Heusner T A, Hamami M E, Ertle J, Hahn S, Poeppel T, Hilgard P, Bockisch A, Forsting M, Antoch G
Institut für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinik Essen, Essen.
Rofo. 2010 Jul;182(7):603-8. doi: 10.1055/s-0029-1245192. Epub 2010 Feb 24.
To retrospectively assess the accuracy of angiography-based C-arm CT for the detection of extrahepatic shunting before SIRT.
30 patients (mean age: 64+/-12 years) with hypervascularized hepatic tumors underwent hepatic angiography, coil embolization of gastrointestinal collaterals and 99mTc-macroaggregated albumin (MAA) SPECT/CT before SIRT. Before MAA injection via a microcatheter from the intended treatment position, an angiography and angiography-based C-arm CT (XperCT, Philips Healthcare) were acquired. Angiographies and XperCT were performed from 48 microcatheter positions followed by MAA injections and MAA-SPECT/CT. MAA-SPECT/CT served as the reference standard for determining the accuracy of hepatic arteriography and C-arm CT for the detection of extrahepatic shunting.
MAA-SPECT/CT revealed extrahepatic shunting in 5 patients (17%). Hepatic arteriography yielded a true negative in 22 (73%), a false negative in 5 (17%), and an unclear result in 3 patients (10%). C-arm CT yielded a true positive in 3 (10%), true negative in 24 (80%), false positive in 1 (3%), and false negative in 2 patients (7%). The specificity and the NPV of hepatic arteriography for the detection of extrahepatic shunting were 88% and 81%, respectively. For C-arm CT the sensitivity, specificity, PPV, NPV, and accuracy for the detection of extrahepatic shunting were 60%, 96%, 75%, 92%, and 90%, respectively.
C-arm CT offers additional information to angiography when assessing SIRT patients for extrahepatic shunting. More accurate detection of extrahepatic shunting may optimize the workflow in SIRT preparations by avoiding unnecessary repeat angiographies.
回顾性评估基于血管造影的C臂CT在钇90微球选择性体内放射治疗（SIRT）前检测肝外分流的准确性。
30例（平均年龄：64±12岁）患有高血供肝肿瘤的患者在SIRT前接受了肝血管造影、胃肠道侧支血管的弹簧圈栓塞和99m锝-大颗粒白蛋白（MAA）单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）。在通过微导管从预期治疗位置注射MAA之前，先进行血管造影和基于血管造影的C臂CT（XperCT，飞利浦医疗保健公司）检查。从48个微导管位置进行血管造影和XperCT检查，随后注射MAA并进行MAA-SPECT/CT检查。MAA-SPECT/CT作为确定肝动脉造影和C臂CT检测肝外分流准确性的参考标准。
MAA-SPECT/CT显示5例患者（17%）存在肝外分流。肝动脉造影显示真阴性22例（73%），假阴性5例（17%），3例患者（10%）结果不明确。C臂CT显示真阳性3例（10%），真阴性24例（80%），假阳性1例（3%），假阴性2例（7%）。肝动脉造影检测肝外分流的特异性和阴性预测值分别为88%和81%。对于C臂CT，检测肝外分流的敏感性、特异性、阳性预测值、阴性预测值和准确性分别为60%、96%、75%、92%和90%。
在评估接受SIRT治疗的患者是否存在肝外分流时，C臂CT可为血管造影提供额外信息。更准确地检测肝外分流可通过避免不必要的重复血管造影来优化SIRT准备工作流程。
