利用超音波能量都卜勒及動態顯影電腦斷層影像之肝臟預後因子研究

Abstract

肝癌每年在全世界造成超過一百萬人的死亡，是常見的惡性腫瘤。根據行政院衛生署的統計資料顯示，20年來「肝癌」一直蟬聯高居台灣十大癌症死因的第一、第二位。如此高的死亡率主要原因是因為肝癌是一種復發率極高的惡性腫瘤，若能減少肝癌復發的機率，便可減少病人接受治療後死亡的機會，此目標首要工作便是在治療前能夠找出容易肝癌復發的病人，針對這些病人以不同的治療方式或給予適當的附加治療，來降低其復發機率，延長病人的存活。 以往對於肝癌預後分析主要依賴病理切片後針對肝癌的大小、形狀、腫瘤的分化程度、有無被膜，以及週邊血管組織的侵犯等指標來對患者進行術後的評估，近年來有許多解析度更好、速度更快、更能反映腫瘤特性的醫學影像工具不斷推陳出新，影像檢查逐漸從單純的診斷目的，漸漸成為可以反映腫瘤生物特性並且預測治療效果的預測工具。腫瘤影像有其非侵入性，較低的醫療成本，使其普遍成為健檢之第一線預防診斷工具，尤其是術前便能取得患者腫瘤的影像，若能藉由影像特徵上的判讀來推斷患者預後情形，將對於醫師是一大幫助。 本研究與台大醫院合作，利用肝癌病患超音波能量都卜勒以及動態顯影電腦斷層影像進行分析，藉由影像血液流量以及明暗程度不同的變化，將腫瘤特徵予以量化來反映出腫瘤的生物特性，並且藉由這些量化的數值找出能夠進一步預測病人預後情形的指標。

The liver cancer causing the death of over one million people in the world each year. Is the common seen malignant tumor. According to the statistics of the Department of health, the “liver cancer” has been reelected to the first or second place of the top ten leading causes of cancer death in Taiwan in the past 20 years. Such a high mortality rate is mainly due to the high recurrence rate of liver cancer. Reduction of the probability of cancer recurrence can significantly reduce the chance of death of patients after primary treatment. The goal of this research is to identify those patients who more like to be subject to recurrence. Different treatments or appropriate additional cares may be then applied to the patients to reduce their probability of recurrence, and extended patients survival rate. Most of the assessment of liver cancer prognosis depend on the results of biopsy, such as the size, shape, degree of tumor differentiation, with or without the capsule, as well as invasion of the peripheral vascular tissue, and other postoperative indicators. The recent years, many medical imaging tools, with better resolutions faster speed and better resolution of tumor characteristics have been introduced, the rule of image detection has been changed from a simple diagnostic tool, to a prediction tool that can reflect tumor biological characteristics and predict the treatment effect. These tumor images are non-invasive, lower costs, and become the first line of the health examination diagnostic tools. In particular, if we can infer the prognosis outlook of the patient by the image characteristics it will be important information for the surgeon to perform the operations. In this study, in cooperation with the National Taiwan University Hospital, we collect images of liver cancer patients with Power Doppler ultrasonic and dynamic imaging computed tomography to analyze tumor characteristics. Blood flow and different levels of brightness change will be quantified to reflect the biological characteristics of the tumor. The quantitative values will better used to indicators of patient prognosis factors.