64层螺旋CT在肝癌治疗中的临床应用价值

The clinical application valuation of three dimensional imaging with 64-slice spiral CT in primary hepatic carcinoma therapy

目的:探讨64层螺旋CT三维成像技术在肝癌治疗中的临床应用。方法:采用64层螺旋CT三维成像检查对97例肝癌患者行肝脏增强后的动脉期及门静脉期扫描,重组方法为最大密度投影(MIP)、多平面重建(MPR)、容积再现技术(VR),并与术中探查结果及数字减影血管造影(DSA)做对照观察。结果:97例中癌肿未侵犯邻近组织、血管者69例,肿瘤压迫邻近血管者19例,肝动脉变异38例(39%),肝动脉-门静脉瘘(HAPF)16例,门静脉癌栓11例,合并肝硬化者71例,门静脉海绵样变性2例,除30例患者行TACE治疗外,其余67例均行手术治疗,与术中探查结果相一致者63例,正确率95.5%。在30例同期行DSA检查的肝癌患者中,3级以下肝动脉分支与DSA无显著差异,对4级以上分支的显示不如DSA,在供血动脉、肿瘤血管及血管变异的显示上与DSA完全一致。结论:64层螺旋CT三维成像检查可以很好的显示肿瘤的大小、形态、累及范围,特别能精确判断肿瘤与肝脏血管的关系,充分了解肝脏血管变异情况,对指导外科及介入治疗具有重要价值。

Objective：To study the clinical application and valuation of three dimensional imaging with 64-slice spiral CT in primary hepatic carcinoma therapy.Methods：The 97 patients of primary hepatic carcinoma were scanned with arterial phase and portal vein phase enhancement,the maximum projection,multi-planar reformation and volume rendering were performed.Results：The three dimensional imaging of 97 patients of primary hepatic carcinoma were displayed.The tissue and vessels of 69 patients were not invaded by tumors,the adjacent vessels of 19 patients were oppressed by tumors,the hepatic artery variation of 38 patients（39%）,the fistula of hepatic artery and portal vein（HAPF） in 16 patients,the portal tumor embolus of 11 patients,merging with hepatic cirrhosis of 71 patients,the portal sponge degeneration of 2 patients.The 67 patients were treated by surgery except of the TACE therapy of 30 patients,there were 63 patients in coincidence with the surgery exploration results,the accurate ratio was 95.5%.There were no significant deviation with DSA and three dimensional imaging under 3-grade hepatic artery branch,The three dimensional imaging were lower than DSA above 4-grade of hepatic artery branch,were identical with DSA in feeding artery,tumor vessel and vessel variation.Conclusion：The size,shape and encroachment scope could be showed with three dimensional imaging of 64-slice spiral CT,especially the tumors and the vessels of liver could be evaluated perfectly,the variation of liver vessels were understood thoroughly.There was important value for conducting the surgery and intervention treat.