多层螺旋CT血管成像在肝癌化疗栓塞中的临床指导作用

背景与目的：多层螺旋CT血管成像具有扫描速度快、覆盖范围大、肝脏血管图像清晰．多角度三维显示等特点，对肝脏病变的诊断和治疗已显示出重要价值。目前对于多层螺旋CT肝脏血管三维成像的研究主要集中在肝脏肿瘤、肝移植术前评价及肝脏血管系统解剖，对于指导肝癌动脉化疗栓塞的研究仍然有限。本研究通过对比分析肝癌患者肝脏多层螺旋CT血管成像（muhislice CT angiography，MSCTA）与数字减影血管造影（digital subtraction angiography，DSA）图像．探讨MSCTA在肝癌肝动脉化疗栓塞治疗中的临床指导作用。方法：本组50例肝癌患者行多层螺旋CT肝脏双期增强扫描。采用最大密度投影（maximal intensitypmjection，MIP）和容积再现（volume rendering technique，VRT）重建技术行肝动脉、门静脉血管成像，再经股动脉插管分别行腹腔动脉、肠系膜上动脉、肾动脉、膈动脉DSA造影及TACE治疗，对比分析肝癌MSCTA与DSA图像。结果：肝动脉解剖分型和肿瘤供血动脉来源的DSA与MSCT的MIP、VRT血管成像显示符合率达到100％，χ^2检验，两者间差异无统计学意义（P=1．00），而对肝动门脉瘘及门脉癌栓的显示MSCTA比DSA更有优势。结论：MSCTA检查无创、简单易行，其图像的三维重建立体感强，可准确提供肝动脉、门静脉及肿瘤供血来源等信息，对指导肝癌经肝动脉化疗栓塞有很好的临床指导作用。

Application of multislice CT angiography on transcatheter arterial chemoembolization for hepatocellular carcinoma

Background and Objective： Multislice CT angiography （MSCTA） is very important in the diagnosis and treatment of liver diseases. Currently, most studies on three-dimensional MSCTA of the liver vascular system are focused on the liver tumors, preoperative assessment of liver transplantation, and the systematic anatomy of the liver vascular system. This study was to investigate the clinical application of MSCTA on transcatheter arterial chemoembolization （TACE） for hepatocellular carcinoma （HCC） by comparing images of MSCTA and digital subtraction angiography （DSA）. Methods： MSCT dual-phase enhanced scanning was performed in 50 patients with advanced HCC. Both hepatic artery angiography and portal vein angiography were conducted using maximal intensity projection （MIP） and volume rendering technique （VRT）. DSA of the celiac artery, superior mesenteric artery, renal artery and diaphragm artery, as well as TACE were performed in all patients. MSCTA and DSA images of the 50 patients were compared. Results： MSCTA and DSA showed equal detectability in revealing classification of hepatic artery anatomy and tumor blood vessels, with a coincidence of 100% （P=1.00）. However, MSCTA was superior to DSA in displaying arterioportal shunt and portal vein tumor thrombus. Conclusions： As a noninvasive and easy to conduct technique, MSCTA can accurately provide information of the hepatic artery, portal vein and tumor supply vessels. Therefore MSCTA has a favorable value to guide TACE for HCC.