The Role of Multi-detector CT as Preoperative Assessment of Hypervascular Hepatocellular Carcinoma Compared with Digital Subtraction Angiography

多層次電腦斷層掃瞄對於高血管性肝細胞腫瘤患者的術前評估之角色：與數位減影血管攝影之比較

劉繼光(Chi-Kuang Liu) ； 周成德(Chen-Te Chou) ； 董道興(Tao-Hsin Tung) ； 李明哲(Ming-Che Li) ； 胡華堃(Hwa-Koon Wu) ； 李國維(Kwo-Whei Lee)

《中華放射線醫學雜誌》 31卷5期 (2006/10) Pp. 215-220

摘要

本研究的目的是為確定多層次電腦斷層掃描是否可以取代具侵入性的數位減影血管攝影作為高血管性肝細胞癌的標準術前診斷。
總共43位臨床證實肝細胞癌的病人進行三相的多層次電腦斷層掃瞄。掃瞄總共包共顯影前(pre-contrast)，肝臟動脈相(hepatic arterial phase)，肝門靜脈相(portovenous phase)和延遲相(delay phase)。掃瞄完畢後一個月之內所有病人皆接受數位減影血管攝影以及經肝動脈化學栓塞療法並注射碘化油滴。病人在血管攝影之後約一個月進行一次，且在碘化油滴多層次電腦斷層掃瞄後3到6個月後再進行第二次多層次電腦斷層掃瞄。病人的所有系列影像均被重新檢視，且以多層次電腦斷層掃瞄與數位減影血管攝影所得之影像進行比較。
對於大於20mm的肝細胞腫瘤，多層次電腦斷層掃瞄和數位減影血管攝影的敏感度相同。對於10-20mm的肝細胞腫瘤，多層次電腦斷層掃瞄偵測敏感度(sensitivity)為94.6%，而數位減影血管攝影之敏感度為83.1%。對於10mm以下的肝細胞腫瘤，多層次電腦斷層掃瞄之敏感度為94.7%，而數位減影血管攝影之敏感度為78.9%。
由於對於肝細胞腫瘤偵測能力之較為優越性，多層次電腦斷層掃瞄可以取代數位減影血管攝影作為肝細胞癌的標準術前診斷。

關鍵字

電腦斷層攝影 ； 數位減影血管攝影 ； 肝細胞癌

並列摘要

The purpose of this study was to determine whether triphasic multi-detector row computed tomography (MDCT) can substitute digital subtraction angiography (DSA) for the preoperative detection of hypervascular hepatocellular carcinoma (HCC).
Forty-three patients with nodular HCC underwent first triphasic MDCT examination: pre-contrast, hepatic arterial, portovenous, and delayed phase. Within 4 weeks, they underwent digital hepatic angiography with an intra-arterial chemoembolization with iodized oil and Pharmorubicin. Lipiodol computed tomography (CT) was performed in 4 weeks after infusion. A follow-up MDCT examination was performed between 3 to 6 months after lipiodol CT. Serial CT scans were reviewed and compared with DSA images to detect hepatic nodules.
MDCT and DSA had the same sensitivity in detecting nodules ＞20mm in diameter. For the nodules 10-20 mm, MDCT detected 56 (sensitivity=94.6%), DSA detected 49 (sensitivity=89.5%, p=0.003). For the nodules ＜10mm, MDCT identified 72 (sensitivity=94.7%), DSA detected 60, sensitivity was 78.9% (p=0.001).
Because of superior lesion detectability of MDCT as compared with DSA, MDCT may substitute DSA in the preoperative examination for hypervascular HCC.

並列關鍵字

Computed tomography ； Digital Subtraction Angiography DSA ； Hepatocellular carcinoma HCC