应用DSA、CT和经肠系膜上动脉门静脉灌注CT成像研究肝转移瘤的血液供应

目的 探讨DSA、CT和经肠系膜上动脉门静脉灌注CT成像对肝转移瘤的血液供应显示状况.方法 回顾性分析100例原发病灶经手术和(或)病理证实的肝转移瘤患者资料,均进行了CT平扫、多期CT增强扫描、选择性腹腔动脉和超选择性肝固有动脉DSA检查,其中,56例还经肠系膜上动脉插管行肠系膜上动脉的门静脉灌注CT成像(P(1TAP)检查,计算转移瘤中心区域、肿瘤边缘、门静脉和正常肝实质的时间-密度曲线(TDC)灰度密度(K值),观察肝转移瘤血液供应来源.DSA图像用Photoshop软件进行定量分析,CT图像用去卷积灌注软件进行分析.结果 DSA表现:肝固有动脉造影TDC显示肿瘤中心K值峰值平均为(67±12)%,肿瘤边缘K值峰值平均为(76±15)%,正常肝实质K值峰值平均为(51±10)%.腹腔动脉造影TDC显示,肿瘤中心及肿瘤边缘K值表现为快速上升,然后为缓慢上升的平台,而正常肝实质则呈现持续缓慢上升的态势.PCTAP扫描表现:肿瘤在30 s的时间内,密度变化几乎呈直线,无增强表现.结论 肝动脉是肝转移瘤的主要血液供应来源,门静脉几乎不参与肝转移瘤血液供应.

Studies on blood supply of liver metastasis with DSA,CT and portal vein perfusion CT during superior mesenteric arterial portography

Objective To probe the blood supply of liver metastasis by celiac artery,proper hepatic artery DSA.portal vein perfusion CT during superior mesenteric arterial poaography(PCTAP).Methods One hundred patients with liver metastases were examined prospectively by plain CT scan,multiphase enhanced CT scan,celiac arteriography and proper hepatic artefiography.Of them,56 patients were examined by PCTAP.All primary lesions wero confirmed by operation and(or)pathology examination.In order to investigate the blood supply of metastasis lesions.the software of Photoshop Was used to obtain the time-attenuation cugves(TDC)of tumor center,tumor edge,portal vein and normal liver parenchyma adjacent to the tumor to talculate liver perfusion for DSA image analysis,while a deconvolution model from CT perfusion software Was designed for the dual blood supply.Results DSA findings:TDC of proper hepatic arteriography showed:the mean peak concentration(K value)in tumor centers was(67±12)%,and it was(76±15)%for peritumor tissue,(51±10)%in normal liver parenchyma.TDC of celiac arteriogaphy showed that the contrast concentration of tumor centers and tumor edge increased fast in early stage.then maintained a slight upward plateau,in the meanwhile,the contrast concentration of normal liver parenchyma kept increasing slowly.PCTAP findings:tumors exhibited no enhancement during 30 s continued scans.Conciusion The blood supply of liver metastasis mainly comes from hepatic artery,but barely from portal vein.