血管造影CT在肝海绵状血管瘤介入治疗中的应用

Application of CT angiography in the hepatic cavernous hemangioma

目的利用血管造影CT及VR重建技术探讨肝海绵状血管瘤血供方式,借以指导临床选择适当的介入方法,并预测单纯肝动脉栓塞术的远期疗效。方法确诊的肝脏海绵状血管瘤患者11例,共26个病灶。每位患者均行CTA、CTAP及常规DSA造影。以肝固有动脉DSA为金标准,对CT三维重建图像进行评估,并判定肿瘤血管。结果本研究26个病灶均见肝动脉分支进入肿瘤内;未见门静脉分支进入瘤体。VR重建与DSA图像有很好的符合率。结论肝动脉是肝海绵状血管瘤重要的供血血管。HAE对绝大多数肝海绵状血管瘤有效。血管造影CT基础上的VR三维重建对HAE选择靶血管具有重要的指导意义。利用VR重建图像,结合肝固有动脉及间接门静脉DSA图像可以推测单纯HAE的远期疗效。

Objective To illustrate the blood supply of the hepatic cavernous hemangioma using three-dimensional volume-rendered multidetector CT angiography,in order to conduct the clinical interventional therapy and to evaluate late result of transcatheter arterial embolization. Methods Eleven patients were diagnosed by an uniform standard of imagiology. All patients were examined by CT arteriography （ CTA ）, CT during arterialportography （ CTAP ） , DSA and volume-rendered based on CT angiography. Three radiologists appraised the blood supply of the tumor through volume-rendered based on CTA or CTAP and compared these three-dimensional imagings with DSA independently. Results The imagings of the hepatic artery DSA and volume-rendered based on CTA showed that the tumor blood was supplied by the hepatic artery. The imagings volume-rendered based on CTAP showed filling defect in the region of the tumor. Conclusion The hepatic artery play an important role in the blood supply of the cavernous hemangioma of the liver,but the portal vein is lesser. The transcatheter arterial embolization is mostly utility for the hepatic cavernous hemangioma. But it is ineffective for the tumors with slight hepatic blood sinus were showed. The late result of transcatheter arterial embolization can be evaluated by the imagings three-dimensional volume-rendered based on CTAP.