C形臂碘油CT在肝癌肝动脉化疗栓塞术中的应用价值

Application value of C-arm lipiodol CT in transhepatic arterial chemoembolization for hepatocellular carcinoma

目的探讨C形臂碘油CT在肝癌肝动脉化疗栓塞术（TACE）中的应用价值。方法对40例肝癌患者,先行64层CT扫描,再行TACE术。术中先行数字减影血管造影（DSA）,然后注入超液态碘化油行诊断性栓塞,即刻行C形臂CT平扫,如发现有明确的肝癌病灶,再经微导管超选择插至病灶的肿瘤供养血管并注入明胶海绵颗粒栓塞。TACE术后7~14 d内复查CT（碘油CT）。由4名医师分别对64层CT、DSA、C形臂碘油CT和碘油CT的图像进行读片,并对肝癌病灶分别计数。以碘油CT的评价标准判断C形臂碘油CT的结果。TACE前后甲胎蛋白（AFP）含量比较采用配对t检验。结果 40例患者64层CT发现13个可疑病灶;DSA确诊10个病灶,发现4个可疑病灶;C形臂碘油CT发现71个病灶;碘油CT确诊67个病灶。TACE前后的AFP值分别为（452.3±192.6）μg/L和（223.8±93.2）μg/L,差异有统计学意义（t=2.131,P=0.039）。结论 C形臂碘油CT在TACE术中可早期发现肝癌微小病灶,使患者得到早期治疗。

Objective To investigate the application value of C-arm lipiodol CT in transhepatic arterial chemoembolization（TACE） for hepatocellular carcinoma transhepatic arterial chemoembolization（HCC）. Methods Totally 40 HCC patients diagnosed clinically underwent TACE after 64-slice CT. Digital substraction angiography（DSA） was fi rstly done then lipiodol was injected into hepatic arterial for diagnostic embolization during TACE. Then C-arm lipiodol CT was done after diagnostic embolization immediately. If HCC lesions were diagnosed, gelfoam particle was superselective injected into the tumor nourishing blood vessel through microcatheter. Lipioldol CT was performed in 7-14 days after TACE. Images acquired with 64-slice CT, DSA, C-arm lipiodol CT and lipiodol CT were retrospectively reviewed by 4 doctors. The number of detected lesions in each examination was counted respectively. Lipiodol CT images were used as the diagnostic reference for C-arm lipiodol CT. AFP was examined before and after TACE. Results 64-slice CT detected 13 doubtful lesions, DSA detected 10 defi nite and 4 doubtful lesions, C-arm lipiodol CT detected 71 and lipiodol CT detected 67 definite lesions. The AFP value was（452.3±192.6）μg/L and（223.8±93.2）μg/L before and after TACE. Statistical difference was found（t=2.131, P=0.039）. Conclusions C-arm lipiodol CT can detect micro HCC lesions early in TACE, so the patients can receive early treatment.