3D-DSA和DynaCT成像在肝癌肝动脉化疗栓塞中的价值  

The value of 3D-DSA and Dyna CT in the hepatocellular carcinoma treated by TACE

作　　者：刘军[1] 王霞[2] 王浩洲[1] 王琳[1] 李吉贞[1] 

机构地区：[1]山东省泰安市中心医院介入放射科,山东泰安271000 [2]山东省泰安市中心医院影像中心,山东泰安271000

出　　处：《医学影像学杂志》2011年第8期1192-1196,共5页Journal of Medical Imaging

摘　　要：目的:探讨3D-DSA和DynaCT重建成像在肝细胞癌肝动脉化疗栓塞中的价值。方法:对47例肝癌患者经肝动脉化疗栓塞前分别进行3D-DSA、DSA和DynaCT扫描检查,应用3D-DSA重建成像Inspace的容积重建技术(VRT)、最大密度投影技术(MIP)、多层面重建技术(MPR)和DynaCT成像对肝脏血管和肿瘤进行多方位、多层面、多视角显示。观察腹腔动脉和?或肠系膜上动脉及其分支的解剖和空间走行,比较肿瘤的供血动脉来源、走行、瘤灶数目、瘤灶染色程度及合并症的显示情况。结果:47例肝癌患者3D-DSA重建成像发现40例肝总动脉自腹腔动脉发出;5例肝右动脉起源于肠系膜上动脉,肝左动脉起自腹腔动脉;2例肝总动脉自肠系膜上动脉发出;其中1例肝总动脉自腹腔动脉发出,由肠系膜上动脉单独发出一支供血动脉到位于肝右下叶的肿块;显示肝动-静脉瘘9例,其中2例大流量混合性肝动脉-门静脉、肝静脉瘘,6例周围型小流量局限性肝动脉-门静脉瘘和1例小流量肝动脉-肝静脉瘘。DynaCT成像发现病灶179个。常规DSA发现病灶145个,动静脉瘘7例,门静脉瘤栓9例。和常规DSA相比较,3D-DSA成像对肝癌供血动脉的起源、腹腔动脉和?或肠系膜上动脉及其主要分支的三维空间结构的显示优于后前位DSA;观察腹腔动脉和?或肠系膜上动脉主干与腹主动脉间的夹角及肝动-静脉瘘较常规DSA更清晰方便;DynaCT重建成像对肿瘤瘤灶数目的显示率高于DSA,差异有统计学意义(P<0.05)。结论:3D-DSA和DynaCT重建成像对于肝癌肝动脉化疗栓塞治疗,尤其是选择适宜形状的导管及合适、适量的栓塞剂具有重要指导意义,但其采集时间最长只有20s,不能同时显示肝脏动脉期血管和静脉期门静脉内瘤栓的情况,必须与常规DSA检查结合,才能更加完整全面的显示病灶和血管的影像学信息。Objective：To discuss the value of of three-dimensional digital reconstruction angiography （3D-DSA） and Dyn： aCT in the hepatocellular carcinoma treated by TACE. Methods：47 patients with HCC underwent routine DSA, 3D-DSA and DynaCT before TACE. By use of volume rendering technique （VRT）. maximum intensity projection （MIP） andMulti-planar reconstructions （MPR） of 3D-DSA and DynaCT to display the liver vessel and the tumor in multidirections, multiple optic angles and multiple serie were displayed. The celiac artery and/or the superior mesenteric artery and their branch＇s anatomy and their shape were observed and the blood-supply of tumor, the number of tumor, the stain of tumor and the complication of the disease were compared. Results：Among 47 patients, the proper hepatic artery origined from the celiac artery were demonstrated by 3D-DSA in 40 patients, the right hepatic artery origined from the superior mesenteric artery and the left hepatic artery origined from the celiac artery in 5 patients, the proper hepatic artery origined from thesuperior mesenteric artery in 2 patients. There were 9 patients with arteriovenous fistula. 179 loci were demonstrated by the DynaCT but the routine DSA only demonstrated 145. There were 7 patients with arteriovenous fistula and 9 portal vein tumor embolus were found in routine DSA. Comparing with the routine DSA, the 3D-DSA had great advantages in the demonstration of the origin of feeding artery, the celiac artery and/or the superior mesenteric artery and their branch＇s a- natomy and shape. The 3D-DSA had great advantages in observation of the angle between the celiac artery and/or the su- perior mesenteric artery and the abdominal aorta. The 3D-DSA demonstrated the arteriovenous fistula more clearly and more conveniencely. The DynaCT had great advantages in demonstrating the number of the tumor comparing with routine DSA（ P〈0. 05）. Conclusion： The 3D-DSA and the DynaCT were importment guidances to TACE. They can guidethe choice of the cathete

关 键 词：肝细胞癌 C臂CT 三维成像 血管造影术 数字减影 栓塞 

分 类 号：R735.7[医药卫生—肿瘤] R814.42[医药卫生—临床医学]