iFlow彩色编码技术实时定量测定肝细胞癌经肝动脉化疗栓塞术前后血流动力学改变的可行性探讨
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摘要
目的探讨使用iFlow彩色血流编码技术在肝细胞癌经肝动脉化疗栓塞术(TACE)前后血流动力学改变的实时量化分析中的价值。方法收集2015年12月-2017年1月于上海市第五人民医院确诊为肝细胞癌患者31例,所有患者均未接受过外科手术、消融等治疗,应用TACE治疗,使用同样的对比剂、高压注射器参数、造影导管位置造影,用iFlow技术生成患者术前、术后的二维彩色编码图像及时间-密度曲线(TDC),测量造影导管口、肿瘤主要供血动脉起点和终点的达峰时间(TTP)以及肿瘤组织与导管口TDC曲线下面积(AUC)的比值。计量资料组间比较采用配对t检验。结果栓塞前、后的肿瘤主要供血动脉终点TTP分别为(4.64±0.49)s、(5.97±0.84)s,肿瘤组织与导管口AUC比值分别为0.53±0.15、0.16±0.12,差异均有统计学意义(t值分别为11.57、25.85,P值均<0.01);而TACE术前、术后造影导管口的TTP及肿瘤主要供血动脉起点的TTP比较,差异均无统计学意义(P值均>0.05)。肿瘤供血动脉TDC栓塞前大致呈"速升-速降"形,斜率、峰值较高;栓塞后呈"上升-平缓-下降"形,并且斜率、峰值均较术前下降。结论 iFlow可术中实时测量感兴趣区的TTP与TDC,定量评价肝细胞癌的血流动力学变化,为判断肿瘤栓塞程度提供客观的定量指标。
Objective To investigate the value of iFlow color-coding technique in quantitative real-time analysis of hemodynamic changes after transarterial chemoembolization( TACE) for hepatocellular carcinoma( HCC). Methods A total of 31 patients who were diagnosed with HCC in Shanghai Fifth People's Hospital from December 2015 to January 2017 were enrolled. No patient underwent surgical operation or ablation. All patients underwent TACE with the same contrast agent,high-pressure injector parameters,and place of angiographic catheter. The iFlow technique was used to generate two-dimensional color-coded images and time-density curve( TDC) before and after surgery and measure the opening of the angiographic catheter and the time to peak( TTP) of the starting and ending points of the major tumor feeding arteries,as well as the ratio of the areas under the curve( AUC) of TDC of tumor tissue and the opening of the angiographic catheter. The paired t-test was used for comparison of continuous data between groups. Results TTP of the major tumor feeding arteries was 4.64 ± 0. 49 s before TACE and 5. 97 ± 0. 84 s after TACE( t = 11. 57,P < 0. 01),and there was a significant difference in AUC between the tumor tissue and the opening of the angiographic catheter( 0. 53 ± 0. 15 vs 0. 16 ± 0. 12,t = 25. 85,P < 0. 01). There was no significant difference in TTP between the opening of the angiographic catheter and the major tumor feeding arteries before and after TACE( P > 0. 05).Before TACE,the TDC of tumor feeding arteries had a shape of"rapid increase-rapid reduction"with relatively high slope and peak value,while after TACE,the TDC had a shape of "increase-flat-reduction"with reductions in slope and peak value. Conclusion The iFlow technique can perform real-time measurement of TTP and TDC of the region of interest and helps with quantitative evaluation of hemodynamic changes in HCC. Therefore,it can provide objective quantitative indices for evaluating the degree of tumor embolism.
