多层螺旋CT在肝癌肝动脉化疗栓塞中的价值

The value of multislice spiral CT in transcatheter arterial chemoembolization of the hepatocellular carcinoma

目的评价多层螺旋CT(MSCT)在肝癌(HCC)肝动脉化疗栓塞中的价值。方法对54例肝癌患者分别行MSCT和DSA检查,比较病灶、合并症的显示情况和肿瘤的供血来源,MSCT观察腹腔动脉的解剖和走行应用三维容积再现(VRT)、最大信号强度投影(M IP)或多平面重组(MPR)技术。其中,12例进行了CT血管造影(CTA)检查。结果54例肝癌患者MSCT发现病灶225个,门静脉瘤栓10例,动静脉瘘14例;DSA发现病灶216个,门静脉瘤栓形成8例,动静脉瘘18例;MSCT和DSA二者比较,MSCT对肿瘤的数目的显示率略高于DSA,但差异无统计学意义(P>0.05);MSCT能够显示腹腔动脉及其主要分支的三维结构,优于后前位DSA,观察与腹主动脉夹角较DSA更方便;MSCT发现肝动脉起源变异5例,与DSA完全符合。结论MSCT对于肝癌肝动脉化疗栓塞有重要指导意义,选择最佳延迟扫描时间是显示病灶和血管的关键。

Objective To evaluate the value of multisliee spiral CT （MSCT） in transeatheter arterial chemoembelization of the bepatocellular carcinoma.Methods MSCT were performed in 54 eases of HCC before interventional procedure. CT findings of hepatic artery phase, portal venous phase and hepatic venous phase were observed respectively. CTA were done in 12 cases, the anatomy of celiac artery and its branches were observed. The schemes of interventional therapy were worked out according to the findings of MSCT. The demonstration of lesions and its complications were compared between CT and DSA. Reconstruction of celiac artery branches used the technique of VRT, MIP or MPR. Results MSCT showed 225 lesions, 10 cases tumor thrombosis of portal vein, 1 case hepatic arteriovenous shunt , and 13 cases hepatic arterioportal shunt. Positive rate of MSCT in showing number of tumor lesions, tumor thrombosis in portal vein was slightly higher than that of DSA, but there was no significant difference （ P 〉 0. 05 ） . Showing of 3D reconstruction of celiac artery branches in CTA is better than that in DSA, Showing of angles between celiac artery and abdominal aorta in MSCT is more convenient than that in DSA. MSCT showed 5 cases hepatic artery original abnormality . The results were in accord with that in DSA. Five cases were demonstrated of multiple supply blood vessels of tumor in MSCT, It was slightly lower than that of DSA. Conclusion MSCT is of importance for guidance of transcatheter arterial chemoembolization of the hepatocellular carcinoma, delay time of CT scan is the key to the showing of lesions and blood vessels.