Hashimoto M, Watanabe O, Hirano Y, Kato K, Watarai J
Department of Radiology, Akita University School of Medicine, Japan.
AJR Am J Roentgenol. 1997 Nov;169(5):1307-10. doi: 10.2214/ajr.169.5.9353447.
Our objective was to determine the usefulness of sonographic angiography with carbon dioxide microbubbles during transcatheter arterial chemoembolization for hepatocellular carcinoma.
Thirty-four patients with hepatocellular carcinoma underwent sonographic angiography during transcatheter arterial chemoembolization. Digital subtraction angiography failed to reveal tumors in 27 patients. Tumor stain became obscure on digital subtraction angiography after the catheter was inserted into distal branches in seven patients. Sonographic angiography was performed after injection of carbon dioxide microbubbles into the hepatic artery selected for transcatheter arterial chemoembolization.
In angiographically undetectable hepatocellular carcinomas, sonographic angiography revealed tumor vascularity in 17 patients in whom transcatheter arterial chemoembolization was then performed. For the two patients who underwent a second transcatheter arterial chemoembolization, the existence of alternative feeding vessels was confirmed by sonographic angiography. In the remaining 10 patients, tumor vascularity was not seen on sonographic angiography; percutaneous ethanol injection therapy was then performed. Sonographic angiography clearly revealed tumor vascularity in patients in whom staining became obscure on digital subtraction angiography after the catheter was inserted into a peripheral branch of the hepatic artery. In all 24 patients who underwent transcatheter arterial chemoembolization, sonographic angiography was useful for determining the artery suitable for transcatheter arterial chemoembolization and for monitoring tumor perfusion in the selected artery.
Sonographic angiography can be used to determine not only the therapeutic strategy for treatment of hepatocellular carcinoma but also whether the tumor is supplied by the artery selected for transcatheter arterial chemoembolization, especially when the tumor is not revealed by digital subtraction angiography.
我们的目的是确定在经导管动脉化疗栓塞治疗肝细胞癌过程中，使用二氧化碳微泡进行超声血管造影的效用。
34例肝细胞癌患者在经导管动脉化疗栓塞过程中接受了超声血管造影。数字减影血管造影未能显示27例患者的肿瘤。7例患者在导管插入肝动脉远端分支后，数字减影血管造影上肿瘤染色变得模糊不清。在向选定用于经导管动脉化疗栓塞的肝动脉内注入二氧化碳微泡后进行超声血管造影。
在血管造影未检测到的肝细胞癌中，超声血管造影显示17例患者存在肿瘤血管，随后对这些患者进行了经导管动脉化疗栓塞。对于接受第二次经导管动脉化疗栓塞的2例患者，超声血管造影证实了存在替代供血血管。在其余10例患者中，超声血管造影未发现肿瘤血管；随后进行了经皮乙醇注射治疗。在导管插入肝动脉外周分支后数字减影血管造影上染色变得模糊不清的患者中，超声血管造影清楚地显示了肿瘤血管。在所有24例接受经导管动脉化疗栓塞的患者中，超声血管造影有助于确定适合经导管动脉化疗栓塞的动脉，并监测选定动脉内的肿瘤灌注。
超声血管造影不仅可用于确定肝细胞癌的治疗策略，还可用于确定肿瘤是否由选定用于经导管动脉化疗栓塞的动脉供血，特别是当数字减影血管造影未显示肿瘤时。
