彩色编码数字减影血管造影在定量分析化疗栓塞前后肝脏肿瘤灌注减少中的应用价值
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摘要
目的探究彩色编码数字减影血管造影(ccDSA)在TACE术中对肝肿瘤灌注的即刻变化进行定量评测。方法回顾性研究了35例TACE治疗肝细胞癌病例。TACE术前后用相同参数采集二维数字减影血管造影(2D-DSA)。图像序列均经二维ccDSA(2D-ccDSA)进行后处理。在ccDSA图像上测量感兴趣区域(ROI),得到时间密度曲线(time-contrast-intensity CI[t]),并获取肿瘤血供时间(TBST),曲线下面积(AUC)、最大强化值(CI-Peak)和最大上升斜率(MS)这些灌注参数来分析评估TACE前后顺行血流和肿瘤染色减少的程度。并对上述参数与主观血管造影栓塞终点(SACE)标准和临床结果之间的关系进行分析。结果 TACE前后灌注参数的比较有显著差异。AUC和CI-Peak在TACE术后大幅下降。TBST在术后较之术前有显著延迟。灌注减少30%~40%相当于SACEⅢ级,灌注减少60%~70%相当于SACEⅣ级。结论 2D-ccDSA可以客观地量化评估TACE术对肝肿瘤血流灌注的影响,为TACE术提供了定量评价动脉血流停滞程度和肿瘤染色减少的指标。
Objective To discuss the application of color-coded digital subtraction angiography(ccDSA) in quantitatively analyzing the instant perfusion changes of hepatic tumors during transcatheter arterial chemoembolization(TACE). Methods The clinical data of 35 patients with hepatocellular carcinoma(HCC) who underwent TACE were reviewed. Before and after TACE, two-dimensional DSA(2D-DSA) was performed by using the same parameters in all patients. The image sequences were post-processed with 2D-ccDSA. On ccDSA images the regions of interest(ROIs) were measured to obtain the time-contrast-intensity(CI[t]) curves as well as the perfusion parameters, including tumor blood supply time(TBST), area under the curve(AUC), contrast-intensity peak(CI-Peak) and maximum upslope(MS), which were used to evaluate the degree of the reduction in direct blood flow and in tumor staining. The relationship between the above parameters and subjective angiographic chemoembolization endpoint(SACE) was analyzed. Results After TACE, the perfusion parameters were significantly different from pre-TACE ones. AUC and CI-Peak values were dramatically decreased. After TACE, TBST slowed a significant delay. The reduction of perfusion about30%-40% was equal to SACE grade Ⅲ; the reduction of perfusion about 60%-70% was equal to SACE grade Ⅳ. Conclusion 2D-ccDSA can be used to objectively and quantitatively evaluate the effect of TACE on the perfusion of hepatic tumors, providing useful indexes for making quantitative assessment of the degree of blood flow stagnation and the reduction of tumor staining.
Objective To discuss the application of color-coded digital subtraction angiography(ccDSA) in quantitatively analyzing the instant perfusion changes of hepatic tumors during transcatheter arterial chemoembolization(TACE). Methods The clinical data of 35 patients with hepatocellular carcinoma(HCC) who underwent TACE were reviewed. Before and after TACE, two-dimensional DSA(2D-DSA) was performed by using the same parameters in all patients. The image sequences were post-processed with 2D-ccDSA. On ccDSA images the regions of interest(ROIs) were measured to obtain the time-contrast-intensity(CI[t]) curves as well as the perfusion parameters, including tumor blood supply time(TBST), area under the curve(AUC), contrast-intensity peak(CI-Peak) and maximum upslope(MS), which were used to evaluate the degree of the reduction in direct blood flow and in tumor staining. The relationship between the above parameters and subjective angiographic chemoembolization endpoint(SACE) was analyzed. Results After TACE, the perfusion parameters were significantly different from pre-TACE ones. AUC and CI-Peak values were dramatically decreased. After TACE, TBST slowed a significant delay. The reduction of perfusion about30%-40% was equal to SACE grade Ⅲ; the reduction of perfusion about 60%-70% was equal to SACE grade Ⅳ. Conclusion 2D-ccDSA can be used to objectively and quantitatively evaluate the effect of TACE on the perfusion of hepatic tumors, providing useful indexes for making quantitative assessment of the degree of blood flow stagnation and the reduction of tumor staining.
引文
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[4]Strother CM,Bender F,Deuerling-Zheng Y,et al.Parametric color coding of digital subtraction angiography[J].AJNR Am J Neuroradiol,2010,31:919-924.
[5]Struffert T,Ott S,Kowarschik M,et al.Measurement of quantifiable parameters by time-density curves in the elastaseinduced aneurysm model:first results in the comparison of a flow diverter and a conventional aneurysm stent[J].Eur Radiol,2013,23:521-527.
[6]Golitz P,Struffert T,Lucking H,et al.Parametric color coding of digital subtraction angiography in the evaluation of carotid cavernous fistulas[J].Clin Neuroradiol,2013,23:113-120.
[7]Zhang XB,Zhuang ZG,Ye H,et al.Objective assessment of transcatheter arterial chemoembolization angiographic endpoints:preliminary study of quantitative digital subtraction angiography[J].J Vasc Interv Radiol,2013,24:667-671.
[8]Brown DB,Cardella JF,Sacks D,et al.Quality improvement guidelines for transhepatic arterial chemoembolization,and chemotherapeutic infusion for hepatic malignancy[J].J Vasc Interv Radiol,2006,17:225-232.
[9]Gupta R,Cheung AC,Bartling SH,et al.Flat-panel volume CT:fundamental principles,technology,and applications[J].Radiographics,2008,28:2009-2022.
[10]Struffert T,Doerfler A.Flat-detector computed tomography in diagnostic and interventional neuroradiology[J].Radiologe,2009,49:820-829.
[11]Wang D,Bangash AK,Rhee TK,et al.Liver tumors:monitoring embolization in rabbits with VX2 tumors:transcatheter intraarterial first-pass perfusion MR imaging[J].Radiology,2007,245:130-139.
[12]Ahmed AS,Deuerling-Zheng Y,Strother CM,et al.Impact of intra-arterial injection parameters on arterial,capillary,and venous time-concentration curves in a canine model[J].AJNR Am J Neuroradiol,2009,30:1337-1341.