原发性肝癌动脉血供彩色多普勒超声与DSA的对比研究

目的:探讨彩色多普勒超声与DSA在肝癌血供的半定量及定量诊断中的应用价值。方法:对52例原发性肝癌的64个肿瘤在经动脉导管栓塞化疗术前3d内进行彩色多普勒超声（CDFI）检查，对每一个肿瘤的动脉血流进行分级，CDFI按国内分级标准分为四级：0,Ⅰ,Ⅱ,Ⅲ。同时测量肝固有动脉、门静脉血流参数。在患者进行TACE过程中行肝动脉数字减影造影（DSA），将肿瘤内部血流分为三级：1,2,3。并对其中30例患者于TACE术后7d内进行CDFI复查，观测上述指标变化。分析CDFI与DSA肿瘤血流分级的相关性，以及TACE治疗后肝动脉、门静脉血流动力学改变。结果:(1) CDFI显示64个肿瘤，0级血供6个，Ⅰ级血供3个，Ⅱ级血供18个，Ⅲ级血供37个;DSA显示64个肿瘤中，乏血供者4个，中等血供者13个，富血供者47个。CDFI 四级分级方法与DSA分级方法具有较好的相关性（rs＝0.644，P<0.01），其中CDFI血供分级的0级与DSA血供分级的1级相对应;Ⅰ，Ⅱ级与2级相对应;Ⅲ级与3级相对应。（2）TACE术后肿瘤血流分级大部分较术前减少，肝动脉内径稍变窄，肝动脉血流量减少，而门静脉血流量反应性增加。结论:CDFI博动性血流四级分级方法与DSA分级方法相关性好， CDFI血供分级的0级，Ⅰ和Ⅱ级，Ⅲ级分别与DSA血供分级的1，2，3级相对应，可以反映原发性肝癌肿瘤内动脉血流的丰富程度，CDFI可以间接反映原发性肝癌TACE术前后血流动力学改变。

The blood supply of primary hepatic carcinoma: comparison of color doppler flow imaging with DSA

Abstract:Objective:To evaluate the value of color Doppler flow imaging (CDFI) in detecting the blood supply of primary hepatic carcinoma in comparison with DSA.Methods:Fifty two hepatic carcinoma patients with 64 tumors were studied. All patients were examined by CDFI within three days before transarterial chemotherapy embolization (TACE) treatment. The artery supply of 64 tumors was graded into four degrees: 0,Ⅰ,Ⅱand Ⅲ. The diameter, peak systolic velocity (PS), and resist index (RI) of proper hepatic artery were measured. Meanwhile the blood flow volume of portal vein and proper hepatic arteria was calculated. In the procedure of TACE, blood supply of tumors was graded into three degrees: grade1, 2, and 3 by DSA. Thirty tumors in 30 patients were followed up with CDFI within 7 days after TACE. The changes of the gradations of blood supply and hemodynamics of proper hepatic arteria, portal flow and tumors were analyzed by CDFI.Results:(1)The gradation of CDFI in the blood supply of HCC had positive correlation rank compared to that of DSA (rs＝0.644，P<0.01). Grade 0,GradeⅠ and Ⅱ,Grade Ⅲ in CDFI closely corresponded to Grade 1,Grade 2,Grade 3 in DSA respectively. (2)After TACE, the gradations of the blood supplies decreased. The diameters of proper hepatic arteries became slightly narrow and their blood flow volumes decreased. But portal flow volumes increased.Conclusions:The gradation in impulse blood of HCC with CDFI has positive correlation rank, Grade 0,GradeⅠ and Ⅱ,Grade Ⅲ in CDFI correspond to Grade 1,Grade 2,Grade 3 in DSA respectively. and CDFI can reflect indirectly the changes of hemodynamics before and after TACE.