MIP及VR三维重建在原发性肝癌TACE介入前血管系统评估中的应用

摘要/Abstract

摘要： 目的探讨最大密度投影(MIP)及容积重建(VR)三维重建在原发性肝癌(PLC)肝动脉化疗栓塞(TACE)介入前血管系统评估中的应用价值。方法选取2020年1月—2022年1月无锡市太湖医院拟行TACE治疗的PLC患者72例纳入研究对象,所有患者治疗前均接受多层螺旋CT(MSCT)及血管造影(DSA)检查,检查结束后通过MIP、VR对MSCT检查获取图像进行三维重建。最后以DSA检查结果为金标准,比较MIP、VR三维重建及DSA中肝动脉分级、肝外动脉、肿瘤供血动脉、肿瘤血管、门静脉分级显示情况。结果 1、2级肝动脉显示结果中MIP、VR、DSA显示率均为100%,且显示例数比较未见明显差异(χ²=0.000、0.000,P＞0.05);3级肝动脉显示结果中MIP显示69例(95.8%)、DSA显示72例(100.0%)显著高于VR显示的41例(56.9%)(χ²=61.226,P<0.05);4级及以上肝动脉显示结果中MIP显示34例(47.2%)显著高于VR显示的13例(18.1%),而DSA显示的62例(81.6%)显著高于MIP显示的34例(47.2%)(χ²=67.154,P<0.05)。MIP显示腹腔干72例(100.0%)、肠系膜上67例(93.1%)、脾动脉72例(100.0%)、肝总动脉72例(100.0%)、胃十二指肠动脉72例(100.0%)、肝固有动脉72例(100.0%),VR显示腹腔干72例(100.0%)、肠系膜上67例(93.1%)、脾动脉72例(100.0%)、肝总动脉72例(100.0%)、胃十二指肠动脉72例(100.0%)、肝固有动脉72例(100.0%),DSA显示腹腔干72例(100.0%)、肠系膜上69例(95.8%)、脾动脉72例(100.0%)、肝总动脉72例(100.0%)、胃十二指肠动脉72例(100.0%)、肝固有动脉72例(100.0%),三者显示例数比较未见明显差异(χ²=24.376,P＞0.05)。MIP显示肿瘤供血动脉70例(97.2%),VR显示肿瘤供血动脉68例(94.4%),DSA显示肿瘤供血动脉72例(100.0%),三者显示例数比较未见明显差异(χ²=4.114,P＞0.05);肿瘤血管显示结果中MIP显示63例(87.5%)、DSA显示72例(100.0%)均明显高于VR显示的26例(36.1%)(χ²=87.716,P<0.05)。MIP显示4级门静脉分支70例(97.2%)、5级门静脉分支67例(93.1%)、6级及以上门静脉分支46例(63.9%),与VR显示的4级门静脉分支66例(91.7%)、5级门静脉分支63例(87.5%)、6级及以上门静脉分支44例(61.1%)比较未见明显差异(χ²=0.004,P＞0.05)。结论 PLC患者TACE治疗前行MIP及VR三维重建可直观、立体地显示肝脏血管系统,能够为后续手术治疗方案的制定提供依据,利于治疗工作的顺利开展。

