肝转移瘤的血供

目的:通过腹腔动脉造影、肝固有动脉造影、单纯门静脉CT灌注成像探讨肝转移瘤的血液供应.方法:对50例肝转移瘤患者进行了CT平扫、CT增强扫描、选择性腹腔动脉造影、超选择性肝固有动脉造影,对其中23例患者行肠系膜上动脉插管单纯门静脉CT灌注扫描,以观察肝转移瘤的影像学表现,计算转移瘤中心区域、肿瘤边缘、门静脉和肿瘤周边正常肝实质的时间密度曲线(TDC).数字减影血管造影术(DSA)图像用PhotoShop软件进行定量分析,CT图像用去卷积分灌注软件进行分析.结果:DSA表现:多血供肿瘤12例,少血供者38例,环形染色36例.肝固有动脉造影TDC显示,肿瘤中心密度(K值)峰值平均为(67.48±11.56)%,肿瘤边缘密度(K值)峰值平均为(76.23±14.89)%,正常肝实质密度(K值)峰值平均为(51.42±10.26)%;肿瘤中心密度达到峰值的时间平均为(9.00±1.03)s,肿瘤边缘密度的达峰时间为(10.69±2.82)s.腹腔动脉造影TDC显示,肿瘤中心及肿瘤边缘密度先表现为快速上升,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,在14 s以后,肿瘤中心的密度不仅小于肿瘤边缘的密度,而且小于正常肝实质的密度.门静脉显影的峰值时间平均为(11.84±1.81)s.多期增强CT扫描表现:动脉期呈明显环状强化者11例;动脉期呈轻度环状强化、门脉期呈渐进性厚壁强化者5例;动脉期不强化、门脉期环状强化者25例;平衡期环形强化者8例;动脉期、门脉期、平衡期均不强化者1例.单纯门静脉灌注CT表现:肿瘤在30 s的时间内,密度几乎呈直线,无增强表现.门静脉达峰时间平均为(14.33±2.23)s,最高峰值平均为(320.00±28.78)HU;而正常肝实质的密度在注射对比剂后呈现缓慢上升的态势,达峰时间为(22.25±3.44)s,最高峰值平均为(110.75±16.31)HU.结论:肝动脉是肝转移瘤血供的唯一来源,门静脉不参与肝转移瘤的血供.

Blood supply of liver metastasis

OBJECTIVE: To probe the blood supply of liver metastasis by celiac arteriography, proper hepatic arteriogaphy, pure portal vein perfusion CT. METHODS: Fifty patients with liver metastasis were examined prospectively by plain CT scan, multiphase enhanced CT scan, celiac arteriography and proper hepatic arteriography, of whom, 23 were examined by pure portal vein perfusion CT during superior mesenteric arterial portography. The imaging manifestations were observed, and the time attenuation curves (TDC)of tumor center, tumor edge, portal vein and normal liver parenchyma were used to calculate liver perfusion with a software of PhotoShop(used in DSA image analysis)and a deconvolution model (CT perfusion software) designed for the dual blood supply. RESULTS: DSA findings: hypervascular 12 cases, hypovascular 38 cases, and ring tumor stain 36 cases. TDC of proper hepatic arteriography showed: the mean peak concentration (K value) in tumor center (67.48+/-11.56)%, the mean peak concentration (K value) on tumor edge (76.23 +/-14.89)%, the mean peak concentration (K value) in normal liver parenchyma (51.42+/-10.26)%; the mean time to peak concentration in tumor center(9.00+/- 1.03) s, and the mean time to peak concentration on tumor edge (10.69+/-2.82) s; TDC of celiac arteriogaphy showed: the concentration of tumor center and tumor edge increased fastly in early stage, then maintained an increasing plateau slowly, in the meanwhile, the concentration of normal liver parenchyma increased slowly and steadily, after 14 s of acquisition, the concentration of tumor center was lower than that of tumor edge and normal liver parenchyma. Mean time to peak concentration of portal vein was(11.84+/-1.81) s. Multiphase enhanced CT scan findings: ring enhancement in artery phase 11 cases; mild ring enhancement in artery phase,continued thick ring enhancement in portal phase 5 cases; no enhancement in artery phase,ring enhancement in portal phase 25 cases; ring enhancement in equilibrium phase 8 cases; no enhancement in artery phase, portal phase and equilibrium phase 1 case. The mean time to peak enhancement of portal vein was(14.33+/-2.23) s, and the mean enhancement peak value (320.00+/-28.78) HU; the densily of normal liver parenchyma increased slowly after contrast medium administration, the mean time to peak enhancement was (22.25+/-3.44) s, and the mean enhancement peak value (110.75+/-16.31) HU. CONCLUSION: The blood supply of liver metastasis only comes from hepatic artery, and portal vein does not join in the blood supply of liver metastasis.