320排容积ct灌注扫描血管成像在肝癌tace治疗 - 第三军医大学学报.doc

探寻320排CT上腹部一站式检查在肝癌TACE治疗中的临床应用价值 张晓宇，罗小平,罗银灯,倪卫国,彭睿 （重庆医科大学附属第二医院放射科，重庆 400010） [摘要]：目的：探寻320排CT上腹部一站式检查在肝癌经动脉插管化疗栓塞（transcatheter arterial chemoembolization，TACE)治疗中的临床应用价值。方法：收集30例肝癌患者TACE术前行320排CT上腹部灌注扫描病例，分析全肝灌注情况，并与TACE术中数字血管减影血管造影（digital subtraction angiography，DSA）图像对比了解其血管成像能力。对320排灌注容积扫描行辐射剂量分析。结果：TACE术前肝癌组织肝动脉灌注量（Hepatic arterial perfusion,HAF）、门静脉灌注量(Portal vein perfusion,PVP)及肝动脉灌注指数（Hepatic arterial perfusion index,HAPI)与非癌组织相比，差异有统计学意义（P0.05）。30次扫描中均能获得满意上腹部CT血管成像（computer tomography angiography,CTA)图像；对1-4级肝动脉CTA与DSA对比无明显差异（P0.05）,5级及5级以上肝动脉CTA与DSA有明显差异（P0.05）。剂量对比发现低参数（100kV、100mA）灌注扫描较常规上腹部增强扫描辐射剂量低，稍高参数灌注扫描方案（100kV、200mA）辐射剂量仅轻度增高。结论：320排CT上腹部一站式检查能很好的显示全肝灌注情况，尤其是肝癌组织的异常灌注情况，血管成像能够从三维角度显示肝动脉及肿瘤滋养动脉，对TACE术前评估及术中操作具有重要的指导意义。 [关键词]：肝细胞癌;CT灌注;数字减影血管造影;栓塞;血管成像 [中图法分类号：R735.7;R815 [文献编码号：A Explore the clinical application of 320-row CT upper abdominal one-stop examination in the TACE treatment of HCC [Abstract]Objective:to explore the clinical application of 320-row CT upper abdominal one-stop examination in the TACE treatment of hepatocellular carcinoma(HCC).Methods:Totally 30 patients with HCC underwent upper abdominal perfusion scan with 320-row CT before TACE.The whole liver perfusion was analyzed,and the angiography capability of 320-row CT was compared with DSA in TACE.Radiation doses of 320-row CT perfusion scan were also analyzed.Results:There were significant differences in HAP,PVP and HAPI of cancer tissues compared with non-cancerous tissues(P0.05).All the 30 times scans obtained satisfactory upper abdominal CTA.The comparisons of 1-4 grade hepatic artery CTA and DSA had no significant difference(P0.05),while 5 and more than 5 grade comparisons confirmed significant difference(P0.05).Perfusion scan with lower parameter(100kV,100mA) had lower radiation dose than the conventional upper abdomen enhanced scan,while that with higher parameter(100kV,200mA) only had slightly higher radiation dose.Conclusions:320-row CT upper abdominal o