C臂CT在经导管动脉化疗栓塞术治疗肝脏恶性肿瘤中的应用

Application of C-arm CT in transcatheter arterial chemoembolization for hepatic malignancies

目的探讨平板探测器C臂CT在TACE治疗肝脏恶性肿瘤中的应用价值。方法 38例肝脏恶性肿瘤患者在常规DSA基础上接受C臂CT检查,观察C臂CT是否能提供更多影像信息及其对介入治疗方案的影响;对C臂CT图像进行伪影分级评分并对其中28例患者C臂CT图像与近期MSCT图像比较,评价其图像质量;分析观察者间一致性。结果与常规DSA比较,C臂CT为26例(26/38,68.42%)提供了更多的影像信息,9例(9/38,23.68%)最初通过常规DSA制定的介入治疗方案因而改变;C臂CT图像质量评分为2.68,稍差于MSCT。所有患者C臂CT图像均有不同程度伪影。在C臂CT图像质量、伪影等级评分、C臂CT是否提供额外影像信息及对介入治疗方案的影响方面,观察者之间有良好的一致性(Kendall's W系数分别为0.78、0.84、0.73及0.67)。结论平板探测器C臂CT可在常规DSA基础上提供更多的影像信息,有助于提高肝脏恶性肿瘤TACE的疗效及安全性。

Objective To observe the potential value of C-arm CT equipped with a flat-panel detector on TACE for hepatic malignancies.Methods Thirty-eight patients with hepatic malignancies underwent C-arm CT examination as an adjunct to conventional DSA before TACE.Whether C-arm CT could provide more information than DSA and its impact on hepatic interventional procedures were evaluated.The artifact score of C-arm CT in all patients were classified and the image quality of C-arm CT in 28 patients was assessed with the images of MSCT.Interobserver agreement was analyzed.Results Compared with conventional DSA,C-arm CT could provide additional imaging information in 26 cases（26/38,68.42%）,and altered interventional procedures in 9 cases（9/38,23.68%）.The average score of C-arm CT image quality was 2.68,lower than that of MSCT.Artifacts with different degrees occurred on C-arm CT in all patients.In the image quality,artifact classify score of C-arm CT,whether C-arm CT could provide more information and impact on interventional procedures,interobserver agreement between the two radiologists were good with Kendall＇s W values of 0.78,0.84,0.73,0.67,respectively.Conclusion C-arm CT equipped with a flat-panel detector can provide more important image information than DSA,and contributes to improve the efficiency and safety of TACE in patients with hepatic malignancies.