C臂CT在肝癌TACE术中评估碘油沉积的应用价值

摘要

目的 探讨C臂CT在肝癌肝动脉化疗栓塞(TACE)术中评估碘油沉积的应用价值.方法 将50例原发性肝癌随机分为2组,A组(30例)在碘油栓塞后术中行C臂CT检查,即刻评价碘油栓塞效果,对碘油沉积缺损部分予追加栓塞,术后1周行常规CT检查；B组(20例)术中不行C臂CT检查,仅术后1周行常规CT检查.结果 A组30例(54个病灶)中,X线透视图像可见碘油沉积病灶49个(49/54,90.7％),初次C臂CT图像可见碘油沉积病灶53个(53/54,98.1％)；初次C臂CT图像显示碘油完全沉积病灶(Ⅰ型病灶)占68.5％(37/54),1周后常规CT图像显示的碘油完全沉积病灶(Ⅰ型病灶)占86.5％(46/54),其碘油完全沉积病灶比率高于初次C臂CT图像(x2=20.4,P＜0.05).B组20例,33个瘤灶1周后常规CT图像显示完全碘油沉积病灶(Ⅰ型病灶)占66.7％(22/33).A组常规CT图像显示碘油完全沉积病灶比率显著高于B组(x2=4.16,P＜0.05).结论 在肝癌TACE术中,行C臂CT可对栓塞效果做出快速评价,方便、有用,并且有利于获得完全的肿瘤栓塞,提高治疗效果.%Objective To discuss the clinical application of DynaCT scanning in assessing iodized oil deposition extent within the tumor during the performance of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Methods During the period from July 2010 to March 2011, a total of 50 patients with hepatocellular carcinoma were admitted to authors' hospital. The patients were randomly divided into group A (n = 30) and group B (n = 20). TACE was carried out in all patients. For patients in group A, DynaCT scanning was employed during the TACE procedure when the chemoembolization was accomplished, and the instant iodized oil deposition extent within the tumor was evaluated. Additional injection of iodized oil, if needed, was adopted in order to make a complete embolization of the tumor as far as possible. Conventional CT scanning was carried out one week after the treatment. For patients in group B, DynaCT scanning was not used during the performance of TACE, and only conventional CT scanning was performed one week after the treatment. The imaging findings were analyzed. The results were compared between the two groups. Results A total of 54 lesions were detected in 30 patients of group A. Fluoroscopically, iodized oil deposition within the tumor could be seen in 49 lesions with a sensitivity of 90.7% (49/54). On the initial DynaCT images iodized oil deposition within the tumor was observed in 53 lesions with a sensitivity of 98.1% (53/54). On the initial DynaCT images complete oil embolization (type Ⅰ lesion) was seen in 37 lesions (37/54), while on the conventional CT images performed one week after the treatment complete oil embolization (type Ⅰ lesion) was seen in 46 lesions (46/54), the difference was statistically significant (x2 = 20.4, P < 0.05). In group B, the conventional CT images performed one week after the treatment revealed 22 type Ⅰ lesions (22/33). The complete oil embolization rate demonstrated on the conventional CT images in group A was significantly higher than that in group B (x2 = 4.16, P < 0.05). Conclusion DynaCT scanning performed during the TACE procedure for HCC after the chemoembolization procedure is accomplished is very useful for making an instant evaluation of the embolization effect. Besides, this technique is helpful for obstructing the HCC lesions as complete as possible. Thus, the therapeutic effect can be improved.