Clinical application of CT perfusion imaging in estimating the efficacy of transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma

Objective To discuss the clinical value of dual-source CT perfusion imaging (CTPI) in estimating the therapeutic efficacy of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Methods Dual-source CTPI was performed in 24 patients with HCC 1 -3 days before and 6-8,30-40 days after TACE. With the help of built-in dual-source CT perfusion software,the color perfusion images of hepatic arterial perfusion (HAP),portal vein perfusion (PVP) and hepatic perfusion index (HPI) of all HCC lesions were obtained,and the relevant perfusion parameters as well as the tumor size were measured on the color images. The parameters obtained before TACE were compared with that obtained after TACE,and the differences were statistically analyzed. Results Before TACE treatment,the HCC lesions were manifested on HAP map as homogeneous hyper-perfusion in 9 cases and inhomogeneous hyper-perfusion in 15 cases. After TACE treatment,the tumor was totally filled with lipiodol in 8 cases and partially filled with lipiodol in 16 cases. Lack of blood perfusion was found in lipiodol-filling areas,but in sparsely or insufficiently lipiodol-filled areas blood perfusion could still be seen. Six to eight days after TACE,in all patients the HAP and HPI of HCC lesions were significantly lower than that measured before TACE (P 0.05),while the difference between the PVP determined before TACE and the PVP determined after TACE was of no statistical significance (P 0.05). The maximal diameter of the lesions 6 days after TACE showed no significant change (P 0.05) when compared to that before TACE. In the recurrent patients,no significant changes in tumor's size were observed 6 days after treatment if compared to that before the treatment (P 0.05). After TACE,the difference in HAP,PVP and HPI between the residual tumor lesions and the surrounding normal liver tissues was statistically significant (P 0.01). Conclusion Dual-source CT perfusion imaging can directly and quantitatively reflect the hemodynamic situation of HCC lesions both before and after TACE,which is very helpful for estimating the therapeutic efficacy of TACE.