三期螺旋CT扫描、经动脉门静脉造影CT扫描及经肝动脉造影CT扫描对经动脉化学栓塞治疗肝细胞肝癌计划及其实施情况的影响  

Combined CT during arterial portography and CT during hepatic arteriography in addition to triple-phase helical CT on the planning and the performance of transcatheter arterial chemoembolization of hepatocellular carcinoma

作　　者：郭彦君[1] 周纯武[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院放射诊断科,北京100021

出　　处：《癌症进展》2011年第3期250-258,227,共10页Oncology Progress

摘　　要：目的探讨在制定不可切除的肝细胞肝癌患者的化学栓塞计划及其实施情况方面,采用CTAP联合CTHA检查是否较常规的THCT联合肝动脉DSA检查更有利、更有价值。材料和方法采用前瞻性研究方式,连续有49名患有不可切除的肝细胞肝癌患者进入本项研究。该49名患者的平均年龄为64.9岁。全部患者在施行TACE前的1个月内均接受了肝脏THCT扫描检查,而且在TACE当天既接受了DSA检查也接受了CTAP及CTHA检查。TACE治疗的初步方案依据THCT检查结果确定。如果有必要可以依据治疗当天的CTAP/CTHA检查结果对本次TA-CE的治疗计划及其施行方式进行修正。结果与TACE前的肝脏THCT扫描检查相比较,CTAP及CTHA检查在15例患者(30.6%)中多发现了肝内病灶。其中,有8例患者(53.3%)的肝内新发现的病灶在介入治疗中的DSA检查上也可以检测到。另外7例患者通过CTAP/CTHA检查所多发现的病灶大多为直径较小的卫星病灶(直径<1.0cm),且多与母灶分布于肝内的同一血管区域内。因此,在本项研究中最后并没有出现由于CTAP及CTHA检查结果影响而改变了原来所拟定的TACE计划及其施行方式等情况。结论 CTAP及CTHA检查结果对TACE的治疗计划及其施行方式影响不大。CTHA检查可提供肝脏肿瘤血供方面的补充信息,对于全面、有效地施行超选择性TACE帮助较大。Objective To assess whether the combined computed tomography during arterial portography （CTAP） and CT during hepatic arteriograpby （CTHA） provides any additional benefit to the conventional triple-phase helical CT and DSA on treatment decisions involving selective ehemoembolization of unresectable hepafoeellular careinoma（HCCs）. Methods Forty-nine consecutive patients with confirmed or suspected unreseetable HCC were referred for chemoembolization. All of them had undergone conventional THCT within 1 month before chemoembolization and were examined with the combined CTAP and CTHA in addition to DSA before undergoing transcatheter arterial chemoembolization TACE on the treatment day. Preliminary plans for selective hepatic arterial ehemoemboLization were prepared according to the results of conventional THCT examination. When necessary , a final plan for chemoembobzation was formulated on the basis of the CTAP and CTHA findings. Results Compared with preprocedural diagnostic THCT examinations, combined CTAP and CTHA found more tumor lesions in 15 patients （30.6%）. The additional lesions were identified not only on CTAP and/or CTHA but also on DSA in 8 patients （53.3%）. In the rest 7 patients, most of the additional lesions were small satellite lesions （mean diameter： 1. 0 cm） adjacent to larger masses or nodules, and were in the same vascular distribution as the parent lesions. As a result, no patients＇ previously tormulated chemoembolization treatment plan based on the preprocedural diagnostic THCT examinations was changed due to CTAP and CTHA image findings. Conclusion Combined CTAP and CTHA findings have limited impact on chemoembolization treatment planning in patients with unresectable HCCs. CTHA can provide complementary information to the angiographic findings and is therefore helpful for superselective TACE of HCCs.

关 键 词：计算机X线断层扫描术 X线数字减影血管造影 肝细胞肝癌 

分 类 号：R735.7[医药卫生—肿瘤]