320排容积CT评估原发性肝癌供血动脉的临床应用

The clinical application of 320-row volume CT in evaluating the blood supply arteries of primary hepatocellular carcinoma

目的探讨320排容积CT(DVCT)评估肝癌供血动脉的价值。方法回顾性分析410例行TACE治疗的肝癌患者临床资料,术前2周行320排DVCT腹部CT多期增强检查,利用动脉期CT血管成像对肿瘤供血动脉进行观察分析,以DSA检查结果为对照进行比较。结果410例患者中经CT检查发现血供变异91例(100支血管),肝动脉解剖变异供血59例(62支血管)和寄生性供血34例(38支血管)。经DSA检查发现血供变异93例(102支血管),其中肝动脉解剖变异57例(60支血管)和寄生性供血37例(42支血管)。经CT指导后DSA共发现血供变异的95例(108支血管),肝动脉解剖变异和寄生性供血分别为59例(62支血管)、38例(46支血管)。以经CT指导后DSA结果为对照,CT检查的病例数和血管支数检出准确率为95.7%(91/95)、92.6%(100/108);DSA检查的病例数和血管支数检出准确率为97.9%(93/95)、94.4%(102/108),差异均无统计学意义(均P>0.05)。肝动脉解剖变异病例数和寄生性供血血管支数CT的检出准确率分别为100%(59/59)、82.6%(38/46),DSA检出准确率分别为96.6%(57/59)、91.3%(42/46)。结论320排DVCT可以清晰的显示肝癌的供血动脉,提供充分并直观的肿瘤供血动脉的解剖形态学信息,使TACE术前全面了解肿瘤的供血血管起源及其走行、形态,为TACE治疗提供供血动脉的精准预判,对TACE治疗具有重要的临床意义。

Objective To discuss the the clinical application value of 320-row dynamic volume CT(DVCT)in evaluating the blood supply arteries of primary hepatocellular carcinoma(PHC).Methods The clinical data of 410 PHC patients,who were treated with TACE,were retrospectively analyzed.Multi-phase enhanced abdominal 320-row DVCT scanning was performed in all patients two weeks before TACE.On the arterial phase CT vascular images,the tumor-feeding arteries were determined and analyzed,and the findings were compared with the DSA manifestations.Results In the 410 patients,CT examination demonstrated blood supply variation in 91 patients(100 vessels in total),including anatomical variation of the hepatic artery(n=59,62 vessels)and parasitic blood supply(n=34,38 vessels).DSA examination revealed blood supply variation in 93 patients(102 vessels in total),including anatomical variation of the hepatic artery(n=57,60 vessels)and parasitic blood supply(n=37,42 vessels).With the help of CT findings,DSA examination detected blood supply variation in 95 patients(108 vessels in total),including anatomical variation of the hepatic artery(n=59,62 vessels)and parasitic blood supply(n=38,46 vessels),which were used as the referring standard.The analysis showed that the accuracy rates of DVCT in detecting the patients with the blood supply variation and in detecting the variation vessels were 95.7%(91/95)and 92.6%(100/108)respectively,while the accuracy rates of DSA in detecting the patients with the blood supply variation and in detecting the variation vessels were 97.9%(93/95)and 94.4%(102/108)respectively.There were no statistically significant differences in the accuracy rates of detecting the patients with the blood supply variation and detecting the variation vessels between DVCT and DSA(P>0.05).The detection rates of anatomical variation of the hepatic artery and parasitic blood supply by DVCT were 100%(59/59)and 82.6%(38/46)respectively,which were 96.6%(57/59)and 91.3%(42/46)respectively by DSA.Conclusion 320-row DVCT scan can clearly display the blood supply arteries of PHC,providing sufficient and intuitive anatomical information of tumor-feeding arteries,thus,the origin,path route and morphology of the tumor-feeding arteries can be fully,clearly and precisely observed before TACE,which is of great clinical significance for TACE therapy.