Objective To investigate the value of iFlow color-coding technique in quantitative real-time analysis of hemodynamic changes after transarterial chemoembolization( TACE) for hepatocellular carcinoma( HCC). Methods A total of 31 patients who were diagnosed with HCC in Shanghai Fifth People's Hospital from December 2015 to January 2017 were enrolled. No patient underwent surgical operation or ablation. All patients underwent TACE with the same contrast agent,high-pressure injector parameters,and place of angiographic catheter. The iFlow technique was used to generate two-dimensional color-coded images and time-density curve( TDC) before and after surgery and measure the opening of the angiographic catheter and the time to peak( TTP) of the starting and ending points of the major tumor feeding arteries,as well as the ratio of the areas under the curve( AUC) of TDC of tumor tissue and the opening of the angiographic catheter. The paired t-test was used for comparison of continuous data between groups. Results TTP of the major tumor feeding arteries was 4.64 ± 0. 49 s before TACE and 5. 97 ± 0. 84 s after TACE( t = 11. 57,P < 0. 01),and there was a significant difference in AUC between the tumor tissue and the opening of the angiographic catheter( 0. 53 ± 0. 15 vs 0. 16 ± 0. 12,t = 25. 85,P < 0. 01). There was no significant difference in TTP between the opening of the angiographic catheter and the major tumor feeding arteries before and after TACE( P > 0. 05).Before TACE,the TDC of tumor feeding arteries had a shape of"rapid increase-rapid reduction"with relatively high slope and peak value,while after TACE,the TDC had a shape of "increase-flat-reduction"with reductions in slope and peak value. Conclusion The iFlow technique can perform real-time measurement of TTP and TDC of the region of interest and helps with quantitative evaluation of hemodynamic changes in HCC. Therefore,it can provide objective quantitative indices for evaluating the degree of tumor embolism.
引文
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[11]WANG J,GUAN X,ZHAO L,et al.Objective assessment of the endpoint of transcatheter arterial chemoembolization using color-coded digital subtraction angiography[J].Chin J Radiol,2014,48(9):758-761.(in Chinese)王嵇,管逊,赵亮,等.二维彩色编码DSA技术评估经导管动脉化疗栓塞最佳状态的价值[J].中华放射学杂志,2014,48(9):758-761.
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[13]QIAN T,YIN HB.Research advances in functional MRI for evaluating the efficacy of transcatheter arterial chemoembolization for liver cancer[J].Chin J Radiol,2013,47(7):669-670.(in Chinese)钱亭,尹化斌.功能MRI评价肝癌经肝动脉灌注化疗栓塞术疗效的研究进展[J].中华放射学杂志,2013,47(7):669-670.
[14]HUANG YL,ZHOU YM,TONG SJ,et al.i Flow in the auxiliary diagnosis of cerebral vascular disease[J].Chin J Interv Imaging Ther,2011,8(5):401-404.(in Chinese)黄远亮,周玉明,童绥君,等.i Flow成像辅助诊断脑血管性病变[J].中国介入影像与治疗学,2011,8(5):401-404.
[15]LOU WS,GU JP,SU HB,et al.Hemodynamic changes of lower extremity peripheral arterial disease following interventional therapy:primary application of i Flow quantitative evaluation[J].Chin J Radiol,2015,49(1):57-60.(in Chinese)楼文胜,顾建平,苏浩波,等.i Flow软件量化评估下肢动脉阻塞性疾病血流改变的价值[J].中华放射学杂志,2015,49(1):57-60.
[16]QIU W,LI P,GUO X,et al.Preliminary study of i Flow application in lower extremity vascular disease[J].Chin J Thorac Cardiovasc Surg,2016,32(1):22-24.(in Chinese)邱威,李彭,郭曦,等.i Flow技术治疗下肢血管疾病的初步研究[J].中华胸心血管外科杂志,2016,32(1):22-24.
[17]QIU W,LI P,LIU GR,et al.Value of i Flow auxiliary technique in evaluating the efifciency of Chimney stent in left subclavian artery during TEVAR[J].J Vasc Endovasc Surg,2016,2(1):45-49,54.(in Chinese)邱威,李彭,刘光锐,等.i Flow技术于TEVAR术中辅助判断左锁骨下动脉烟囱支架植入疗效[J].血管与腔内血管外科杂志,2016,2(1):45-49,54.
[2]GESCHWIND JF,RAMSEY DE,CLEFFKEN B,et al.Transcatheter arterial chemoembolization of liver tumors:effects of embolization protocol on injectable volume of chemotherapy and subsequent arterial patency[J].Cardiovasc Intervent Radiol,2003,26(2):111-117.
[3]IKEDA M,MAEDA S,SHIBATA J,et al.Transcatheter arterial chemotherapy with and without embolization in patients with hepatocellular carcinoma[J].Oncology,2004,66(1):24-31.
[4]LLOVET JM,REAL MI,MONTANA X,et al.Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma:a randomised controlled trial[J].Lancet,2002,359(9319):1734-1739.
