动态容积灌注CT成像多维度显示直肠癌及对肠系膜下动脉的可行性研究

One-stop Dynamic Volume Perfusion CT Imaging Multi-dimensional Display of Rectal Cancer and the Feasibility Study of the Classification of the Inferior Mesenteric Artery

目的:探究采用一站式低管电压、高浓度造影剂及高流速注射方法采集动态容积灌注CT(dVPCT)图像集,经后处理重建多期增强图像结合多平面重建(MPR)对直肠癌进行术前T分期,肿瘤灌注分析,并同时三维重建肠系膜下动脉且对其分型及清晰度等可行性研究。方法:回顾性分析我院于2020年4月至12月间经腹腔镜直肠癌根治手术的临床及病理资料术后病理诊断为直肠腺癌(非特殊型)并行全腹部dVPCT成像患者共107例;采集数据采用低管电压、高浓度造影剂及高流速注射速率19期dVPCT数据集图像经后处理并研究观察以下指标:(1)重建全腹部多期增强图像,包括动脉期、肿瘤强化最佳期、门静脉期并结合MPR评估直肠癌T分期准确性;(2)基于动脉期图像三维重建肠系膜下动脉(IMA),并对(1) IMA及其主要分支,包括左结肠动脉(LCA)、乙状结肠动脉(SA)、直肠上动脉(SRA)走行解剖分型进行评估,(2)基于血管三维重建图像中的曲面重建测量IMA根部至LCA起始端纵向距离,(3)对IMA显示效果进行评估;同时三维重建血管与肿瘤融合图像;(3)经体部肿瘤灌注后处理了解直肠癌与正常肠壁多个灌注参数情况,包括血流量(BF)、血容量(BV)、平均通过时间(MTT)及渗透性(FE)。结果:107例研究对象中女性42例,男性65例,平均年龄66.27±10.83岁,BMI为23.11±2.96kg/m2;1)基于术后病理分期,直肠癌术前多期重建图像T分期总体准确性约为87.9%;2)107例患者血管三维重建图像中IMA、LCA、SA、SRA的解剖走行为:I型(直乙共干型) 52例(50.5%);Ⅱ型(左乙共干型) 46例(43.0%);Ⅲ型(全支共干型) 7例(6.5%);IV型(无左结肠动脉型) 0例,且IMA总体显示效果较好或很好。3)IMA曲面重建测量IMA根部至LCA起始端纵向距离平均值约为3.8cm(1.7cm-7.8cm);4)灌注伪彩图显示直肠癌全肿瘤多个灌注参数与正常肠壁存在差异。结论:基于一站式低管电压、高浓度造影剂及高流速注射速率方法采集dVPCT数据集可重建多期增强图像,并结合MPR仍可为原发性直肠癌的术前评估提供可靠的影像学依据;基于动脉期图像三维重建IMA的图像总体效果较好或很好,且可显示其重要分支分型及走行,为腹腔镜手术提供重要术前动脉处理依据;基于一站式低辐射剂量dVPCT可对直肠癌肿瘤进行灌注功能性评估,因其稳定性及可重复性强,在肿瘤诊断及新辅助治疗疗效评估方面具有较大潜能。

Objective:To explore the use of a one-stop method of low radiation dose,high concentration of contrast agent and high flow rate injection rate to acquire dynamic volume perfusion CT(dVPCT)image collection,and postprocessing to reconstruct multi-phase enhanced images combined with multi-planar reconstruction(MPR)for rectal cancer Preoperative T staging,tumor perfusion analysis,and three-dimensional reconstruction of the inferior mesenteric artery(IMA)at the same time,and the feasibility study of its classification and definition.Methods:A retrospective review of the clinical and cancer-root surgery of rectal cancer by laparoscopic data from our Hospital from April to December 2020;the 19th phase of the VPCT data set images were processed and studied and observed:1)Reconstruction of the entire series Phase enhancement indicators,including arterial phase,best enhancement phase of rectal cancer,portal venus phase and MPR to assess the accurate T staging stage of rectal cancer;2)Three-dimensional reconstruction of the inferior mesenteric artery(IMA)based on the arterial phase image to improve IMA and its main branches,including the left colon artery(LCA),sigmoid colon artery(SA),superior rectal artery(SRA),are anatomically classified;②Measure the longitudinal distance from the root of IMA to the starting end of LCA based on the curved surface reconstruction in the three-dimensional reconstruction image of blood vessel,Evaluate the display effect of IMA,as well as reconstruct the fusion image of blood vessel and tumor in three-dimensional reconstruction;3)3)After body tumor perfusion,to understand multiple perfusion parameters of the whole tumor perfusion of rectal cancer and normal intestinal wall,including blood flow(BF),blood volume(BV),mean transit time(MTT)and permeability(FE).Results:Among the 107 subjects,42 were females and 65 were males,with an average age of 66.27±10.83 years old,and a BMI of 23.11±2.96kg/m^(2);(1)Based on postoperative pathological staging,the overll accuracy of preoperative multi-stage reconstruction image T staging for rectal cancer is about 87.9%;(2)The anatomical walking behaviors of IMA,LCA,SA,SRA in the three-dimensional reconstruction images of blood vessels in 107 patients:TypeⅠ(the LCA arose independently from the SA)have 52 cases(50.5%);TypeⅡ(the LCA and SA arose from the IMA at the same point)have 46 cases(43.0%);of typeⅢ(the LCA and SA had a common trunk)have 7 cases(6.5%);O cases of typeⅣ(there was a deficit of the LCA),And the overall display effect of IMA is good or very good.(3)IMA curved surface reconstruction measures the average longitudinal distance from the root of IMA to the starting end of LCA is about 3.8cm(1.7cm-7.8cm);4)Perfusion pseudo-color map shows that multiple perfusion parameters of rectal cancer are different from normal intestinal wall.Conclusion:The collection of dVPCT data set based on the one-stop method of low radiation dose,high concentration contrast agent and high flow rate injection rate can reconstruct multi-phase enhanced images,and combined with MPR,it can still provide reliable images for the preoperative evaluation of primary rectal cancer.the overall effect of the IMA image based on the threedimensional reconstruction of the arterial phase image is good or very good,and can show its important branch classification and course,providing important preoperative arterial treatment basis for laparoscopic surgery;based on one-stop low radiation dose dVPCT can evaluate the perfusion function of rectal cancer tumors.Because of its stability and reproducibility,it has great potential in evaluating the efficacy of neoadjuvant therapy for tumors.