关键词: 原发性肝癌, 肝动脉化疗栓塞, 最大密度投影, 容积重建, 三维重建, 血管造影

Abstract: Objective To investigate the application value of maximum density projection (MIP) and volume reconstruction (VR) of three-dimentional (3D) reconstruction in vascular system evaluation of primary liver cancer (PLC) before transcatheter arterial chemoembolization (TACE).Methods A total of 72 PLC patients who underwent TACE treatment from January 2020 to January 2022 were selected and included in the study. All patients received multi-slice spiral computed tomography (MSCT) and angiography (DSA) examinations before treatment. The images obtained by MSCT were reconstructed by MIP and VR. Finally, the results of DSA were used as the gold standard to compare the grading of hepatic artery, extrahepatic artery, tumor feeding artery, tumor blood vessel, and portal vein in MIP, VR of 3D reconstruction and DSA.Results The display rates of MIP, VR and DSA in the results of grade 1 and grade 2 hepatic artery display were all 100%, and there was no significant difference in the number of displayed cases (χ²=0.000、0.000, P>0.05); Among the results of grade 3 hepatic artery display, 69 cases were shown by MIP (95.8%), 72 cases were shown by DSA (100.0%), which were significantly higher than that of 41 cases shown by VR (56.9%)(χ²=61.226, P<0.05). In the results of hepatic artery of grade 4 and above, 34 cases (47.2%) displayed by MIP, which were significantly higher than that of 13 cases (18.1%) displayed by VR, and 62 cases (81.6%) displayed by DSA, which were significantly higher than that of 34 cases (47.2%) displayed by MIP. (χ²=67.154, P<0.05). MIP showed celiac trunk in 72 cases (100.0%), superior mesentery in 67 cases (93.1%), splenic artery in 72 cases (100.0%), common hepatic artery in 72 cases (100.0%), gastroduodenal artery in 72 cases (100.0%) ), proper hepatic artery in 72 cases (100.0%), celiac trunk in 72 cases (100.0%), superior mesenteric in 67 cases (93.1%), splenic artery in 72 cases (100.0%), and common hepatic artery in 72 cases (100.0%), gastroduodenal artery in 72 cases (100.0%), proper hepatic artery in 72 cases (100.0%), DSA showed celiac trunk in 72 cases (100.0%), superior mesentery in 69 cases (95.8%), splenic artery in 72 cases (100.0%), common hepatic artery in 72 cases (100.0%), gastroduodenal artery in 72 cases (100.0%), and proper hepatic artery in 72 cases (100.0%), there was no significant difference in the number of cases among the three (χ²=24.376, P>0.05). MIP showed tumor feeding arteries in 70 cases (97.2%), VR showed tumor feeding arteries in 68 cases (94.4%), DSA showed tumor feeding arteries in 72 cases (100.0%), and there was no significant difference between the three cases (χ²=4.114, P>0.05); As the results of tumor blood vessel display, 63 cases (87.5%) displayed by MIP and 72 cases (100.0%) displayed by DSA, both were significantly higher than those of 26 cases (36.1%) displayed by VR(χ²=87.716, P<0.05). As for portal vein branches, MIP displayed 70 cases (97.2%) of grade 4 portal vein branches, 67 cases (93.1%) of grade 5 portal vein branches, 46 cases (63.9%) of grade 6 and above portal vein branches; VR displayed 66 cases (91.7%) of grade 4 portal vein branches, 63 cases (87.5%) of grade 5 portal vein branches, and 44 cases (61.1%) of grade 6 and above portal vein branches. There were no significant difference was found between the portal vein branches displayed by MIP and VR (χ²=0.004, P>0.05).Conclusion 3D reconstruction by MIP and VR in PLC patients before TACE treatment can intuitively and three-dimensionally display liver vascular system, which can provide basis for establishing optimised treatment regimes, as well as the follow-up plans post surgical treatment.

Key words: Primary liver cancer, Hepatic arterial chemoembolization, Maximum density projection, Volume reconstruction, Three-dimensional reconstruction, Angiography

朱烨晨, 耿承军, 殷慧康, 李亚南, 冯权烨. MIP及VR三维重建在原发性肝癌TACE介入前血管系统评估中的应用[J]. 肝脏, 2023, 28(5): 559-563.

ZHU Ye-chen, GENG Cheng-jun, YIN Hui-kang, LI Ya-nan, FENG Quan-ye. The application of three-dimensional reconstruction in the evaluation of vascular system of primary liver cancer before TACE intervention[J]. Chinese Hepatolgy, 2023, 28(5): 559-563.

