螺旋CT肝双期扫描对肝癌肝动脉化疗碘油栓塞后血供的诊断价值

Helical dual-phase CT scan in evaluating blood supply of primary heptocellular carcinoma after transcatheter hepatic artery chemoembolization with lipiodol

目的探讨螺旋CT肝双期扫描及3DCT对肝癌LP-TACE治疗后肿瘤非坏死低密度区血供的诊断价值。方法34例肝癌患者LP-TACE治疗后行螺旋CT肝双期扫描,5例同时行肝动脉MIP、SSD及门静脉MIP三维重建。结果34例肝癌LP-TACE治疗后非坏死低密度区分为4个类型:周围型、侧边型、中心型和弥漫型。17例肝动脉期及门静脉期均强化;8例肝动脉期强化,门静脉期无强化;3例肝动脉期无强化,门静脉期强化;6例肝动脉及门静脉期均无强化。2例肝静脉参于供血。5例肝动脉及门静脉血管MIP、SSD成像可较好显示肝动脉及门静脉血管与非坏死低密度区的关系。结论螺旋CT肝双期扫描及3DCT是评价肝癌LP-TACE治疗后肿瘤非坏死低密度区血供无创伤性的有效方法,对其治疗效果的评估及继续治疗方案的制定有一定临床意义。

Objective To evaluate the blood supply of low density viable area of primary heptocellular carcinoma after transcatheter hepatic artery chemoembolization using lipiodol(LP-TACE) , by helical dual-phase CT scanning and three dimensional CT (3DCT) . Methods Thirty-four patients with primary heptocellular carcinoma after LP-TACE were examined by hepatic helical dual-phase CT. 3DCT model of the maximum intensity projection (MIP) , surface shaded display (SSD) reconstruction of the hepatic artery and portal vein were simultaneously done in 5 cases. Results Viable tumor areas of 34 cases of primary heptocellular carcinoma after LP-TACE were divided into four types: peripheral, lateral, central and diffused types. Enhanced tumor vessel or tissue in viable tumor area was found during hepatic dual-phase in 17 cases, during hepatic artery- phase only in 8 and hepatic portal vein-phase only in 3. The viable tumor areas were found to have blood supply from the hepatic vein in 2 cases. The viable tumor area unenhanced during hepatic dual-phase was found in 6 cases. In 5 cases, the relation between the viable tumor area and branches of hepatic artery and portal vein was showed by MIP and SSD of hepatic artery and portal vein. Conclusion Hepatic helical dual-phase CT scan with 3DCT is effective in evaluating the blood supply of viable tumor areas and the therapeutic effect of primary heptocellular carcinoma after LP-TACE.