锥形束CT技术在结直肠癌肝转移瘤介入治疗中的应用价值

目的探讨锥形束CT技术在结直肠癌肝转移瘤(colorectal liver metastases，CRLM)动脉灌注化疗栓塞术（transarterial chemoembolization，TACE）治疗中的应用价值，为临床CRLM的介入治疗提供有效信息。 方法选取CRLM患者50例，行腹部CT或磁共振成像（magnetic resonance imaging，MRI）强化检查共检出146个转移瘤。所有患者行数字减影血管造影(digital subtraction angiography，DSA)二维血管造影，观察肝转移瘤（liver metastases，LM）染色表现、数目及部位，后行锥形束CT（cone beam CT,CBCT）增强扫描，观察LM染色情况、数目及部位。结合两者表现，进行超选择碘油栓塞，栓塞完成后再次行CBCT平扫，观察LM栓塞程度。 结果50例患者常规DSA造影下可见97个CRLM，血管造影表现为动脉中早期肿瘤周边环形染色，中心区域无染色，动脉晚期环形染色变淡，正常肝实质期充盈缺损影显影清晰。24个为中等血供，73个为乏血供，未见富血供的CRLM。CBCT增强扫描共检出142个LM，比 DSA血管造影多检出45个，差异有统计学意义（P＜0.05）。LM在CBCT增强扫描中表现为肿瘤周边强化，而中心区域无强化，与CT或MRI影像学表现一致。50例患者栓塞后行CBCT平扫，142个转移瘤清晰的显示肝转移瘤栓塞程度，其中107个转移瘤与CBCT增强扫描及术前影像学强化范围沉积一致，35个转移瘤与双期扫描强化范围较差，予以二次栓塞，再次行CBCT平扫显示肝转移瘤沉积范围与强化范围一致。 结论对于CRLM患者行TACE治疗时，在DSA二维血管造影后行CBCT增强扫描，能有效地发现二维血管造影中漏诊的转移瘤；同时在CRLM栓塞完成后行CBCT平扫，能准确、即时地判断碘油沉积情况，提高CRLM的TACE疗效，CBCT技术在CRLM中可起到指导性作用。

The value of cone beam CT in the interventional treatment of colorectal cancer liver metastases

ObjectiveTo explore the value of cone beam CT in transarterial chemoembolization of colorectal liver metastases（CRLM), and to provide effective information for the interventional treatment of clinical CRLM.MethodsFifty patients with CRLM were enrolled. A total of 146 metastases were detected by abdominal CT or magnetic resonance imaging (MRI) intensive examination. All patients underwent digital subtraction angiography（DSA） two-dimensional angiography, and the liver metastases（LM） staining, number and location were observed. Cone beam CT(CBCT) enhanced scanning was performed to observe the LM staining, number and location. Combined with the performance of two methods, super-selective lipiodol embolization was performed. After the embolization was completed, the CBCT was scanned again to observe the degree of LM embolization.ResultsFifty patients underwent routine DSA. angiography, 97 CRLM were seen. The angiographic findings showed ring-shaped staining around the early tumor in the artery. There was no staining in the central region, and the annular staining in the late arterial phase became lighter. The normal liver parenchyma filling defect was clearly developed. Twenty-four were moderate of blood supply, 73 were lack of blood supply, and no CRLM were rich of blood supply. A total of 142 LM were detected by CBCT enhanced scan, and 45 more than DSA angiography(P＜0.05), there were statistically significant. LM showed peripheral enhancement of the tumor in the CBCT enhanced scan, while the central area was not enhanced, consistent with CT or MRI imaging findings. Fifty patients underwent CBCT scan after embolization, and 142 metastases clearly showed embolization of liver metastases. The 107 metastases were consistent with CBCT enhanced scan and preoperative imaging enhancement, 35 metastases and dual-phase scans. The enhancement range was poor, and the second embolization was performed. The CBCT scan again showed that the deposition range of the liver metastasis was consistent with the enhancement range.ConclusionWhen patients of CRLM is treated with TACE, CBCT enhanced scan after DSA two-dimensional angiography can effectively detect metastasis missed in two-dimensional angiography, and CBCT plain scan after CRLM embolism can accurately and immediately judge the deposition of iodized oil and improve the TACE efficacy of CRLM. CBCT technique can play a guiding role in CRLM.