Division of Interventional Radiology, Stanford University Medical Center, 300 Pasteur Dr, H3652, Stanford, CA 94305-5642, USA.
J Vasc Interv Radiol. 2010 Mar;21(3):339-47. doi: 10.1016/j.jvir.2009.11.007. Epub 2010 Feb 4.
To evaluate the utility of C-arm computed tomography (CT) on treatment algorithms in patients undergoing transhepatic arterial chemoembolization for hepatocellular carcinoma (HCC).
From March 2008 to July 2008, 84 consecutive patients with HCC underwent 100 consecutive transhepatic arterial chemoembolizations with iodized oil. Unenhanced and iodinated contrast medium-enhanced C-arm CT with planar and three-dimensional imaging were performed in addition to conventional digital subtraction angiography (DSA) in all patients. The effect on diagnosis and treatment was determined by testing the hypotheses that C-arm CT, in comparison to DSA, provides (a) improved lesion detection, (b) expedient identification and mapping of arterial supply to a tumor, (c) improved characterization of a lesion to allow confident differentiation of HCC from pseudolesions such as arterioportal shunts, and (d) an improved evaluation of treatment completeness. The effect of C-arm CT was analyzed on the basis of information provided with C-arm CT that was not provided or readily apparent at DSA.
C-arm CT was technically successful in 93 of the 100 procedures (93%). C-arm CT provided information not apparent or discernible at DSA in 30 of the 84 patients (36%) and resulted in a change in diagnosis, treatment planning, or treatment delivery in 24 (28%). The additional information included, amongst others, visualization of additional or angiographically occult tumors in 13 of the 84 patients (15%) and identification of incomplete treatment in six (7.1%).
C-arm CT is a useful collaborative tool in patients undergoing transhepatic arterial chemoembolization and can affect patient care in more than one-fourth of patients.
评估 C 臂 CT 在经肝动脉化疗栓塞治疗肝细胞癌（HCC）患者治疗方案中的应用价值。
2008 年 3 月至 2008 年 7 月，84 例 HCC 患者连续进行了 100 次经肝动脉化疗栓塞术，术中共使用碘油。所有患者均在常规数字减影血管造影（DSA）的基础上，行 C 臂 CT 平扫及增强扫描，并进行三维成像。通过检验以下假设来确定 C 臂 CT 对诊断和治疗的影响，即与 DSA 相比，C 臂 CT 能否：(a) 提高病灶检出率；(b) 快速确定并描绘肿瘤的动脉供血；(c) 改善病灶特征，使 HCC 与假性病灶（如动静脉分流）能得到准确区分；(d) 提高治疗完全性评估。根据 C 臂 CT 提供的、而 DSA 未提供或不易察觉的信息来分析 C 臂 CT 的效果。
100 次治疗中有 93 次（93%）成功进行了 C 臂 CT 检查。在 84 例患者中，有 30 例（36%）患者的 C 臂 CT 结果提供了 DSA 不明显或无法辨别的信息，24 例（28%）患者的诊断、治疗计划或治疗方法因此发生了改变。这些附加信息包括：在 84 例患者中，有 13 例（15%）发现了额外或血管造影隐匿性肿瘤，6 例（7.1%）发现了治疗不彻底。
C 臂 CT 是经肝动脉化疗栓塞术患者的有用辅助工具，可影响四分之一以上患者的治疗。
