase), a one-time injection of non-ionic contrast medium (iohexol 350mgI/ml) 100ml speed 3.0ml / s, using intelligent tracking technology (Smart Prep) triggered scanning, generally take The abdominal aorta of the target vessel, the use of small doses of the same layer dynamic test method (Test Bolus) time density curve (TDC), the CT values ??rose 150HU as start scanning trigger point, the early arterial phase about the injection of the contrast agent after 20s about late arterial phase delay in the early arterial phase on the basis of the 10s, the portal phase extension for 30s, the delay period is generally longer delay 60s scan. 2.2 CTP scanning method CTP the GE 64 rows of light-speed VCT machines, fasting, supine patients breath, breath training; twice about liver scan, select the tumor perfusion levels (as much as possible, including the abdominal aorta, portal vein trunk and its branches), and then by the the forearm vein disposable rapid injection of non-ionic contrast agent (of iohexol 300mgI/ml) 45ml speed 4ml / s. Asked the patient breath-hold (the patient's physical condition does not allow those who can be cummerbund under the control of the calm shallow breathing) delay 5s multiple layers of the same layer, according to the liver the tumor perfusion agreement (liver tumorperfusion) dynamic perfusion scanning the 45s, including five cases with film scanning mode (Cinefull 1.0sec), the remaining cases axis sweep (axial) mode. The slice thickness 5mm/4i (after reconstruction to 10mm/2i) scan field: Large voltage (Kv): 120KVp current (mA): 60mA, axis scan 200 layer 5mm image. Processing the scanned image input workstation AW4.3 (Advantage Windows 4.3). Selected lesions for the region of interest (region of interest, ROI) data processing 3.1 four enhanced image processing image acquisition, the same ROI, respectively, in a different time phase measurement, comparison and calculation. And select the early arterial phase by volume rendering of the original image (Volumerendering, VR), maximum intensity projection (Maximum intensity projection, MIP), thickening of MIP and other post-processing method for reconstruction of tumor-feeding artery. 3.2 CTP image processing CTP perfusion (livertumor perfusion) agreement with GE's CT perfusion-3.0 perfusion package of liver tumors (deconvolution algorithm) to calculate, mapping and analysis, its quantitative function to generate the specified type images and perfusion parameters . On a series of attempts to identify the abdominal aorta and the main portal vein or its branches as supply artery and outflow vein size 2-6 pixels placed to avoid the partial volume effect. Then threshold definition generally the about 0 ~ 200Hu of the removal of surrounding bone, fat, air and other organizations. Finally, the selection of the region of interest, the time density curve (TDC) and perfusion parameters: blood flow (Blood Flow, BF), blood volume (Blood Volume, BV), mean transit time (the Mean transittime MTT), permeability surface sex (Permeability Surface, PS) and hepatic arterial fraction (HepaticArterial Fraction, HAF). And calculated according to the data obtained the hepatic artery the perfusion (Hepaticarterial perfusion of HAP) HAP = BF × HAF. All values ??in the measurements were repeated two more times during the study period and averaged. The region of interest (ROI) selection should be as comprehensive as possible on behalf of the organization, and should reach the target edge, from the impact of the partial volume effect, and should avoid large blood vessel and lesion necrosis and cystic area. Small hepatocellular carcinoma ROI selected the maximum blood volume cancerous liver tissues, select the the lesions around 1cm area (referred liver paracancerous) control liver tissue lesions around 2-5cm area (referred to as the control liver) is selected, the measured perfusion parameters were compared. 4. Pathology specimen processing pathology specimens slices produced by the Department of Pathology, assist in the completion. Observe HE staining of small hepatocellular carcinoma is divided into well-differentiated (G1), moderately differentiated (G2) in both groups (the group of researchers poorly differentiated small HCC cases). 5 All data of the statistical methods used statistical package SPSS processing. Measurement data with the (?) ± s reference range using a 95% confidence interval. Between the two groups using independent sample t tests, univariate analysis of variance was used to compare the three groups, the homogeneity of variance using LSD method mean multiple comparisons unequal variances by Games-Howell. Correlation analysis between the parameters the Pearson Law (count data) and Spearman (ranked data). P <0.05 represents a statistically significant difference, P <0.01 represents a statistically significant difference. Results 1. Lesion in the left hepatic lobe nine cases, the right lobe of the 25 cases, 34 lesions early arterial phase showed a high density of 14, the average CT value (75.6 ± 23.1) HU, the detection rate was 41.2%; late arterial phase showed a high density 28, the average CT value (92.9 ± 16.5) HU, the detection rate was 82.4%; dual arterial phase shows 31 high-density lesion detection rate of 91.2%, 29 portal venous phase shows low density lesions (another 5 lesions showed high density), the detection rate was 85.3%; delayed phase appears as the density of the low-density 32 (the other two were still comprehensive clinical data of the diagnosis of small hepatocellular carcinoma, after intervene confirmed the rich blood supply small liver cancer), 94.1%. 7 enhanced early arterial lesions, four cases were in the late arterial phase, low-density performance. 2 lesions in the arterial phase, portal phase showed a low-density, after intervention confirmed the lack of blood for small hepatocellular carcinoma. Four performance enhancements strengthen the characteristics of the resulting lesion perfusion resulting TDC liver are in good agreement, and can take advantage of the early arterial phase image of the the SHCC vascular imaging processing, can be reconstructed small HCC feeding arteries in 18 patients. 2.SHCC the CT four enhanced features and perfusion income TDC are in good agreement; SHCC's size, edge, peak enhancement, strengthening the correlation between the degree of indicators and lesion perfusion parameters and pathological type. Different scanning (film scanning and axis sweep) play a major role in the diagnosis of small hepatocellular carcinoma, no significant difference in perfusion parameters, can effectively reduce ray the measurement axis scan mode advantage. 4 small hepatocellular carcinoma compared with the control liver tissue BF, BV, HAF, HAP and the difference was statistically significant (p <0.05), significantly increased the above parameters of small hepatocellular carcinoma. Clear boundaries of small hepatocellular carcinoma with paraneoplastic liver, BF, BV, HAF, HAP difference was significant (p <0.05), the ill-HCC and adjacent noncancerous liver, no significant difference in the above parameters. Enhance the original image and the perfusion image statistically significant difference (P <0.05) in measuring the size of small hepatocellular carcinoma tumor perfusion images measured tumor volume. 6 different types of pathology SHCC differences in perfusion parameters were statistically significant. Moderately differentiated group the SHCC The HAF and HAP higher than the well-differentiated group. Conclusion 1. Applications 64-slice volume CT liver The four enhanced scan can not only improve the detection rate of small hepatocellular carcinoma, but also to provide a richer, intuitive imaging information. 2-axis scan mode not only more accurate access to various perfusion parameters, and compared with film scanning mode, can effectively reduce ray dose promising application. Through the blood supply of small hepatocellular carcinoma blood flow calculation of perfusion parameters, quantitative analysis of small hepatocellular carcinoma, to help small liver cancer diagnosis and treatment options. Perfusion images can more accurately reflect the size of the lesion, thus guiding the clinical selection of the right hepatic resection or embolization and radiofrequency ablation range, to avoid therapeutic range is too small and caused by a lesion recurrence or metastasis. Can be inferred from the degree of malignancy through the CT features of small hepatocellular carcinoma and perfusion parameters change, contribute to the clinical development of therapeutic measures to determine the efficacy and prognosis.

64-slice Spiral CT Stage-4 Enhanced and Perfusion Scans in the Diagnosis of Small Hepatocellular Carcinoma

Abstract

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