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目的探讨多层螺旋CT血管成像(MSCTA)对肝癌经导管动脉内化疗栓塞(TACE)插管操作的指导价值。资料与方法对临床确诊的80例肝癌患者分别行MSCTA和数字减影血管造影(DSA)检查。对比分析:肝癌供血血管的起源、走行、形态、变异以及寄生供血、腹腔动脉与腹主动脉的夹角;比较MSCTA与DSA的符合情况,分析MSCTA对TACE插管操作的指导价值。结果MSCTA中最大密度投影(MIP)和容积再现技术(VRT)对肝癌规则性供血情况下二级肝动脉的显示率分别为97.5%、95%。MIP和VRT对三级肝动脉的显示率分别为96.25%、75%。MSCTA与DSA对二级肝动脉显示率差异无统计学意义(P>0.05),对三级肝动脉的显示率,MIP与DSA图像差异无统计学意义(P>0.05),VRT与DSA差异有统计学意义(P<0.05)。MSCTA显示寄生动脉20支,肝动脉变异18例;DSA显示寄生动脉24支,显示肝动脉变异21例;MSCTA发现肝癌寄生动脉和肝动脉解剖变异的阳性率分别为83.3%和85.7%。MSCTA和DSA在发现寄生动脉和肝动脉解剖变异概率上的差异无统计学意义(P>0.05)。MSCTA显示腹主动脉和腹腔干动脉在矢状面夹角狭窄4例,横断面极度左偏3例;MSCTA显示情况与DSA吻合。结论MSCTA与DSA比较具有高度的一致性;它能全方位详尽清晰地显示肝动脉分支的起源、走行、形态;检出肝癌变异供血动脉及肝外寄生供血动脉,显示腹腔干动脉与腹主动脉的夹角,对指导TACE术中插管操作具有重要价值。
Objective To investigate the value of multislice spiral CT angiography (MSCTA) for intubation of transcatheter arterial chemoembolization (TACE) in liver cancer. Materials and Methods Eighty patients with clinically diagnosed HCC were examined by MSCTA and digital subtraction angiography (DSA). Contrast analysis: the origin, the movement, the shape, the variation and the parasitic blood supply of the blood vessels of the hepatic cancer; the angle between the celiac artery and the abdominal aorta; compare the coincidence of MSCTA and DSA, and analyze the guiding value of MSCTA for intubation of TACE. Results The maximal density projection (MIP) and volumetric rendering (VRT) in MSCTA were 97.5% and 95% for the secondary hepatic artery in the case of regular liver cancer. The display rate of MIP and VRT to the tertiary hepatic artery was 96.25% and 75% respectively. There was no significant difference in the expression rate of hepatic artery between MSCTA and DSA (P> 0.05). There was no significant difference in the display rate of hepatic artery, MIP and DSA (P> 0.05) Statistical significance (P <0.05). MSCTA showed 20 parasitic arteries and 18 hepatic arteries. DSA showed 24 parasitic arteries and 21 hepatic arteries. The positive rates of MSCTA were 83.3% and 85.7%, respectively. There was no significant difference in the probability of finding anatomical variation of parasitic artery and hepatic artery between MSCTA and DSA (P> 0.05). MSCTA showed the abdominal aorta and celiac artery in the sagittal angle of stenosis in 4 cases, 3 cases of extreme left-sided cross-sectional; MSCTA showed the situation consistent with DSA. Conclusion MSCTA is highly consistent with DSA. It can clearly and clearly show the origin, course and morphology of the hepatic artery branches in all aspects. The hepatic artery variant hepatic artery and extrahepatic parasympathetic artery are detected. Of the angle, the guidance of TACE intubation operation has important value.