胃左动脉参与肝细胞癌供血的双源CT血管成像研究

Evaluation of hepatocellular carcinoma supplied by the left gastric artery with dual-source CT angiography

目的:探讨胃左动脉(LGA)参与肝细胞癌(HCC)供血的影响因素。方法:采用双源CT对91例左叶HCC患者进行血管成像扫描,采用MPR、CPR、MIP、VR等后处理技术重建LGA。分析LGA参与HCC供血与病灶大小、位置、假包膜的完整性及接受经导管动脉化疗栓塞(TACE)治疗的关系。结果:91例患者共计104个HCC病灶,23个病灶有LGA参与供血,发生率为22.1%。23个有LGA参与供血的HCC病灶中,19个为巨块型,4个为结节型,22个突破了肝被膜,17个接受了TACE治疗,23个病例均无完整假包膜。LGA参与供血的形式包括:通过左叶肝动脉供血3个,通过左叶副肝动脉供血5个,直接发出分支进入瘤体15个。结论:LGA是常见的左叶HCC肝外侧支动脉,其发生与肿瘤较大、突破肝被膜、缺乏完整假包膜和接受TACE治疗有关。

Objective：To investigate the incidence and influential factors of hepatocellular carcinoma（HCC） supplied by the left gastric artery.Methods：91 patients with HCC in left lobe were prospectively included in the study.Standardized dual-source CT（DSCT） multi-phases acquisition was performed for all patients.Thin slice source images were reconstructed using techniques of multi-planar reconstruction,curved planar reconstruction,maximum intensity projection and volume rendering to display the left gastric artery.The images were interpreted by three experienced abdominal radiologists.The incidence of HCC fed by LGA and factors like the size,location,pseudocapsule of HCC lesions and previous history of transarterial chemoembolization（TACE） therapy were analyzed.Results：There were 23（22.1%） cases supplied by LGA in 91 patients with a total of 104 HCC lesions,while 19 lesions were type macro-mass compared with 4 lesions as type nodus,22 lesions invaded Glisson capsule and 17 lesions had previous history of TACE therapy.All lesions had no unbroken pseudocapsule.LGA participated in HCC blood supply by left lobe hepatic artery（n=3） and accessory left lobe hepatic artery（n=5） originated from LGA,as well as branch direct supplying the lesions（n=15）.Conclusion：LGA is common extrahepatic collateral artery of left lobe HCC and the presence is significantly correlated with the tumor size,the location,the status of pseudocapsule and history of TACE therapy of HCC lesion.