锥形束CT联合三维重建技术与传统的血管造影在肝动脉化疗栓塞术中的比较研究  

Cone-beam CT with three-dimensional reconstruction techniques versus conventional digital subtraction angiography in transcatheter arterial chemoembolization of hepatocellular carcinoma

作　　者：高龙[1] 邵海波[1] 马腾闯 倪尔会[1] 吴文颖[1] 苏洪英[1] 徐克[1] 

机构地区：[1]中国医科大学附属第一医院介入放射科,辽宁沈阳110001

出　　处：《影像诊断与介入放射学》2015年第1期29-33,共5页Diagnostic Imaging & Interventional Radiology

摘　　要：目的探讨在肝动脉化疗栓塞术(TACE)中联合应用锥形束CT(CBCT)与三维重建技术的价值,同时与传统的血管造影(DSA)作比较。方法收集我院36例接受超选择TACE的原发性肝癌患者。16例患者(35处病灶)在术中行CBCT。运用三维血管造影、三维路图和多平面重建技术来指导手术并评价栓塞效果。其余20例患者(44处病灶)术中行传统的血管造影。分别评价和比较两种方法辨别肿瘤供血动脉、病灶检出、超选择插管的技术成功率、手术时间、患者的累计受辐射量、对比剂用量及碘油沉积等情况。参考标准为术后1个月的增强CT。结果所有手术均顺利完成,没有出现严重的手术相关并发症。所有的病人都接受了术后1个月的CT随访。CBCT联合三维重建技术在显示肿瘤供血动脉、病灶的检出和超选择插管的技术成功率方面均优于DSA(100%比75%,P=0.031;97.14%,34/35比70.45%,31/44,P=0.002;93.75%比65%,P=0.039),且CBCT组患者的对比剂用量较少(30.38比34.05 ml,P=0.134)。尽管如此,CBCT组的手术时间及该组患者受辐射剂量均多于DSA组(43.88比33.55 mins,P<0.001;240.88比155 m Gy,P<0.001)。在碘油沉积评价方面,CBCT组明显优于DSA组(91.43%比66%,P=0.007)。结论与DSA相比,TACE术中行CBCT联合3D重建技术在识别肿瘤供血动脉、病灶检出、指导超选择插管及碘油栓塞评价方面均表现出良好的临床应用价值,但这会以延长手术时间及增加患者的受辐射剂量为代价。Objective To evaluate the efficacy of cone-beam computed tomography （CBCT） with three-dimensional （3D） reconstruction techniques in transcatheter arterial chemoembolization （TACE） of hepatocellular carcinoma （HCC）. Methods 16 patients with 35 HCC were randomly selected to undergo CBCT angiography with 3D-roadmap and multi-planar reconstruction （MPR） and no conventional digital subtraction angiography （DSA） whereas 20 patients with 44 HCC underwent DSAduring super-selective TACE..The two methods for guiding TACE were retrospectively compared by follow-up contrast-enhanced CT at 1 month. Results TACE was successful in all patients without serious complications. .3D CBCT was significantly better at demonstrating the feeding arteries （100%） and HCC lesions （97.14%） with higher success rate of super-selective catheterization （93.75%） than DSA （75.0%, 70.45%, 65.0%）. The amount of contrast agent required was not significantly lower with CBCT （30.38 mL） than that of DSA （34.05 mL）. The duration of TACE with CBCT （43.88 minutes） was significantly （P〈0.001） longer with significantly （P〈0.001） higher radiation exposure （241 mGy） than those with DSA （33.55 minutes,155mGy）. Lipiodol deposition of CBCT （91.43%） was significantly （P=0.007） higher than that of DSA （66%）. Conclusion CBCT with 3D reconstruction techniques is superior to DSA for demonstrating the feeding artery and lesions,.guiding catheterization and evaluating effect of embolization in TACE of HCC with longer procedure time and radiation exposure.

关 键 词：锥形束CT 血管造影术 肝动脉栓塞术 三维重建 原发性肝癌 

分 类 号：R735.7[医药卫生—肿瘤]