4D CT成像辅助引导经动脉精准化疗栓塞治疗原发性肝癌

目的 描述四维(4D)CT成像方法 ,并探究经动脉化疗栓塞(TACE)术前应用四维CT成像引导肝癌的化学栓塞治疗的价值。方法利用容积螺旋动态穿梭技术,前瞻性完成拟行TACE治疗的原发性肝细胞癌患者的增强CT扫描。扫描范围覆盖全肝,从动脉前期至静脉期动态研究肿瘤病灶。针对目标病灶的4D CT重组图与数字减影血管造影(DSA)图在肝动脉解剖、肿瘤供血血管、肿瘤血管显示以及肿瘤染色方面进行比较。栓塞效果经CT随访进行评价。结果本研究纳入了39位患者的46个孤立肝癌病灶。根据Michels分型,25位(64.1%)具备正常的肝动脉解剖,其余存在解剖变异。该信息为肝动脉插管造影提供了很好的依据,并经过DSA证实。4D CT成像无创性显示了病灶的肿瘤供血动脉(41/46),肿瘤血管(36/46),肿瘤染色(42/46)。因4D CT成像可以引导超选择性置入微导管,使得化学栓塞治疗成功完成。结论 四维CT成像可以有效地评价肝动脉解剖,定位肿瘤供血动脉,为肝癌介入化学栓塞提供影像引导。

Four-dimensional CT navigation for transarterial chemoembolization of hepatocellular carcinoma

Objective To evaluate four-dimensional (4D) CT navigation for transarterial chemoembolization (TACE) of hepatocellular carcinomas (HCC). Methods Dynamic contrast-enhanced CT with volume helical shuttle technique was performed before TACE in 39 patients with 46 HCC. The whole liver was imaged in unenhanced, hepatic arterial and portal venous phases. All 4D CT reconstruction images were compared with digital subtraction angiography (DSA) including anatomy of hepatic arteries, tumor supply arteries, vessels and stain. Effect of embolization was also evaluated on follow-up CT. Results The hepatic artery anatomy was normal in 25/39 patients whereas variations were found in 14/39 patients requiring selective hepatic arterial DSA. 4D CT showed tumor supply arteries(41/46),tumor vessels(36/46), and tumor staining (42/46) and provided navigation for superselective microcatheter placement and successful TACE with lipiodol accumulation in specific regions of the liver. Conclusion 4D CT is helpful in evaluating hepatic artery anatomy and locating tumor supply arteries for TACE of HCC.