不同角度数字减影血管造影技术在肝癌介入治疗中的应用

Evaluation on different angle(DSA) in an interventional procedure of liver neoplasm

目的:探讨不同角度数字减影血管造影术(DSA)在肝癌经动脉介入栓塞术中的应用价值。方法:采用C型臂X线机系统,对52例原发性肝癌患者在介入栓塞治疗前后分别行肝固有动脉常规DSA及不同角度DSA,比较两种方法显示肝内肿瘤供血动脉和小病灶个数的差异,并分析小肝癌与非肿瘤性肝动脉门静脉分流在不同角度DSA中的鉴别诊断征象。结果:常规DSA显示病灶62个,有21例患者肝亚段动脉因相互重叠而不能被独立分辨,18例因多支动脉分支与肿瘤位置重叠而不能确认肿瘤供血来源。不同角度DSA显示病灶66个,发现4个常规DSA漏诊的小病灶,在50例中清晰显示了肝亚段动脉的结构和复杂的肿瘤供血动脉及其走行。两种方法显示肝内肿瘤供血动脉比较,χ2=12.64,P<0.05。结论:不同角度DSA能够多方位清晰显示迂曲走行的动脉和重叠隐匿的较小的肿瘤病灶,提高小病灶检出率,对小肝癌与非肿瘤性肝动脉门静脉分流鉴别诊断很有帮助,与常规DSA结合使用有助于提高肝癌经肝动脉栓塞化疗治疗的质量。

Objective To discuss the application value of different angle angiography digital subtraction（DSA） technique in the interventional management of liver neoplasm.Methods With philips Allrua DSA unit,both conventional and different angle DSA angiography of the proper hepatic artery were performed in 52 patients with liver neoplasm who were divided into control group and different angle DSA group before and after the interventional management.Numbers of lesions and tumor-feeding artery were compared between the images of the two groups.Differential diagnosis signs on small liver cancer and arterioportal shunt by different angle DSA were studied.Results 62 focuses of the liver neoplasm were displayed in control group,the tumor-feeding artery could not be clearly displayed due to excessive tortuosity of the vessels in 18 patients,sub-segmental branches of hepatic artery could not be clearly resolved due to interlay in 21 patients;66 focuses of the liver neoplasm were displayed in different angle DSA group,sub-segmental branches of hepatic artery could be demonstrated satisfactorily in 50 patients.Different angle DSA revealed 4 small lesions,which were missed by conventional angiography.The tumor arteries and lesions were observed and analyzed using χ^2 test（χ^2=12.64,P〈0.05）.Conclusions The different angle DSA can well display tumor-feeding arteries from different angles and detect small lesions which were overlapped on conventional images.As an important supplementary means,different angle DSA is of great help to improve the successful rate of super-selective catheterization.It is helpful about differential diagnosis between small liver neoplasm and APS.Combined application of different angel DSA with conventional DSA will help to improve transcatheter arterial chemo-embolization efficiency.