锥形束CT增强扫描在结直肠癌肝转移瘤TACE术中的指导作用

Role of contrast-enhanced CBCT scanning in guiding TACE for colorectal cancer liver metastases

目的:研究锥形束CT(CBCT)增强扫描在指导结直肠癌肝转移瘤肝动脉化疗栓塞术(TACE)中的作用。方法:将我院2017年1月至2020年5月间收治的140例行TACE治疗的直肠癌肝转移瘤患者纳为研究对象,所有患者均行术前磁共振(MRI)检查、术中数字剪影血管造影(DSA)及CBCT检查,统计不同的影像学方法在提示肝转移瘤数目及其供血动脉中的价值。结果:术前MRI共发现201个肿瘤病灶,术中DSA共发现213个病灶,术中CBCT共发现239个肿瘤病灶,其中118例患者术前MRI与术中CBCT检查结果一致,125例患者术中DSA检查与CBCT检查出肿瘤个数一致。DSA可明确184个肿瘤供血动脉,CBCT可明确221个肿瘤供血动脉,两者均未能对其中12个肿瘤供血动脉进行显示,术中CBCT显示肿瘤供血动脉的敏感度为92.47%(221/239),DSA明确肿瘤供血动脉的敏感度为76.99%(184/239)。140例患者239个结肠癌转移瘤经栓塞后行CBCT平扫,结果显示,其中163个转移瘤与术前影像学强化范围沉积一致,呈环形沉积。76个转移瘤呈轻微环形染色,与术前影像学相比,强化范围沉积较差,均给予第二次栓塞治疗。结论:CBCT应用于TACE术中能有效提示直肠癌肝转移瘤个数及转移瘤供血动脉,并在评估肿瘤栓塞效果中也具有良好应用价值。

Objective:To investigate the role of contrast-enhanced cone beam CT(CBCT)scanning in guiding transcatheter hepatic arterial chemoembolization(TACE)for colorectal cancer liver metastases.Methods:A total of 140 patients with colorectal cancer liver metastases who underwent TACE in our hospital from January 2017 to May 2020 were enrolled.Preoperative magnetic resonance imaging(MRI),intraoperative digital subtraction angiography(DSA),and CBCT were performed.Then the value of different methods in examining the number of liver metastases and blood supply arteries was analyzed.Results:A total of 201 tumor lesions was found by preoperative MRI,213 lesions were found by intraoperative DSA,and 239 tumor lesions were found by intraoperative CBCT.Among them,the results of preoperative MRI and intraoperative CBCT were consistent in 118 patients,and the number of tumors detected by DSA and CBCT was consistent in 125 patients.DSA could identify 184 tumor feeding arteries and CBCT could identify 221 tumor feeding arteries,while both methods failed to display 12 of the tumor blood arteries.In detecting the number of blood supply arteries,the sensitivity of intraoperative CBCT was 92.47%(221/239),and the sensitivity of DSA was 76.99%(184/239).A total of 140 patients with 239 colon cancer metastases underwent CBCT plain scan after embolization.The 163 metastatic tumors were deposited in the same area as the preoperative imaging enhancement,which was in the shape of a ring.The remaining 76 metastatic tumors were given a second embolization treatment,due to slight ring staining and poor enhanced range deposition compared with preoperative imaging.Conclusion:CBCT can effectively indicate the number of liver metastases and blood supply arteries of colorectal cancer liver metastases during TACE,and it also has good application value in evaluating the effect of tumor embolization.