Irie T, Yamada T, Ganaha F, Ujita M, Ishii C, Tada S
Department of Radiology, Jikei University School of Medicine.
Nihon Igaku Hoshasen Gakkai Zasshi. 1998 Jun;58(7):338-42.
We evaluated the usefulness of CO2 US angiography in the detectability of and the effectiveness of TAE and/or PEIT for hepatocellular carcinoma (HCC). Twenty-three patients with HCC underwent CO2 angiography during the interventional procedure to treat HCC after examination of CT and conventional US. CO2 US angiography was observed on the US monitor by injecting CO2 microbubbles through a catheter placed in the hepatic artery. Contrast materials for CO2 US angiography were 3 ml of CO2 microbubbles prepared by vigorously mixing 3 ml of normal saline with 3 ml of 20% Intralipid, 3 ml of 20% albumin or 3 ml of the patient's own blood. In all patients, CO2 US angiography revealed equal or superior tumor detectability as compared with CT, conventional US and angiography. For demonstrating the inner structure of HCC, the image of CO2 microbubbles mixed with Intralipid was better than that of CO2 microbubbles mixed with albumin. In 9 of 23 patients, CO2 US angiography depicted nodules that had not been seen in the other images. TAE was performed in 21 patients with HCC who showed hypervascularity. In one patient in whom it was difficult to clearly depict the small lesion of HCC by conventional angiography and US, PEIT was successful under CO2 US angiography. The detectability of HCC was higher in CO2 US angiography than in CT, conventional US or angiography. The distribution of blood supply to HCC was observed easily by CO2 US angiography. In TAE of HCC, CO2 US angiography was useful to determine the dose of embolization materials without having to perform repeated angiography. It was possible to perform PEIT easily for non-detectable tumors without CO2 US angiography. CO2 US angiography was useful to evaluate the stage of HCC and to perform TAE and PEIT.
我们评估了二氧化碳超声血管造影在肝细胞癌（HCC）检测以及经动脉栓塞化疗（TAE）和/或经皮乙醇注射治疗（PEIT）疗效方面的实用性。23例HCC患者在CT和传统超声检查后，于介入治疗HCC的过程中接受了二氧化碳血管造影。通过将导管置于肝动脉内注入二氧化碳微泡，在超声监视器上观察二氧化碳超声血管造影。用于二氧化碳超声血管造影的对比剂为3毫升二氧化碳微泡，其制备方法是将3毫升生理盐水与3毫升20%的英脱利匹特、3毫升20%的白蛋白或3毫升患者自身血液充分混合。在所有患者中，与CT、传统超声和血管造影相比，二氧化碳超声血管造影显示出同等或更好的肿瘤检测能力。为了显示HCC的内部结构，与白蛋白混合的二氧化碳微泡相比，与英脱利匹特混合的二氧化碳微泡图像更好。在23例患者中的9例中，二氧化碳超声血管造影显示出其他图像中未见的结节。对21例显示血管丰富的HCC患者进行了TAE。在1例通过传统血管造影和超声难以清晰显示HCC小病灶的患者中，在二氧化碳超声血管造影引导下PEIT成功实施。二氧化碳超声血管造影对HCC的检测能力高于CT、传统超声或血管造影。通过二氧化碳超声血管造影可以轻松观察到HCC的血供分布。在HCC的TAE中，二氧化碳超声血管造影有助于确定栓塞材料的剂量，而无需进行重复血管造影。对于无法检测到的肿瘤，不使用二氧化碳超声血管造影也可以轻松进行PEIT。二氧化碳超声血管造影有助于评估HCC的分期以及实施TAE和PEIT。
