Impact of multidetector CT hepatic arteriography on the planning of chemoembolization treatment of hepatocellular carcinoma
Impact of multidetector CT hepatic arteriography on the planning of chemoembolization treatment of hepatocellular carcinoma
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DOI：
10.2214/ajr.177.6.1771339
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发表时间：
2001-12-01
影响因子：
5
通讯作者：
Jeffrey, RB
中科院分区：
文献类型：
--
作者：
Sze, DY;Razavi, MK;Jeffrey, RB
目标.我们研究了多排CT肝动脉造影对治疗决策的敏感性增加的影响，涉及选择性化疗栓塞的肝细胞癌。主题和方法：30例患者被称为化疗栓塞不可切除的肝细胞癌。根据诊断性双相CT或MR成像制定初始选择性化疗栓塞计划。使用多层螺旋CT扫描仪和选择性造影剂注入肝动脉进行超快CT肝动脉造影。在约20秒的单次屏气中扫描整个肝脏，切片厚度为1 mm，识别病变及其动脉供应，并立即使用这些数据制定最终的化疗栓塞计划。在29例患者中检测到富血管肿块。在16例（53%）患者中，术前CT或MR成像低估了病变数量。在这16例患者中，有9例（30%）仅在CT肝动脉造影中检测到额外的病变，而在传统血管造影中未检测到。CT肝动脉造影结果对计划进行化疗栓塞治疗的方式有重要影响。在9名患者中的3名中，先前未检测到的病变接受了额外的超选择性化疗栓塞治疗。在其他6例患者中，化疗栓塞的选择性低于最初的计划。首先，由于多层螺旋CT肝动脉造影在显示小的和多灶性肝癌方面的高灵敏度，这种方式的结果经常改变涉及选择性化疗栓塞材料的治疗计划。
OBJECTIVES. We examined the impact of the increased sensitivity for hypervascular masses of multidetector CT hepatic arteriography on treatment decisions involving selective chemoembolization of hepatocellular carcinomas.SUBJECTS AND METHODS: Thirty patients were referred for chemoembolization of unresectable hepatocellular carcinoma. Initial selective chemoembolization plans were formulated on the basis of diagnostic biphasic CT or MR imaging. Ultrafast CT hepatic arteriography was performed using a multidetector CT scanner and selective contrast material injection into the hepatic artery. The entire liver was scanned in a single breath-hold of approximately 20 sec with a slice thickness of 1 mm, Lesions and their arterial supplies were identified, and these data were immediately used to formulate a final plan for chemoembolization.RESULTS. Hypervascular masses were detected in 29 patients. In 16 (53%) of the patients, preprocedural CT or MR imaging underestimated the number of lesions. In nine (30%) of these 16 patients, the additional lesions were detected only on CT hepatic arteriography, not on conventional angiography. CT hepatic ateriography findings had a major impact on planning the way in which chemoembolization treatment was performed. In three of the nine patients, the previously undetected lesions were treated with additional superselective chemoembolization. In the other six patients, chemoembolization was performed less selectively than originally planned.CONCLUSION. Primarily because of the high sensitivity of multidetector CT hepatic arteriography in revealing small and multifocal hepatomas, findings of this modality frequently alter treatment plans involving selective administration of chemoembolic material.