原发性肝癌TACE术后CT和DSA随访对比分析

Evaluation of CT and DSA follow-up checkups for primary hepatocellular carcinoma after transcatheter arterial chemoembolization:a comparative study

目的评价CT和DSA在原发性肝癌TACE治疗后肿瘤残存和复发的诊断价值。方法对临床确诊45例原发性肝癌患者,分别于1～4次肝癌TACE治疗后1～6个月行CT和DSA复查,2项检查间隔时间为3～5d。分析和比较CT和DSA对肿瘤残存和复发的显示情况。结果碘油沉积形态可分3种类型:密整型,缺损型,稀少型。密整型9例(20.0%,9/45),CT与DSA6个月内复查均未见复发。缺损型32例(71.1%,32/45),32例中DSA示27例病灶残存或复发,CT双期动态增强扫描显示19例残存或复发,CT于动脉期见病灶显著强化者16例,门静脉期进一步强化者3例(提示有门静脉参与供血),DSA发现该区有明显染色及供血,另有8例CT与DSA表现不一致,CT双期增强无强化,但DSA可见肿瘤血供及肿瘤染色;稀少型4例(8.9%,4/45),CT双期增强轻度强化,DSA提示肿瘤为少血供。结论肝癌TACE治疗后CT平扫及双期增强CT扫描可作为显示肿瘤残存和复发的首选检查方法,DSA是观察肿瘤变化和评价疗效的最敏感和特异的方法;两者的结合对病灶的显示和后续治疗作出更好指导。

Objective To compare the clinical usefulness of CT and DSA in evaluating the residual lesion and recurrence of tumor for primary hepatocellular carcinoma（PHC）after transcatheter arterial chemoembolization（TACE）with Lipiodol and to compare the effectiveness between CT and DSA.Methods Forty-five patients with HPC underwent CT and DSA within 1-6 months after 1-4 procedure（s）of TACE. The interval between two examinations was 3-5 days.The detection and demonstration of the residual lesions and the recurrence of tumor on CT and DSA were compared and the results were analyzed.Results The Lipiodol deposition appearance was classified into three patterns：complete compact pattern（n=9, 20%）,defect pattern（n=32,71.1%）and discrete pattern（n=4,8.9%）.In patients with complete compact pattern,no signs of recurrence were found on CT and DSA six months after the procedure.Of 32 patients with defect pattern,signs of recurrence on DSA and on dual-phase CT scans were found in 27 and in 19 respectively.During arterial phase,marked enhancement of the lesion was demonstrated in 16 cases, further enhancement in portal venous phase was manifested in 3 cases,which indicated that the portal vein participated in the tumor feeding.On DSA,the above enhancement areas showed pronounced opacification and vascularization.In another 8 cases,the CT signs and DSA findings were not in accord with each other,the lesions showed no enhancement on dual-phase CT scans but the lesions made their appearance as tumor＇s vessels and opacification.In patients of discrete pattern,only mild enhancement was seen on dual-phase CT scans,indicating that the tumor was of hypo-vascularization.Conclusion Both plain and dual-phase CT scanning can well demonstrate the residual lesions and the recurrence of hepatocellular carcinoma after TACE.Therefore,in evaluating the therapeutic results of TACE,CT study should be considered as the examination of choice.DSA is the most sensitive and specific method for observing and assessing the therapeutic response.A combination of CT and DSA can more effectively guide the clinical treatment.