基于多层螺旋CT灌注成像早期肝癌微血管侵犯术前预测研究

In Ningxia province, a high incidence area of liver diseases, liver cancer brings heavy burden to society as well as local families, and is one of the common villains leading to poverty-caused-by-disease phenomenon in southern mountain area of Ningxia.Liver cancer with microvascular invasion (MVI) is the independent risk factor influencing the reoccurrence of early liver cancer and for overall survival. Predicting MVI preoperatively is beneficial to take a more targeted and positive intraoperative surgery strategy. But so far, there is still a lack of a preoperative predicting method with high specificity and practability. This research, based on the low dose perfusion imaging performed with multi-slice spiral CT, studies on predicting preoperative MVI of early liver cancer, and on finding evaluation basis of preoperative blood flow status and its MVI of early liver cancer.Collecting clinically diagnosed cases of early liver cancer, this research will progressively accomplish the evaluation of the quality of images of whole-liver perfusion imaging of different doses based on iterative reconstruction techniques, accomplish the research of difference of CT perfusion in different areas, accomplish the research on consistency between parameter of CT perfusion and postoperative pathological diagnosis MVI (gold standard), and establish the preoperative imaging prediction model and evaluation system of MVI of early liver cancer.

宁夏是肝病的高发区，肝癌的高发给社会和家庭带来了沉重的负担，是宁夏南部山区因病致贫的主要疾病之一。肝癌伴有微血管侵犯（MVI）是影响早期肝癌复发和总体生存的独立危险因素。术前准确预测MVI有利于术中采取更具针对性、更积极的外科治疗策略。目前尚缺乏特异性和实用性很高的术前预测方法。本研究基于多层螺旋CT低剂量灌注成像技术，进行术前早期肝癌微血管侵犯预测研究，探索术前早期肝癌血流状况及其微血管侵犯的评价依据。收集临床确诊的早期肝癌病例，逐步完成基于迭代重建技术的不同辐射剂量全肝CT灌注成像图像质量评估、早期肝癌不同区域CT灌注差异性研究及CT灌注参数与术后病理诊断微血管侵犯（金标准）一致性研究，初步构建早期肝癌微血管侵犯术前影像预测模型和评价体系。

肝癌伴有微血管侵犯（MVI）是影响早期肝癌复发和评价总体生存状况的独立危险因素。MVI 的术前精准预测有利于采取更积极且有针对性的外科治疗策略。本研究基于多层螺旋CT低剂量灌注成像技术，对术前早期肝癌的微血管侵犯现象进行预测研究，探索术前早期肝癌血流状况及其微血管侵犯依据。本研究通过收集临床确诊的138例早期肝癌的临床资料和影像学特征进行单因素分析、同期56例肝癌进行全肝CT灌注成像及不同区域CT灌注差异性研究及CT灌注参数与术后病理诊断微血管侵犯的一致性研究。研究结果：临床分期、肿瘤最大径、包膜、强化模式、肿瘤边缘、瘤周低密度晕环及瘤周异常强化与MVI有关。肝癌肿瘤最大径、强化模式、肿瘤边缘为MVI的独立危险因素，术前可通过模型预测HCC的MVI。应用ROC曲线分析对肿瘤最大径、强化模式，肿瘤边缘的联合诊断明显提高了效能。明确肝细胞癌肿瘤组织、癌旁组织及肝硬化背景下肝实质血流机制为明确肝细胞癌和肝硬化病理生理变化提供一定的影像学支持。初步明确MVI阳性HCC与MVI阴性HCC肿瘤实质与癌旁组织的灌注差别，通过术前灌注成像可以预测肝细胞癌是否存在MVI。通过多因素logistics回归模型进行独立危险因素分析，癌旁1cm组织肝动脉灌注量HAP、门静脉灌注量PVP、癌旁2cm总灌注量TLP为肝细胞癌MVI的独立危险因素。本研究明确了HCC患者术前一般临床资料、CT影像学特征、CTPI在术前预测MVI中的价值，为肝癌患者的治疗和管理提供循证医学依据。