C臂锥形束CT成像在前列腺动脉栓塞术中的应用价值

Application of cone-beam CT in prostatic arterial embolization

目的探讨C臂锥形束CT成像在前列腺动脉栓塞术（PAE）中的应用价值。方法回顾性分析接受PAE的81例中、重度前列腺增生患者的DSA和C臂锥形束CT资料。81例患者的162侧髂内动脉中，6侧因图像质量欠佳而剔除，156侧髂内动脉的DSA和C臂锥形束CT资料纳入分析。对比观察DSA和C臂锥形束CT成像中的PA数目、起源及与邻近动脉的吻合支。采用χ2检验比较DSA和C臂锥形束CT对血管显示率的差异。结果156侧髂内动脉的选择性前列腺动脉（PA）DSA和C臂锥形束CT成像共确认161支PA，其中C臂锥形束CT准确辨认的PA为158支（98．1％，158／161），经DSA准确辨认的PA为130支（80．8％，130／161），差异有统计学意义（X2=25．78，P〈0．05）。27侧（17．3％，27／156）髂内动脉发出的28支PA（17．4％，28／161）仅在髂内动脉前干的C臂锥形束CT成像中得以辨认；有3支PA（1．9％，3／161）仅在DSA中得以辨认，差异有统计学意义（χ2=22．31，P〈0．05）。单纯依靠DSA认定的137支PA中，有7支（5．1％，7／137）经C臂锥形束CT成像排除。11侧（7．1％，11／156）髂内动脉发出的PA仅在C臂锥形束CT成像中得以辨认其起源，其余145侧（92．9％，145／156）髂内动脉发出的PA在DSA和C臂锥形束CT成像中均可辨认其起源。C臂锥形束CT成像确定的PA与邻近动脉存在吻合支的比率为42．3％（66／156），高于单纯DSA的观察结果（31．4％，49／156），差异有统计学意义（χ2=3．98，P〈0．05）。结论C臂锥形束CT成像对PAE术中准确辨认前列腺动脉及其起源、吻合有重要价值。

Objective To explore the utility of cone-beam CT in the evaluation of prostatic arterial embolization （PAE）. Methods In a retrospective study, images of DSA and cone-beam CT for PAE in 81 patients with moderate to severe grade benign prostatic hyperplasia were evaluated. In 162 cases of internal iliac arteries （ Ⅱ As） in 81 patients, images of 6 Ⅱ As were excluded due to the technical problems. Therefore, images of 156 Ⅱ As were included for evaluation. We aim to evaluate the utility of cone-beam CT versus DSA in differentiating PAs and their origins, and demonstrating anastomoses with adjacent arteries. Statistical analyses were performed with Chi-square test to compare the rate of demonstrating vessels between cone-beam CT and DSA. Results One hundred and sixty-one PAs were demonstrated in 156 Ⅱ As by selective DSA and Cone-beam CT. Cone-beam CT and DSA images demonstrated 158 （98.1%, 158/161） and 130 （80.8%, 130/161） PAs, respectively. The statistical difference was significant （χ2=25.78, P〈0.05）. PAs were demonstrated by cone-beam CT images alone in 27 Ⅱ As （17.3%, 27/156） and were demonstrated by DSA images alone in 3 Ⅱ As （1.9%, 3/161）.The statistical difference was significant （χ2=22.31, P〈0.05）. In 137 PAs that were initially defined by DSA alone, 7 of those （5.1%, 7/137） were eventually proven not to be PAs by further selective cone-beam CT acquisitions. Origins of PAs were shown by Cone-beam CT images alone in 11 Ⅱ As. In the remaining 145 Ⅱ As （92.9%, 145/156）, origins of PAs were shown by both cone-beam CT and DSA images. The percentage of PA anastomoses demonstrated by cone-beam CT was 42.3% （66/156）, which was higher than DSA （31.4%, 49/156）. The statistical difference was significant （χ2= 3.98, P〈0.05）. Conclusions Cone-beam CT is useful in demonstrating PAs and their origins from Ⅱ As, as well as anastomoses with adjacent arteries.