原发性肝癌合并下腔静脉癌栓的DSA表现及临床意义

目的 探讨原发性肝癌合并下腔静脉癌栓的DSA表现及其临床意义。方法 回顾性分析8例原发性肝癌合并下腔静脉癌栓患者的肝动脉造影,下腔静脉造影的影象表现和介入治疗方法。结果 6例肝动脉造影见肝动脉和肝静脉间有较大的动-静脉分流和肝静脉癌栓,下腔静脉内可见充盈缺损,下腔静脉癌栓见较明显的“条纹征”,4例右心房内可见实质性肿块,并与下腔静脉癌栓相连,2例可见较明显的“条纹征”。4例经肝动脉化疗栓塞（TACE）术后癌栓内碘油散在栓主要由肝动脉供血,CT,MRI和DSA对其有较高的诊断价值,肝TACE术和下腔静脉内支架置放术是治疗原发性肝癌合并下腔静脉癌栓的有效方法。

DSA manifestation of primary hepatocellular carcinoma complicated by tumor thrombus in the inferior vena cava]

OBJECTIVE: To study the manifestations of the primary hepatocellular carcinoma (PHC) complicated by tumor thrombus (TT) in the inferior vena cava (IVC) in digital subtraction angiography (DSA) and to understand their clinical implications. METHODS: A retrospective study of the hepatic arterial angiography, the inferior vena cavography and the interventional treatment in 8 cases of PHC patients was conducted. RESULTS: Hepatic arterial-venous shunt, tumor thrombus in the hepatic veins and filling defect in the IVC were identified in 6 patients. The IVC TT presented obvious "strip signs" in DSA images. In 4 patients TT in the right atrium (RA) was found in connection with the IVC TT. Scattered lipiodol deposits were observed in the IVC TT, which decreased in volume in 4 patients after hepatic arterial chemoembolization. Five patients with TT in the IVC and blood backflow blockage received IVC stent implantation for alleviation of the symptoms. CONCLUSIONS: The blood supply of TT in IVC is derived from the hepatic artery, and computed tomography, magnetic resonance imaging and DSA all have superior diagnostic value for such TT. Transcatheter hepatic arterial chemoembolization and IVC stent implantation may constitute effective treatment modalities for PHC complicated by TT in the IVC.