Hepatic Intra-Arterial Lipiodol on Computed Tomography-Preliminary Experience

硏究肝動脈內注射油性碘(LIPIODL)在電腦斷層攝影上之表徵及機轉－初步報告

錢本文(Poon-Ung Chieng) ； 田德楊(Robert D. Tien) ； 陳百榮(Pak-Wing Chen) ； 關強(Cheung Kwan) ； 張賴昇平(Sheng-Pyng ChangLai) ； 徐劍耀(Jane Chien-Yao Hsu) ； 黃國茂(Kou-Mou Huang)

《中華放射線醫學雜誌》 14卷4期 (1989/12) Pp. 297-308

摘要

吾等初步完成9例肝動脈內注射油性碘(LIPIODOL)，並輔以電腦斷層攝影來研究LIPIODOL（簡稱HIAL/CT）瘀留在肝瘤內之可能機轉。個案全部皆為男性患者，年齡分佈在39至68歲間。包括6例肝細胞癌，2例血管瘤及1例肝囊腫。所測到最小的〝子腫瘤直徑為8公厘，唯在第三星期就消失，故認為HIAL/CT最好在二星期間完成。在本研究中，吾人遇到一例未被曾文獻報導過之病例－那就是LIPIODOL因肝癌內的動脈門脈間有嚴重分流造成無瘀留現象。因此吾等試對油性碘留在肝腫瘤內之機轉推出－假說。此假說認為油性碘並非選擇地瘀留在肝腫瘤內，鍵是取決於血流量及肝腫瘤之血管性，另外肝動脈內注射油性碘之方法，量之多寡，時間之長短皆為關表面看來油性碘選擇性地瘀留在肝腫瘤內，那是由於油性碘在肝腫瘤內與無腫瘤之肝實質內之排除時間不一致，尤其是當肝硬化時更伴有動門脈分流更加速排泄。為了作HIAL/CT時能達到油性碘之最高瘀留，吾人強調下例技術層面，如超選擇性，緩慢(SI-HIAL)或極慢(LI-HlaL)注射技術以取代快速(FP-HIAL)注射油性碘。特別是低血管性或碩大腫瘤為然。

並列摘要

We Performed 9 cases of hepatic intraarterial Lipiodol coupled with CT (HIAL/CT) in an attempt to characterize the phenomenon of Lipiodol localization in hepatic tumors. They were 9 males with a range of ages from 39 to 68, consisting of 6 hepatocellular carcinomas (HCC), 2 haemangiomas and 1 hepatic cyst. The smallest daughter nodule detected was 8 mm. It was nonvisualized on HIAL/CT after third week, so we believe that the optimal period for HIAL/CT is within 2 weeks. In this study, we came across a situation not mentioned in the English literature before, that is the absence of Lipiodol due to severe arterioportal (A-P) shunting in HCC. Hereby, we proposed a hypothesis for the mechanism of iodized oil localization in the hepatic tumors. This hypothesis states that the localization of iodized oil in hepatic tumors is not selective, or rather it is dependent on blood-flow and vascularity, mode and duration as well as amount of intraarterial administration of iodized oil. The apparent tumor ”selectivity” of iodized oil lies in the different rate of clearance of iodized oil in the tumor and non-tumorous liner parenchyma, which could be enhanced in the presence of liver cirrhosis and A-P shunting. In-order to achieve optimal tumor-to-non-tumor ratio in HIAL, we emphasized on several technical aspects such as super-selectivity and slow infusion (SI-HIAL) or lymphangiographic infusion (LI-HIAL) instead of first past (FP-HIAL) injection of emulsified iodized oil in hypovascular hepatic tumors, and larger amount in huge tumors.

並列關鍵字

computed tomography ； lipiodol ； hepatic intraarterial ； liver neoplasms ； shunts ； arteriovenous