C-臂CT在骶骨肿瘤动脉栓塞中的应用  

Application of C-arm CT in arterial embolization of sacral tumors

作　　者：余寅涛 陈祥述[1] 常承[1] 彭晓新[1] YU Yin-tao;CHEN Xiang-shu;CHANG Cheng;PENG Xiao-xin(Department of Radiology,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院放射科

出　　处：《影像诊断与介入放射学》2019年第6期433-438,共6页Diagnostic Imaging & Interventional Radiology

摘　　要：目的通过分析C-臂CT在骶骨肿瘤动脉栓塞中的应用,探讨其临床价值。方法回顾我院2016年~2019年62例接受骶骨肿瘤介入治疗的患者,所有患者均行病理诊断,其中骨巨细胞瘤47例(40例原发,7例复发);脊索瘤5例;血管瘤2例;尤文氏肉瘤1例;动脉瘤样骨囊肿7例,术前均行增强MSCT检查,其中43例介入前行C-臂CT检查,通过比较是否使用C-臂CT的两组病例,观察C-臂CT的诊断信息、图像质量;采用独立样本t检验,比较X射线总辐射剂量以及后续手术的出血量。结果31例患者根据C-臂CT检查调整了介入治疗计划;C-臂CT图像质量的逊于MSCT并且所有图像均有不同程度伪影,但对诊断没有明显影响。C-臂CT组平均射线剂量825.3±448.0 mGy,未使用C-臂CT平均射线剂量1620.6±767.4 mGy(P<0.01),应用C-臂CT明显减少了手术使用的射线剂量。37例术前栓塞患者,后续手术全部成功,未出现切口不愈合等介入相关并发症,C-臂CT组平均出血量1943±2131 ml,未使用C-臂CT组平均出血量2560±1648 ml,差异没有统计学意义(P=0.34)。C-臂CT可准确判断肿瘤供血情况,其对目标血管是否需要栓塞的预测准确度高于MSCT,减少了对可疑血管的造影,并可提供更多的目标血管影像信息,降低了插管难度。利用C-臂CT在保证介入治疗质量的前提下,大大简化了手术操作,减少X射线剂量。结论在骶骨肿瘤的介入治疗中,C-臂CT可提供更多的有效影像学信息,在保证手术质量的前提下,提高了介入治疗的效率及安全性。Objective To assess the clinical value of C-arm CT in sacral tumor embolization.Methods From 2016 through 2019,62 patients with sacral tumors underwent interventional therapy.All patients had pathologically confirmed diagnosis of giant cell tumors(40 primary,7 recurrent),chordomas(5),hemangiomas(2),Ewing’s sarcoma(1),and aneurysmal bone cysts(7)of the sacrum.Contrast-enhanced multi-slice CT(MSCT)was performed on all patients including C-arm CT examination(43)before interventional therapy.The image quality with and without C-arm CT were compared qualitatively.Independent sample t test was used to compare the total X-ray radiation dose and bleeding during post-operative follow-up.Results The treatment plans of 31 patients were adjusted according to C-arm CT examination.The image quality of C-arm CT was inferior to that of MSCT.All patients had varying degrees of artifacts on C-arm CT images with little influence on diagnosis.The average radiation dose in the Carm CT group(825.3±448.0 mGy)was significantly lower(P<0.01)than that of the group without C-arm CT(1620.6±767.4 mGy).In 37 patients with preoperative arterial embolization,the follow-up surgery was successful in all patients without complications related to interventional therapy such as wound non-union.The average blood loss in C-arm CT group(1943±2131 mL)was not significantly lower(P=0.34)than that of non-C-arm CT group(2560±1648 ml).Conclusion In the interventional treatment of sacral tumors,C-arm CT can accurately determine the vascular supply for pre-operative embolization,facilitate surgery,and reduce the radiation exposure.

关 键 词：体层摄影术 X线计算机 骶骨 肿瘤 栓塞 

分 类 号：R738[医药卫生—肿瘤] R730.44[医药卫生—临床医学]