旋转数字减影血管造影三维重建在肝癌介入治疗中的应用研究

摘要/Abstract

摘要： 目的探讨旋转数字减影血管造影(DSA)三维重建在肝癌介入治疗中的应用价值。方法选取复旦大学附属上海市第五人民医院收治的104例行介入治疗的肝癌患者作为研究对象,按照检查方式的不同分为三维组(行旋转DSA三维重建)和常规组(常规DSA),对两种检查方法下病灶的显示效果及手术疗效等进行回顾性对比分析。结果与常规组相比,三维组的碘油沉积完全率、超选择动脉插管成功率更高(96.30% vs 72.00%,94.44% vs 76.00%),手术时间更短[(32.62±5.42)min vs(44.24±6.53)min ],P<0.05。两组的造影剂用量、肿瘤供血动脉显示率比较,差异无统计学意义(P>0.05)。相比常规组,三维组的甲级片占比更高(92.59% vs 68.00%),肿瘤侧支循环显示率(50.00% vs 24.00%)、小病灶显示率(25.93% vs 6.00%),小病灶供血动脉显示率(25.93% vs 6.00% 、小病灶侧支循环显示率(31.48% vs 0)和肝动脉3/4级检出率更高(96.30% vs 68.00%),差异均有统计学意义(P<0.05)。三维组的总缓解率为70.37%,明显高于常规组的44.00%,P<0.05。结论在肝癌介入治疗中采用旋转DSA三维重建技术能够提高图像质量,同时缩短手术时间,提高手术效果。

关键词: 旋转数字减影血管造影, 三维重建, 肝癌, 介入治疗, 图像质量

Abstract: Objective To investigate the application value of 3D (three-dimensional) reconstruction of rotational digital subtraction angiography (DSA) in interventional treatment for hepatocellular carcinoma (HCC). Methods One hundred and four patients with HCC treated by interventional therapy in our hospital were selected, they were divided into 3D group (3D reconstruction by rotational DSA) and conventional group (conventional DSA) according to different examination methods. The display effect on lesions and the surgical effect of the two examination methods were retrospectively analyzed. Results Compared with the conventional group, the lipiodol deposition rate and the success rate of superselective arterial catheterization in the 3D group were higher (96.30% vs 72.00%, 94.44% vs 76.00%). The operation time of 3D group was shorter [(32.62±5.42) min vs (44.24±6.53) min], P<0.05. There was no significant difference in the amount of arterial contrast agent and the display rate of tumor blood supply arteries between the two groups (P>0.05). Compared with the conventional group, the first film rate (92.59% vs 68.00%) and the detection rate of hepatic artery grade 3/4 (96.30% vs 6.00%) in the 3D group were higher. The display rate of tumor collateral circulation (50.00% vs 24.00%), small lesions (25.93% vs 6.00%), blood supply artery of small lesions (25.93% vs 6.00%) and collateral circulation of small lesions (31.48% vs 0) in the 3D group were higher than those of the conventional group. The differences were all statistically significant (P<0.05). The total remission rate of 3D group was 70.37%, which was significantly higher than that of conventional group (44.00%, P<0.05). Conclusion In the interventional treatment of liver cancer, 3D reconstruction technology of rotational DSA can improve the image quality, shorten the operation time and improve the operation effect.

Key words: Rotational digital subtraction angiography, Three-dimensional reconstruction, Liver cancer, Interventional therapy, Image quality

庄华庆, 蒋华, 杨怡静. 旋转数字减影血管造影三维重建在肝癌介入治疗中的应用研究[J]. 肝脏, 2021, 26(12): 1328-1331.

ZHUANG Hua-qing, JIANG Hua, YANG Yi-jing. Application study on three dimensional reconstruction of rotational digital subtraction angiography in interventional treatment for hepatocellular carcinoma[J]. Chinese Hepatolgy, 2021, 26(12): 1328-1331.

参考文献

[1] 肖东健,王勇,岳鑫,等. DSA和CTA在中晚期肝癌血供及灌注研究中的应用. 中国CT和MRI杂志, 2020, 18:5-7,14.
[2] 杨玉龙,杜纯忠,刘奎伟,等.肝脏肿瘤介入治疗应用旋转DSA三维重建技术价值分析. 中华肿瘤防治杂志, 2019, 26:98-99.
[3] 秦刚,郭李娜,秦飞燕,等.三维旋转血管造影技术在颅内动脉瘤诊断和介入治疗中的作用. 影像研究与医学应用, 2020, 4:94-95.
[4] 叶胜龙,秦叔逵,吴孟超,等.原发性肝癌规范化诊治的专家共识.中华肝脏病杂志,2009,20:403-410.
[5] Kaneko S,Tsuchiya K,Yasui Y,et al. Early radiological response evaluation with response evaluation criteria in solid tumors 1.1 stratifies survival in hepatocellular carcinoma patients treated with lenvatinib. JGH Open,2020,4:1183-1190.
[6] 崔安明. 肝癌供血动脉的CTA及DSA表现在TACE治疗中的应用价值. 中国实用医药, 2020, 15:79-81.
[7] 刘辉来. DSA三维重建技术对肝脏肿瘤辅助治疗的价值研究. 影像研究与医学应用, 2019, 3:131-132.
[8] 范宏伟. 肝脏肿瘤介入治疗应用旋转DSA三维重建技术的临床分析. 现代医用影像学, 2018, 27:347-348.
[9] 曾思略,祝文,方驰华,等. 以血管为轴心的巨块型肝癌三维可视化评估及虚拟现实技术研究. 中华普通外科杂志, 2019, 34:323-327.
[10] 陈国慧.肝癌介入治疗中旋转数字减影血管造影三维重建技术的价值分析.饮食保健,2019,6:230.
[11] 毕军刚. 旋转DSA三维重建技术用于肝癌介入治疗中的效果. 临床医学研究与实践, 2020, 5:114-116.
[12] 朱武刚, 刘欢, 庄步强,等. 三维DSA在原发性肝癌肝动脉化疗栓塞术中的应用价值. 医学影像学杂志, 2019, 29:790-793.
[13] 沈旭峰,金川连.旋转数字减影血管造影(DSA)三维重建技术在肝脏肿瘤介入治疗中的应用效果.医药前沿,2018,8:176-177.
[14] 沈海洋,宋浩,李倩,等.3D-DSA在微细血管供血肝癌的介入治疗中应用价值.影像研究与医学应用,2020,4:5-7.
[15] 韦宝军.DSA图像质量影响因素及旋转DSA造影技术的应用价值.中西医结合心血管病电子杂志,2020,8:65,86.