血管造影CT在肝海绵状血管瘤介入治疗中的应用

目的:利用CT造影及VR重建技术探讨肝海绵状血管瘤血供方式,借以指导临床选择适当的介入方法,并预测单纯肝动脉栓塞术(HAE)的远期疗效。材料与方法:肝脏海绵状血管瘤患者11例,共26个病灶。每位患者均行CTA、CTAP及常规DSA造影。以肝固有动脉DSA为金标准,对CT三维重建图像进行评估,并评定肿瘤血管。结果:本研究26个病灶均见肝动脉分支进入肿瘤内;所有病灶均无门静脉分支进入瘤体的直接证据。VR重建与DSA图像有很好的符合率。结论:血管造影CT基础上的VR三维重建对HAE选择靶血管具有重要的指导意义。利用VR重建图像,结合肝固有动脉及间接门静脉DSA图像可以推测单纯HAE的远期疗效。

Application of CT angiography in interventional treatment of hepatic cavernous hemangioma

Objective: To illustrate the blood supply of hepatic cavernous hemangioma using three-dimensional volume-rendering multidetector CT angiography, in order to conduct clinical interventional therapy and evaluate the efficacy of transcatheter arterial embolization. Materials and Methods: Eleven patients were treated and diagnosed by an uniform standard of imaging. All patients had been examined by CT arteriography(CTA), CT arterial portography(CTAP), DSA and volume-rendering images based on CT angiography. Three radiologists appraised the blood supply of the tumor through volume-rendering images and compared these three-dimensional images with DSA independently. Results: The images of the hepatic artery on DSA and volume-rendering images CTA showed that the tumor blood was supplied by the hepatic artery. The volume-rendering images based on CTAP showed filling defect in the region of the tumor except two giant cavernous hemangioma of the liver(the size of these tumor was 134.0mm, 142.7mm respectively). There were slight hepatic blood sinus in the region of these giant tumors in volume-rendering images based on CTAP. Conclusion: The cavernous hemangioma of liver was supplied by dual blood origin, the hepatic artery and the portal vein. The hepatic artery played an important role in the blood supply of the cavernous hemangioma of the liver, while portal vein is less important. The transcatheter arterial embolization was mostly for the hepatic cavernous hemangioma. But it was ineffective for these tumors which had slight hepatic blood sinus. We can evaluate the efficacy of transcatheter arterial embolization by the three-dimensional volume-rendering images based on CTAP.