肝癌16层螺旋CT多期肝血管造影与DSA对比研究  

Comparative study between multiphase hepatic angiography of 16-slice spiral CT and DSA in primary hepatocellular carcinoma

作　　者：罗云辉[1] 陈加源[1] 何虹[1] 彭秀斌[1] 刘玉涛[1] 陈海东[1] 孙放[1] 林丽娟[1] 

机构地区：[1]广东省珠海市人民医院暨南大学附属第三医院影像科,广东珠海519000

出　　处：《中国中西医结合影像学杂志》2009年第4期260-263,共4页Chinese Imaging Journal of Integrated Traditional and Western Medicine

基　　金：2006年珠海市科技局立项科研课题(编号:200601040)

摘　　要：目的:探讨原发性肝癌16层螺旋CT多期肝血管成像技术、优势及其临床价值。方法:对70例原发性肝癌患者分别行肝动脉期、门静脉期、肝实质期螺旋CT多期肝血管造影,分析MIP、VRT、SSD3种血管重建方法对肝癌并发的肿瘤血管性病变的显示,并与DSA进行对比分析。结果:70例肝癌DSA共检出肿瘤供血动脉115支,MSCTA检出110支,符合率约95.6%,两者间无统计学显著性差异(P=0.071)。其中MIP、VRT显示较佳,SSD显示较差(45/115,39%)。DSA显示70例均存在瘤内肿瘤血管,其中MSCTA检出65例,两者表现相似,其间无统计学显著性差异(P=0.069)。MSCTA、DSA分别检出门-肝静脉癌栓36支、27支,存在统计学显著性差异(P=0.004),DSA对较小分支癌栓显示不佳;DSA显示肝动脉-门静脉瘘29例,MSCTA检出27例(符合率93.1%),两者表现一致。MSCTA检出肝动脉解剖变异22例(31.4%),共中9例变异肝动脉参与肝癌供血,与DSA的诊断符合率为100%。结论:16层螺旋CT多期肝血管造影可全面、准确评价原发性肝癌并发的肿瘤血管性病变,与DSA检查有很高的符合率,可为外科手术及介入术前提供重要信息及指导作用。Objective： To discuss the advantage and clinical value of multiphase hepatic angiography in primary hepatocellular carcinoma（PHC） with 16-slice spiral CT. Methods： The CT angiography（CTA） of hepatic arterial phase, portal-vein phase, and liver parenchyma phase were performed in 70 PHC patients. MIP,VRT and SSD were used to reconstruct liver vessels,and the displaying status of the hepatic tumorous vascular pathological changes （HTVPC）were analyzed and compared with DSA. Results： One hundred and fifteen branches of blood-supply tumor arteries were detected in DSA,while 110 branches in MSCTA. There was no statistically significant differences（ P =0. 071）between them. MIP and VRT were obviously superior to SSD. Seventy cases of liver cancer were discovered intratumoral tumor vessels（ ITTVs） in DSA,and 65 cases were detected ITTVs in MSCTA. Both showed the similar imaging findings, and there was no statistically significant differences（ P = 0. 069）between them. Thirty-six branches cancer embolus veins were detected in MSCTA,27 in DSA. There was statistically significant differences between them（ P =0. 004）. Twenty-nine cases of hepatic portal fistulae were detected in DSA,27 cases in MSCTA （coincidence ratio 93.1%）. Both showed the same imaging manifestation. Twenty-two cases of hepatic artery aberrance （31.4 %）were found in MSCTA. Of them, 9 cases were blood-supply tumor arteries. The diagnostic coincidence ratio with DSA was 100 %. Conclusion： Multiphase hepatic angiography of 16-slice spiral CT is a non-invasive technique for accurately evaluating the HTVPC in PHC. It has very high coincidence ratio with DSA, and can provide important information and guidance effect for surgery operation and intervention therapy.

关 键 词：原发性肝癌 血管造影术 体层摄影术 X线计算机 数字减影血管造影 

分 类 号：R735.7[医药卫生—肿瘤] R814.43[医药卫生—临床医学]