螺旋CT平扫及双期动态增强对肝癌TACE术后的影像评估价值

Imaging estimation of plain and dual-phase enhanced spiral CT scan for hepatocellular carcinoma after TACE treatment

目的探讨肝癌TACE术后螺旋CT平扫及双期增强的评估价值,从而指导再行介入治疗时机。方法搜集临床确诊的肝癌患者43例,行TACE术后4周再行螺旋CT平扫及双期动态增强扫描,观察癌区内碘化油沉积情况,并与血管造影对比分析,观察栓塞区非坏死性低密度灶的强化规律与供应血管关系。结果CT平扫可明确碘油沉积区、坏死液化区及非坏死低密度区,双期动态增强扫描于动脉期见非坏死性低密度区显著强化者38例,血管造影发现该区有残存或再通的肝癌血管或和侧支供血;门静脉期进一步强化者8例,有门静脉参与供血;另有5例双期无明显强化。结论螺旋CT平扫及双期增强可反应肝癌TACE术后瘤体的组织学及供血变化,及时发现肿瘤复发及新病状出现,指导再行TACE治疗时机。

Objective To evaluate the plain and dual-phase enhanced spiral scans of hepatocellular after TACE treatment for guiding the next TACE treatment. Methods Plain and dual-phase enhanced CT scans were performed in 43 patients who had received embolization with lipiodol 4 weeks ago. Compared with the selective angiography, The relationship between CT features and the blood supply of the survival tumor was analyzed. Result The lipiodol deposition, liquefaction necrosis and survival tumor could be identified on CT plain. Marked enhancement of the survival areas in 38 cases during hepatic arterial phase indicated partial racanalization of tumor vessels or the formation of collateral circulation identified by angiography. Further enhancement seen during portal venous phrase represented additional blood supply from portal veins. No enhancement were seen in other cases with dual-phase. Conclution The plain and dual-phase enhanced spiral scans can reflect histologic components and blood supply of tumor, reveal new lesions, and guide the next TACE treatment .