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目的探究彩色编码数字减影血管造影(ccDSA)在TACE术中对肝肿瘤灌注的即刻变化进行定量评测。方法回顾性研究了35例TACE治疗肝细胞癌病例。TACE术前后用相同参数采集二维数字减影血管造影(2D-DSA)。图像序列均经二维ccDSA(2D-ccDSA)进行后处理。在ccDSA图像上测量感兴趣区域(ROI),得到时间密度曲线(time-contrast-intensity CI[t]),并获取肿瘤血供时间(TBST),曲线下面积(AUC)、最大强化值(CI-Peak)和最大上升斜率(MS)这些灌注参数来分析评估TACE前后顺行血流和肿瘤染色减少的程度。并对上述参数与主观血管造影栓塞终点(SACE)标准和临床结果之间的关系进行分析。结果 TACE前后灌注参数的比较有显著差异。AUC和CI-Peak在TACE术后大幅下降。TBST在术后较之术前有显著延迟。灌注减少30%~40%相当于SACEⅢ级,灌注减少60%~70%相当于SACEⅣ级。结论 2D-ccDSA可以客观地量化评估TACE术对肝肿瘤血流灌注的影响,为TACE术提供了定量评价动脉血流停滞程度和肿瘤染色减少的指标。
Objective To investigate the quantitative assessment of immediate change of hepatic tumor perfusion by color coded digital subtraction angiography (ccDSA) in TACE. Methods A retrospective study of 35 cases of TACE treatment of hepatocellular carcinoma cases. Two-dimensional digital subtraction angiography (2D-DSA) was acquired with the same parameters before and after TACE. Image sequences were post-processed by two-dimensional ccDSA (2D-ccDSA). The region of interest (ROI) was measured on the ccDSA images and the time-contrast-intensity CI [t] was obtained. The tumor blood supply time (TBST), area under the curve (AUC) -Peak) and maximal ascent slope (MS) were used to analyze and assess the extent of antegrade blood flow and tumor staining before and after TACE. The relationship between these parameters and subjective angiographic embolism end-point (SACE) criteria and clinical outcomes was analyzed. Results The perfusion parameters before and after TACE were significantly different. AUC and CI-Peak decreased significantly after TACE. TBST postoperatively compared with preoperative significant delay. Perfusion reduced 30% to 40% is equivalent to SACE Ⅲ grade, perfusion reduced 60% to 70% is equivalent to SACE Ⅳ level. Conclusion 2D-ccDSA can objectively quantify the effect of TACE on the blood perfusion of liver tumors and provide a quantitative measure of the degree of arterial blood flow arrest and tumor staining reduction for TACE.