Fujii J, Ozaki T, Kawai A, Kunisada T, Sugihara S, Inoue H
Department of Orthopaedic Surgery, Okayama University Medical School, Japan.
Clin Orthop Relat Res. 1999 Mar(360):197-206. doi: 10.1097/00003086-199903000-00024.
Eleven abnormal findings of digital subtraction angiography were analyzed in 25 patients with bone sarcoma and in 23 patients with soft tissue sarcoma. The relation between digital subtraction angiographic findings and the histologic effect of chemotherapy was evaluated. Digital subtraction angiography was performed with the patient under local anesthesia with the Seldinger technique, using an ADVANT X unit. Contrast medium was injected at a rate of 4 to 6 ml per second, with the usual single bolus dose of approximately 6 to 8 ml. Eleven abnormal findings included tumor stain, hypervascularity, arterial distortion, vascular stretch, arterial dilatation, arteriovenous shunt, arterial encasement, occlusion, blood pool, caliber with irregular wall, and dilatation of draining vein. Each finding after preoperative chemotherapy was compared with that before chemotherapy and divided into three grades; Grade 1, not effective; Grade 2, effective; and Grade 3, very effective. Angiographic Grades 2 and 3 were defined as responders. The histologic effect was examined and scored according to the modified classification proposed by Huvos. Histologic Grades 1 and 2 were classified as nonresponders and Grades 3 and 4 as good responders. In bone sarcomas, hypervascularity and tumor stain were seen in all patients. In soft tissue sarcomas, tumor stain was shown in all 23 patients and hypervascularity was seen in 21 patients. Tumor stain, hypervascularity, vascular stretch, and arterial encasement were correlated closely with histologic findings and showed an accuracy equal to or greater than 70%. When these four findings changed to angiographic Grade 3 after preoperative chemotherapy, 90% of patients had good histologic outcome.
对25例骨肉瘤患者和23例软组织肉瘤患者的11项数字减影血管造影异常表现进行了分析。评估了数字减影血管造影表现与化疗组织学效果之间的关系。采用Seldinger技术在局部麻醉下使用ADVANT X设备对患者进行数字减影血管造影。以每秒4至6毫升的速率注射造影剂，通常单次推注剂量约为6至8毫升。11项异常表现包括肿瘤染色、血管增多、动脉扭曲、血管拉伸、动脉扩张、动静脉分流、动脉包绕、闭塞、血池、管壁不规则的管径以及引流静脉扩张。将术前化疗后的每项表现与化疗前进行比较，并分为三个等级：1级，无效；2级，有效；3级，非常有效。血管造影2级和3级被定义为反应者。根据Huvos提出的改良分类法检查组织学效果并评分。组织学1级和2级被归类为无反应者，3级和4级为良好反应者。在骨肉瘤中，所有患者均可见血管增多和肿瘤染色。在软组织肉瘤中，所有23例患者均显示肿瘤染色，21例患者可见血管增多。肿瘤染色、血管增多、血管拉伸和动脉包绕与组织学结果密切相关，准确率等于或大于70%。当这四项表现在术前化疗后变为血管造影3级时，90%的患者组织学结果良好。
