使用延迟动脉期锥形束CT在肝动脉内治疗期间提高转移性疾病在肝脏中的可视性。
Improved Visibility of Metastatic Disease in the Liver During Intra-Arterial Therapy Using Delayed Arterial Phase Cone-Beam CT.
作者信息
Schernthaner Ruediger E, Haroun Reham R, Duran Rafael, Lee Howard, Sahu Sonia, Sohn Jae Ho, Chapiro Julius, Zhao Yan, Gorodetski Boris, Fleckenstein Florian, Smolka Susanne, Radaelli Alessandro, van der Bom Imramsjah Martijn, Lin MingDe, Geschwind Jean Francois
机构信息
Section of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 330 Cedar Street, TE 2-230, New Haven, CT, 06520, USA.
出版信息
Cardiovasc Intervent Radiol. 2016 Oct;39(10):1429-37. doi: 10.1007/s00270-016-1406-2. Epub 2016 Jul 5.
PURPOSE
To compare the visibility of liver metastases on dual-phase cone-beam CT (DP-CBCT) and digital subtraction angiography (DSA), with reference to preinterventional contrast-enhanced magnetic resonance imaging (CE-MRI) of the liver.
METHODS
This IRB-approved, retrospective study included 28 patients with neuroendocrine (NELM), colorectal (CRCLM), or sarcoma (SLM) liver metastases who underwent DP-CBCT during intra-arterial therapy (IAT) between 01/2010 and 10/2014. DP-CBCT was acquired after a single contrast agent injection in the tumor-feeding arteries at early and delayed arterial phases (EAP and DAP). The visibility of each lesion was graded by two radiologists in consensus on a three-rank scale (complete, partial, none) on DP-CBCT and DSA images using CE-MRI as reference.
RESULTS
47 NELM, 43 CRCLM, and 16 SLM were included. On DSA 85.1, 44.1, and 37.5 % of NELM, CRCLM, and SLM, were at least partially depicted, respectively. EAP-CBCT yielded significantly higher sensitivities of 88.3 and 87.5 % for CRCLM and SLM, respectively (p < 0.01), but not for NELM (89.4 %; p = 1.0). On DAP-CBCT all NELM, CRCLM, and SLM were visible (p < 0.001). Complete depiction was achieved on DSA for 59.6, 16.3, and 18.8 % of NELM, CRCLM, and SLM, respectively. The complete depiction rate on EAP-CBCT was significantly higher for CRCLM (46.5 %; p < 0.001), lower for NELM (40.4 %; p = 0.592), and similar for SLM (25 %, p = 0.399). On DAP-CBCT however, the highest rates of complete depiction were found-NELM (97.8 %; p = 0.008), CRCLM (95.3 %; p = 0.008), and SLM (100 %; p < 0.001).
CONCLUSION
DAP-CBCT substantially improved the visibility of liver metastases during IAT. Future studies need to evaluate the clinical impact.
目的
参照肝脏介入前对比增强磁共振成像（CE-MRI），比较双期锥形束CT（DP-CBCT）和数字减影血管造影（DSA）对肝转移瘤的显示情况。
方法
本研究经机构审查委员会（IRB）批准，为回顾性研究，纳入了28例患有神经内分泌（NELM）、结直肠癌（CRCLM）或肉瘤（SLM）肝转移的患者，这些患者于2010年1月至2014年10月期间在动脉内治疗（IAT）期间接受了DP-CBCT检查。在肿瘤供血动脉内单次注射造影剂后，于动脉早期和延迟期（EAP和DAP）采集DP-CBCT图像。由两名放射科医生以CE-MRI为参考，对DP-CBCT和DSA图像上每个病变的显示情况进行一致评级，分为三个等级（完全、部分、无）。
结果
共纳入47例NELM、43例CRCLM和16例SLM。在DSA上，NELM、CRCLM和SLM分别有85.1%、44.1%和37.5%至少部分显示。EAP-CBCT对CRCLM和SLM的敏感性分别显著提高至88.3%和87.5%（p<0.01），但对NELM无显著提高（89.4%；p = 1.0）。在DAP-CBCT上，所有NELM、CRCLM和SLM均可见（p<0.001）。在DSA上，NELM、CRCLM和SLM分别有59.6%、16.3%和18.8%实现了完全显示。EAP-CBCT对CRCLM的完全显示率显著更高（46.5%；p<0.001），对NELM更低（40.4%；p = 0.592），对SLM相似（25%，p = 0.399）。然而，在DAP-CBCT上，完全显示率最高的是NELM（97.8%；p = 0.008）、CRCLM（95.3%；p = 0.008）和SLM（100%；p<0.001）。
结论
DAP-CBCT显著提高了IAT期间肝转移瘤的显示情况。未来研究需要评估其临床影响。
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