论文部分内容阅读
目的探讨阿霉素缓释微球经导管肝动脉化疗栓塞术(TACE)中采用C型臂双相位锥形束CT是否能够帮助预测1个月随访的肝细胞癌病人的肿瘤应答反应。材料与方法这项前瞻性研究符合HIPAA协议,经机构审查委员会和动物使用与保护委员会批准。回顾性分析29例经药物缓释微球TACE治疗病人[男16例,女13例;平均年龄(61.9±10.7)岁]的50个有针对性的HCC病灶。分别于TACE治疗结束后及1个月后进行MRI检查。在TACE治疗前后分别进行双相位锥形束CT检查。对双相位锥形束CT上动脉早期及静脉延迟期强化的病灶与MRI表现进行回顾性盲法评估。肿瘤反应在MRI上的表现根据欧洲肝脏研究学会(EASL)指南进行评估。2例病人因双相位锥形束CT检查无法显示而被排除。采用相关数据的Logistic回归模型比较不同模式肿瘤增强的变化。对一头猪进行双相位锥形术CT辐射剂量的测量。结果 1个月随访的MRI显示,74%及76%的动脉及静脉期病灶分别表现为完全和(或)部分肿瘤应答。利用配对t检验比较TACE治疗前后的影像发现两种类型肿瘤强化均显著降低(P<0.0001)。双相位锥形束CT显示的TACE治疗后肿瘤强化降低与MRI表现呈线性相关。估计的相关系数在第一期(R=0.89)及第二期(R=0.82)均有很好的相关性。利用多变量Logistic回归模型发现经TACE治疗后锥形束CT上肿瘤强化和MR成像上完全和(或)部分肿瘤反应之间具有显著相关性。动脉期:比值比为0.95,95%CI:0.91~0.99;P=0.023;静脉期:比值比为0.96;95%CI:0.93~0.99;P=0.035。两次双相位锥形束CT扫描的辐射剂量为3.08mSv。结论术中C型臂双相位锥形束CT可进行阿霉素缓释微球TACE治疗后的立即成像来预测1个月随访的MRI上的肿瘤应答反应。
Objective To investigate whether the use of C-arm biphasic cone beam computed tomography in transcatheter arterial chemoembolization (TACE) of adriamycin sustained-release microspheres can help predict tumor response in patients with hepatocellular carcinoma who have been followed up for one month. Materials and Methods This prospective study complies with the HIPAA Agreement and is approved by the Institutional Review Board and the Animal Care and Use Committee. A retrospective analysis of 29 targeted HCC lesions in 16 patients with TACE (16 males and 13 females; mean age (61.9±10.7) years) was performed with TACE microspheres. MRI examinations were performed after the end of TACE treatment and one month later. Biphasic cone beam CT was performed before and after TACE. Retrospectively blind assessment of lesions and MRI findings in early arterial and venous delay phases on biphasic cone-beam CT. The performance of tumor response on MRI was assessed according to the European Association for the Study of the Liver (EASL) guidelines. Two patients were excluded due to the inability of the biphasic cone beam CT examination to show. Logistic regression models using relevant data were used to compare changes in tumor enhancement in different models. A biphasic conical CT radiation dose was measured on one pig. Results One-month follow-up MRI showed that 74% and 76% of the arterial and venous phase lesions exhibited complete and/or partial tumor responses, respectively. Using paired t-test to compare the images before and after TACE treatment showed a significant reduction in both types of tumor enhancement (P<0.0001). Biphasic cone beam computed tomography showed a linear correlation between reduced tumor enhancement and MRI performance after TACE treatment. The estimated correlation coefficient has a good correlation between the first period (R=0.89) and the second period (R=0.82). A multivariate Logistic regression model was used to find a significant correlation between tumor enhancement and MR imaging on T-beam computed tomography and/or partial tumor response. Arterial phase: the odds ratio was 0.95, 95% CI: 0.91 to 0.99; P=0.023; venous phase: odds ratio was 0.96; 95% CI: 0.93 to 0.99; P=0.035. The radiation dose of two double-phase cone beam CT scans was 3.08 mSv. Conclusion Intraoperative C-arm biphasic cone beam computed tomography can perform immediate imaging after TACE treatment with doxorubicin sustained-release microspheres to predict tumor response response on MRI at one month follow-up.