参考文献

[1] Chassagne F, Rojas TR, Bertani S, et al. A 13-year retrospective study on primary liver cancer in cambodia: a strikingly high hepatitis c occurrence among hepatocellular carcinoma cases. Oncology, 2016, 91(2):106-116.
[2] 吴姗姗, 王振常, 吕艳杭, 等. 柔肝化纤解毒方治疗原发性肝癌TACE术后综合征的临床疗效观察. 中华中医药杂志, 2021, 36(5):3038-3041.
[3] 付志豪, 孙兆菲, 王亚东. 缺氧在布-加综合征引发原发性肝癌相关机制研究进展. 中华医学杂志, 2018, 98(46):3805-3808.
[4] 廖娟, 王春晖, 李肖, 等. 经导管肝动脉化疗栓塞术对原发性肝癌患者细胞免疫及调节T细胞的影响. 肝脏, 2011, 16(3):198-201.
[5] Lei W, Ke Q, Deng M, et al. Adjuvant transarterial chemoembolization for patients with hepatocellular carcinoma after radical hepatectomy: a real world study. Scand J Gastroenterol, 2019, 54(11):1403-1411.
[6] Tarazov PG, Polysalov VN, Prozorovskij KV, et al. Ischemic complications of transcatheter arterial chemoembolization in liver malignancies. Acta Radiol, 2015, 41(2):156-160.
[7] Jandl NM, Rolvien T, Rupp T, et al. Diagnostic yield of cone beam computed tomography for small foreign body detection in the hand in comparison with radiography, msct and mri: an ex vivo study. Injury, 2021, 52(10):2841-2847.
[8] Liu Q, Wei X, Guan J, et al. Assessment of condylar morphology and position using msct in an asian population. Clin Oral Investig, 2018, 22(7):2653-2661.
[9] Wessling J, Esseling R, Raupach R, et al. The effect of dose reduction and feasibility of edge-preserving noise reduction on the detection of liver lesions using msct. Eur Radiol, 2020, 17(7):1885-1891.
[10] 中华人民共和国卫生部. 原发性肝癌诊疗规范(2011年版). 中华肝脏病杂志, 2012, 20(6):929-946.
[11] Takahashi S, Murakami T, Takamura M, et al. Multi-detector row helical ct angiography of hepatic vessels: depiction with dual-arterial phase acquisition during single breath hold. Radiology, 2002, 222(1):81-88.
[12] Tanikake M, Shimizu T, Narabayashi I, et al. Three-dimensional ct angiography of the hepatic artery: use of multi-detector row helical ct and a contrast agent. Radiology, 2003, 227(3):883-889.
[13] Muthusami P, Shkumat N, Rea V, et al. CT reconstruction and mri fusion of 3d rotational angiography in the evaluation of pediatric cerebrovascular lesions. Neuroradiology, 2017, 59(6):625-633.
[14] Glybochko PV, Alyaev YG, Khokhlachev SB, et al. 3D reconstruction of ct scans aid in preoperative planning for sarcomatoid renal cancer: a case report and mini-review. J X-Ray Sci Technol, 2019, 27(10):1-7.
[15] Santis MD, Ariosi P, Calò GF, et al. Hepatic arterial vascular anatomy and its variants. Radiol Med, 2000, 100(3):145-151.
[16] 臧越, 周杰, 姜涛, 等. 儿童先天性血管环的多层螺旋CT诊断. 中华医学杂志, 2015, 95(35):2861-2864.
[17] Koops A, Wojciechowski B, Broering DC, et al. Anatomic variations of the hepatic arteries in 604 selective celiac and superior mesenteric angiographies. Surg Radiol Anat, 2004, 26(3):239-244.
[18] Nagai H, Mukozu T, Ogino YU, et al. Sorafenib and hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombus. Anticancer Res, 2015, 35(4):2269-2277.
[19] Miyayama S, Matsui O, Taki K, et al. Extrahepatic blood supply to hepatocellular carcinoma: angiographic demonstration and transcatheter arterial chemoembolization. Cardiovasc Intervent Radiol, 2006, 29(1):39-48.
[20] 李万湖, 董帅, 胡旭东, 等. 多层螺旋CT血管造影对原发性肝癌动静脉瘘和肝外供血动脉评估价值. 中华肿瘤防治杂志, 2017, 24(11):755-758.