C臂CT在经导管动脉化疗栓塞术治疗肝脏恶性肿瘤中的应用

目的探讨平板探测器C臂CT在TACE治疗肝脏恶性肿瘤中的应用价值。方法 38例肝脏恶性肿瘤患者在常规DSA基础上接受C臂CT检查,观察C臂CT是否能提供更多影像信息及其对介入治疗方案的影响;对C臂CT图像进行伪影分级评分并对其中28例患者C臂CT图像与近期MSCT图像比较,评价其图像质量;分析观察者间一致性。结果与常规DSA比较,C臂CT为26例（26/38,68.42%）提供了更多的影像信息,9例（9/38,23.68%）最初通过常规DSA制定的介入治疗方案因而改变;C臂CT图像质量评分为2.68,稍差于MSCT。所有患者C臂CT图像均有不同程度伪影。在C臂CT图像质量、伪影等级评分、C臂CT是否提供额外影像信息及对介入治疗方案的影响方面,观察者之间有良好的一致性（Kendall＇s W系数分别为0.78、0.84、0.73及0.67）。结论平板探测器C臂CT可在常规DSA基础上提供更多的影像信息,有助于提高肝脏恶性肿瘤TACE的疗效及安全性。

Application of C-arm CT in transcatheter arterial chemoembolization for hepatic malignancies

Objective To observe the potential value of C-arm CT equipped with a flat-panel detector on TACE for hepatic malignancies. Methods Thirty-eight patients with hepatic malignancies underwent C-arm CT examination as an adjunct to conventional DSA before TACE. Whether C-arm CT could provide more information than DSA and its impact on hepatic interventional procedures were evaluated. The artifact score of C-arm CT in all patients were classified and the image quality of C-arm CT in 28 patients was assessed with the images of MSCT. Interobserver agreement was analyzed. Results Compared with conventional DSA, C-arm CT could provide additional imaging information in 26 cases (26/38, 68.42%),and altered interventional procedures in 9 cases (9/38, 23.68%). The average score of C-arm CT image quality was 2.68,lower than that of MSCT. Artifacts with different degrees occurred on C-arm CT in all patients. In the image quality, artifact classify score of C-arm CT, whether C-arm CT could provide more information and impact on interventional procedures, interobserver agreement between the two radiologists were good with Kendall's W values of 0.78, 0.84, 0.73, 0.67, respectively. Conclusion C-arm CT equipped with a flat-panel detector can provide more important image information than DSA, and contributes to improve the efficiency and safety of TACE in patients with hepatic malignancies.