[5]MAEDA S,FUJIYAMA S,TANAKA M,et al.Survival and local recurrence rates of hepatocellular carcinoma patients treated by transarterial chemolipiodolization with and without embolization[J].Hepatol Res,2002,23(3):202-210.
[6]RHEE TK,YOUNG JY,LARSON AC,et al.Effect of transcatheter arterial embolization on levels of hypoxia-inducible factor-1alpha in rabbit VX2 liver tumors[J].J Vasc Interv Radiol,2007,18(5):639-645.
[7]XIONG ZP,YANG SR,LIANG ZY,et al.Association between vascular endothelial growth factor and metastasis after transcatheter arterial chemoembolization in patients with hepatocellular carcinoma[J].Hepatobiliary Pancreat Dis Int,2004,3(3):386-390.
[8]ZENG SS.Current status of transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma[J].China Med Herald,2016,13(33):56-59,63.(in Chinese)曾姗姗.经肝动脉化疗栓塞术治疗肝细胞癌的研究进展[J].中国医药导报,2016,13(33):56-59,63.
[9]van BEERS BE,LECONTE I,MATERNE R,et al.Hepatic perfusion parameters in chronic liver disease:dynamic CT measurements correlated with disease severity[J].AJR Am J Roentgenol,2001,176(3):667-673.
[10]LIN YY,LEE RC,TSENG HS,et al.Objective measurement of arterial Flow before and after transcatheter arterial chemoembolization:a feasibility study using quantitative color-coding analysis[J].Cardiovasc Intervent Radiol,2015,38(6):1494-1501.
[11]WANG J,GUAN X,ZHAO L,et al.Objective assessment of the endpoint of transcatheter arterial chemoembolization using color-coded digital subtraction angiography[J].Chin J Radiol,2014,48(9):758-761.(in Chinese)王嵇,管逊,赵亮,等.二维彩色编码DSA技术评估经导管动脉化疗栓塞最佳状态的价值[J].中华放射学杂志,2014,48(9):758-761.
[12]QIAN T,CHEN M,GAO F,et al.Diffusion-weighted magnetic resonance imaging to evaluate microvascular density after transarterial embolization ablation in a rabbit VX2 liver tumor model[J].Magn Reson Imaging,2014,32(8):1052-1057.
[13]QIAN T,YIN HB.Research advances in functional MRI for evaluating the efficacy of transcatheter arterial chemoembolization for liver cancer[J].Chin J Radiol,2013,47(7):669-670.(in Chinese)钱亭,尹化斌.功能MRI评价肝癌经肝动脉灌注化疗栓塞术疗效的研究进展[J].中华放射学杂志,2013,47(7):669-670.
[14]HUANG YL,ZHOU YM,TONG SJ,et al.i Flow in the auxiliary diagnosis of cerebral vascular disease[J].Chin J Interv Imaging Ther,2011,8(5):401-404.(in Chinese)黄远亮,周玉明,童绥君,等.i Flow成像辅助诊断脑血管性病变[J].中国介入影像与治疗学,2011,8(5):401-404.
[15]LOU WS,GU JP,SU HB,et al.Hemodynamic changes of lower extremity peripheral arterial disease following interventional therapy:primary application of i Flow quantitative evaluation[J].Chin J Radiol,2015,49(1):57-60.(in Chinese)楼文胜,顾建平,苏浩波,等.i Flow软件量化评估下肢动脉阻塞性疾病血流改变的价值[J].中华放射学杂志,2015,49(1):57-60.
[16]QIU W,LI P,GUO X,et al.Preliminary study of i Flow application in lower extremity vascular disease[J].Chin J Thorac Cardiovasc Surg,2016,32(1):22-24.(in Chinese)邱威,李彭,郭曦,等.i Flow技术治疗下肢血管疾病的初步研究[J].中华胸心血管外科杂志,2016,32(1):22-24.
[17]QIU W,LI P,LIU GR,et al.Value of i Flow auxiliary technique in evaluating the efifciency of Chimney stent in left subclavian artery during TEVAR[J].J Vasc Endovasc Surg,2016,2(1):45-49,54.(in Chinese)邱威,李彭,刘光锐,等.i Flow技术于TEVAR术中辅助判断左锁骨下动脉烟囱支架植入疗效[J].血管与腔内血管外科杂志,2016,2(1):45-49,54.