320排CT的4DDSA在原发性肝癌血管解剖中的临床应用

Clinical application of 320-row computed tomography 4D digital subtraction angiography in hepatocelluar carcinoma

目的探讨320排CT的4DDSA在原发性肝癌血管成像中的价值。方法对中山大学附属第三医院2009年9月—2010年10月40例肝癌患者进行320排CT增强扫描，重建获得4DDSA图像，对肝动脉正常解剖及变异情况进行观察，并从肿瘤强化情况、供血动脉、瘤染色及瘤血管等方面评估血管与肿瘤的关系，同时与肿瘤供血动脉的DSA图像（20例）进行比较。结果320排CT的4DDSA最多可显示6—7级肝内动脉分支。40例患者的肝动脉解剖及走行正常者35例（MichelSI型）占87．5％（35／40），12．5％（5／40）发现变异。4DDSA与DSA对肝动脉的解剖及变异诊断符合率为100％。40例肝癌患者均出现肿瘤染色，肿瘤血管28例，肿瘤供血动脉26例，3例有两条动脉供血。20例有DSA对照者的320排4DDSA共检出肿瘤供血动脉18支，而DSA共检出肿瘤供血动脉19支。以DSA为标准，320排CT在检出肝癌供血动脉方面的准确性为94．7％（18／19）。结论低对比剂剂量320排CT的4DDSA成像能够精确显示肝动脉解剖及变异，能多角度、重复、立体观察肿瘤与血管的空间关系，且在检出肝癌动脉血供方面与DSA具有良好的一致性，为临床提供一种快速、仿DSA、非损伤性的血管成像检查技术。

Objective To explore the application value of 320-row computed tomography （CT） 4D digital subtraction angiography （DSA） for hepatocellular carcinoma （HCC）. Methods A total of 40 HCC patients received 320-row CT contrast scans. The 4D DSA images were obtained on the basis of baseline data. The normal anatomy and anatomical variations of hepatic artery, tumor supplying arteries, tumor vessels, tumor staining were observed by comparing DSA （ n = 20）. Results 320-row CT 4D DSA could show 6-7 levels of intrahepatic arterial branch. Normal hepatic artery anatomy was found in 35 cases （87.5%, Michels I type） and variations in 5 cases （12. 5% ）. The diagnose accordance rate was 100% between 4D DSA and DSA in showing the anatomy and variation of hepatic artery. Among them, 320-row CT 4D DSA showed tumor staining （n = 40）, tumor vessels （n = 28 ）, tumor supplying arteries （n = 26 ） and two hepatic supplying arteries （ n = 3 ）. The number of tumor supplying arteries observed by 4D DSA （ n = 20） was 18 versus 19 by DSA. Compared with DSA, the accurate rate of4D DSA was 94. 7% （18/19） in detecting tumor supplying arteries. Conclusion As a noninvasive vascular examination modality, 320-row CT 4D DSA can accurately visualize normal anatomy and variation of hepatic artery, dynamically display tumor staining and reproducibly delineate the three-dimension relationship between tumor and blood vessels. In consistency with DSA in detection blood supply of HCC, 320-row CT 4D DSA provides a rapid, DSA-like and non-invasive alternative.