DSA和CTA在中晚期肝癌血供及灌注研究中的应用  

Apply of DSA and CTA Imaging in the Blood Supply and Dynamic Blood Perfusion of Middle-late Stage Primary Hepatic Carcinoma

作　　者：肖东健 王勇[1] 岳鑫[1] 林玉琳[2] 王金岸[1] XIAO Dong-jian;WANG Yong;YUE Xin(Department of Imaging,Zhongshan Hospital Affiliated To Xiamen University,Xiamen 361004,Fujian Province,China)

机构地区：[1]厦门大学附属中山医院影像科,福建厦门361004 [2]厦门大学附属中山医院磁共振室,福建厦门361004

出　　处：《中国CT和MRI杂志》2020年第3期1-3,10,共4页Chinese Journal of CT and MRI

摘　　要：目的应用DSA和CTA技术探讨中晚期肝癌的血供特点及血流灌注动态变化情况。方法选取我院于2013年1月至2015年1月间收治的28例中晚期肝癌患者为研究对象,对其肝动脉及门静脉等进行DSA及CT血管造影检查,检测患者的血供及血流灌注动态变化情况。结果 DSA和CT血管造影显示所有患者的病灶数目、大小及位置一致。肝动脉造影表现为动脉期多血供,且CTHA例数显著高于DSA肝动脉造影(27 VS 23)(P=0.000);间接门静脉造影表现为门静脉期乏血供,在DSA门脉造影和CTAP上均未发现门脉血供。肝癌组织在CTHA单层动态扫描上呈明显强化,且肝动脉期具有丰富动脉血流灌注,而在CTAP单层动态扫描上呈无明显强化,且肝门静脉期无门脉血流灌注,差异具有统计学意义(P=0.000)。中晚期肝癌患者的DSA和CT血管造影结果显示:弥漫型、结节型及巨块型肝癌病理类型的动脉血供比较,差异无统计学意义(P>0.05),且均未发现门脉血供。结论中晚期肝癌患者以肝动脉供血为主,侧枝动脉供血为辅,门静脉供血较低或无;应用DSA和CT血管造影技术综合评价肝癌的血供特点和血流灌注动态变化,可为介入治疗提供参考依据。Objective To investigate the blood supple characteristics and blood perfusion dynamic change in middle-late hepatic carcinoma by DSA and CT imaging. Methods A total of 28 patients with middle-late hepatic carcinoma were chosen from September 2014 to January 2015, they all underwent digital subtractive angiography(DSA) and computed tomography(CT) examination. During DSA and CT imaging, the blood supply of tumor was measured, and the blood perfusion dynamic changes were performed. Results DSA and CT imaging showed that patients suffered the same lesions number, size and location. Hepatic arteriography showed multiple blood supply in arterial period, and the number of CTHA was significantly higher than that of DSA(27 VS 23)(P=0.000). Indirect portal vein angiography showed no portal vein blood supply in DSA portal vein angiography and CTAP. Liver cancer tissue was significantly strengthen on CTHA monolayer dynamic scanning, and it was rich artery perfusion in hepatic arterial period, but there was no obvious reinforcement on CTAP monolayer dynamic scanning, and there was no perfusion in hepatic portal venous phase, difference has statistical significance(P=0.000). The DSA and CT angiography results show that diffuse type, nodular type and block type artery of liver pathological type of comparison, there was no statistically significant difference(P>0.05), and have not found the portal blood supply. Conclusion The middle-late hepatic carcinoma were mainly supplied by hepatic artery, collateral blood supply of collateral artery and low blood supply of portal vein. DSA and CT angiography were used to comprehensively evaluate the blood supply characteristics and dynamic changes of blood flow perfusion in hepatocellular carcinoma, which could provide reference for interventional therapy.

关 键 词：数字减影血管造影 计算机断层成像 CT血管造影 肝癌 血供 血流灌注 

分 类 号：R735[医药卫生—肿瘤] R814[医药卫生—临床医学]