消化道肿瘤肝转移的DSA表现及其临床意义

The DSA appearance and clinical significance in liver metastases generated from malignant tumor of alimentary tract

目的通过分析消化道恶性肿瘤肝转移的DSA表现,明确肿瘤血供情况,指导介入治疗。方法分析69例消化道恶性肿瘤肝转移介入治疗前的DSA图像,包括动脉期、实质期及门静脉期图像。同时收集原发性肝癌20例作为对照组。结果69例肝转移瘤中,血供丰富15例(21.7%),血供中等22例(31.9%),血供稀少32例(46.4%),部分病例呈混杂型血供;团块状染色13例(18%),蜂窝状32例(46%),结节状18例(25%),环状43例(61%),部分病例呈两种或以上染色方式;少数病例于动脉期无异常改变,仅在门静脉期显影染色;上、下消化道恶性肿瘤肝转移灶在血供类型、染色方式无差异;单、少结节组与多结节组在血供类型、染色方式上有差异。结论消化道恶性肿瘤肝转移常为多发病灶,以环形染色为主,右叶分布占优势;其DSA表现不一,诊断必须综合考虑;对于由门静脉供血的瘤体应通过间接门静脉灌注方式给药,对于血供稀少的瘤体应结合非血管性介入治疗。

Objectives To evaluate the DSA appearance of liver metastases generated from the malignant tumor of alimentary tract,explicating the tumor blood supply,gniding the interventional therapy, Methods To analyze the DSA appearance of 69 liver metastases retrospectively, collecting and analyzing the picture during the artery period,substance period and portal vein period;Collecting the 20 patients with primary hepatic carcinoma as the control.Result The study showed that in 69 cases,15 （21.7%）cases were hypervascular, 22（31.9%）cases were moderate vascular and 32（46.4%）cases were hypovascular,some cases presented the mixed type of blood supply;the staining pattern was 13 cases（18%）with bolus form,32（46%）with honey form, 18（25%）with nodular form,43（61%）with circular form,respectivdy.Some cases presented two kinds of or more staining pattern;A little amount cases showed no-change in the artery period ,just to staining in vein period;there was not significantly defferent in blood supply of metastasis generated from upper or lower gastrointestinal tract,the blood supply and the staining form were significantly different between hypo-nodule and multi nodule group.Conclusion The liver metastases generated from the malignant tumor of alimentary tract were often multi-foci,major in circular form staining,more distributing in the right liver;diagnosis must synthesize the clinical data because of its various DSA appearance：the angiography time, should be enough long;Infusion should be performed through indirect portal vein for these foci which blood providing from portal vein.For these hypovascular tumor, the non-vascellum interventional therapy should be combined.