经肠系膜上动脉行门静脉血管成像及CT灌注成像评价肝转移癌血供  

Blood Supply of Liver Metastatic Tumors Observed by both CT Arterial Portography via Superior Mesenterica Arterial and Multi-slice Spiral CT Perfusion Imaging

作　　者：时高峰[1] 王琦[1] 李志岗[1] 王士杰[1] 杜煜[1] 王亚宁[1] 

机构地区：[1]河北医科大学第四医院CT室,河北石家庄050011

出　　处：《癌症》2007年第11期1257-1262,共6页Chinese Journal of Cancer

基　　金：河北省科技厅资助项目(No.05276101D-67);河北省强势特色学科基金项目~~

摘　　要：背景与目的:肝转移癌的血供来源关系到血管介入治疗的给药途径和栓塞靶血管的选择。本研究探讨经肠系膜上动脉(superior mesenterica arterial,SMA)CT门静脉血管造影(CT arterial portography,CTAP)和多层螺旋CT灌注成像方法两种技术相结合评价肝转移癌的血供来源。方法:选取20例肝转移癌患者,采用经肠系膜上动脉间接门静脉血管造影(CTAP)及肝脏单纯门静脉灌注成像,观察血管走行与肿瘤的关系,通过时间密度曲线判断20例患者的33个转移灶肿瘤强化前后CT值变化特点,同时使用单血供灌注软件测量转移灶及瘤周正常肝组织的血流量(blood flow,BF)、血容量(blood volume,BV)、平均通过时间(mean transit time,MTT)、毛细血管表面通透性(capillary vessel permeability surface,PS),并进行统计学分析。结果:33个结节直径0.8～3.5cm,所有病灶通过时间-密度曲线观察强化后CT值增量均不超过10Hu。经SMA注射造影剂后肝内肿块内部无肿瘤血管。以门静脉作为单血供肝脏灌注扫描后得到肝内转移灶及瘤周正常肝组织各项灌注参数值,转移癌组织的BF、BV、MTT、PS的平均值分别为(17.15±11.38)ml·min-1·100ml-1、(1.62±0.97)ml·100g-1、(9.47±2.78)s、(3.97±3.44)ml·min-1·100ml-1。33个转移癌的BF值均小于30ml·min-1·100ml-1。瘤周正常肝组织的BF、BV、MTT、PS的平均值分别为(133.43±67.17)ml·min-1·100ml-1、(16.56±11.15)ml·100g-1、(9.52±2.84)s、(35.16±14.03)ml·min-1·100ml-1。其中BF、BV和PS两者之间差异有显著性(P值均<0.001),MTT两者比较差异无显著性(P=0.96)。结论:经肠系膜上动脉动脉插管门静脉造影CT灌注成像可以准确测量纯门静脉血流量。门静脉未参与肝转移癌的血液供应,肝转移癌主要由肝动脉供血。BACKGROUND ＆ OBJECTIVE： The blood supply of liver metastatic tumors affects the selection of administration approach and target vessels of interventional therapy. This study was to investigate the blood supply of liver metastatic tumors with both CT arterial portography （CTAP） via the superior mesenterica arterial （SMA） and multi-slice spiral CT perfusion imaging. METHODS, Twenty patients with liver metastatic tumors received CTAP via SMA and multi-slice spiral CT perfusion imaging. The CT values of 33 metastatic lesions and 20 specimens of normal liver tissue from the patients were measured through the time-density curves （TDC） of region of interest （ROI）. The blood flow （BF）, blood volume （BV）, mean transit time （MTT）, capillary vessel permeability surface （PS） of the portal vein were calculated with single-blood perfusion model, RESULTS; The diameters of the 33 metastatic lesions were 0.8-3.5 cm. The increment of CT values after enhancement was no more than 10 Hu in all lesions. At portal venous phase of SMA-digital subtraction angiography （DSA）, no tumor vessel was found in the lesions. The BF, BV, MTT, and PS of the portal vein were （17.15±11.38） ml·min^-·100 ml^-1, （1,62±0.97） ml·100 g^-1, （9.47±2.78） s, and （3.97±3.44） ml·min^-1·100 ml^-1, respectively, in metastatic lesions, and were （133.43±67.17） ml·min^-1·100 ml^-1, （16.56±11.15） ml·100 g^-1, （9.52±2.84） s, （35.16±14.03） ml·min^-1·100 ml^-1, respectively, in normal liver tissues. The differences in BF, BV and PS between the 2 groups were significant （P〈0.001）. However, the difference in MTT was not significant （P=0.96）. CONCLUSIONS： CTAP via SMA can be used to measure accurately portal venous flow. The portal vein is not involved in the blood supply of liver metastatic tumors.

关 键 词：肝肿瘤/继发性 灌注 体层摄影 X线计算机 肠系膜上动脉 门静脉 CT血管成像 血供 

分 类 号：R735.7[医药卫生—肿瘤] R730.42[医药卫生—临床医学]