锥体束CT三维肝动脉造影在TACE术中判断原发性肝癌肿瘤供血动脉的临床价值  

Evaluation of cone-beam CT hepatic angiography in detecting the tumor-feeding arteries during the performance of TACE for HCC

作　　者：胡俊刚[1] 王晓东[1] 朱旭[1] 曹广[1] 陈辉[1] 杨仁杰[1] 

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所介入科,教育部恶性肿瘤发病机制及转化研究重点实验室

出　　处：《介入放射学杂志》2015年第6期481-487,共7页Journal of Interventional Radiology

基　　金：国家自然科学基金面上项目(81271671);2011年度北京市留学人员科技活动择优资助项目(优秀类);北京市卫生系统高层次卫生技术人才培养项目(2013-3-084)

摘　　要：目的准确判断肿瘤供血动脉是实现肝癌超选择性肝动脉化疗栓塞(TACE)的基础。本研究探讨原发性肝癌TACE术中,锥体束CT三维肝动脉造影(cone-beam computed tomography hepatic arteriography,CBCT-HA)对比DSA肝动脉造影(DSA-HA)在判断肿瘤供血动脉的价值。方法 23例原发性肝癌患者入组研究。术中分别进行DSA-HA、CBCT-HA、碘油-TACE(Lip-TACE)、碘油CBCT(LipCBCT)。2名有经验的介入科医师共同分析DSA-HA和CBCT-HA影像学资料,判断肿瘤供血动脉。卡方检验进行统计学分析。结果 75个肿瘤通过金标准确定肿瘤供血动脉。DSA-HA确认肿瘤供血动脉(阳性)40个,其中真阳性32个,假阳性8个。CBCT-HA确认肿瘤供血动脉(阳性)72个,其中真阳性68个,假阳性4个。CBCT-HA对肿瘤供血动脉判断的灵敏度为68/75(90.7%),明显高于DSA-HA(32/75,42.7%)(P<0.001);阳性预测值(68/72,94.4%),亦高于后者(32/40,80.0%)(P=0.040)。结论 CBCT-HA对肝癌肿瘤供血动脉的判断明显优于传统DSA-HA,对超选择性TACE治疗有明显的临床指导意义。Objective To accurately judge the tumor-feeding artery is the most important basis for a successful treatment of hepatocellular carcinoma（HCC） with super-selective hepatic arterial chemoembo lization therapy. This study aims to assess the clinical value of cone-beam CT hepatic arteriography（CBCTHA） in detecting tumor-feeding arteries during the performance of conventional transarterial chemoembo lization（TACE）, and to compare the diagnostic effects between CBCT-HA and non-selective hepatic DSA.Methods Twenty-three consecutive patients with inoperable HCC were enrolled in this study. TACE was carried out in all patients. During the performance of TACE, the DSA-HA, CBCT-HA, Lipiodol-TACE and Lipiodol-CBCT were performed separately. The imaging materials, including DSA-HA and CBCT-HA, were analyzed by two experienced interventional physicians together to judge the tumor-feeding arteries. Statistic analysis was conducted by using chi square test. Results Tumor stain and lipiodol accumulation were regarded as the ＂gold standard＂ of the presence of tumor-feeding artery, based on which the tumor-feeding artery was confirmed in 75 lesions. DSA-HA demonstrated positive tumor-feeding artery in 40 lesions, among which true-positive tumor-feeding artery was seen in 32 and false-positive one in 8. CBCT-HA showed positive tumor-feeding artery in 72 lesions, which included true-positive tumor-feeding artery in 68 and false-positive one in 4. The sensitivity of CBCT-HA in judging tumor-feeding artery was 90.7%（68/75）, which was much higher than that of DSA-HA（42.6%, 32/75）, the difference was statistically significant（P〈0.001）.The positive predictive value of CBCT-HA in detecting tumor-feeding artery was also higher than that of DSA-HA（94.4% vs. 80.0%; P =0.040）. Conclusion Cone-beam CT hepatic arteriography is obviously superior to DSA hepatic arteriography in identifying tumor-feeding arteries, which is very helpful in guiding super-selective TACE for HCC.

关 键 词：CBCT肝动脉造影 DSA肝动脉造影 原发性肝癌 肝动脉化疗栓塞术 

分 类 号：R735.7[医药卫生—肿瘤]