Kikkawa A, Ichikawa T
Department of Radiology, Nippon Medical School, Tokyo, Japan.
Nihon Ika Daigaku Zasshi. 1998 Oct;65(5):367-76. doi: 10.1272/jnms1923.65.367.
The aim of this study was to clarify the clinical usefulness of combined CT during arterial portography (CTAP), and CT arteriography (CTA), for the diagnosis of hepatocellular carcinoma.
CTAP and CTA were performed in 58 patients with a combined 144 hepatocellular carcinoma (HCC) lesions. Arterial vascular access was obtained through bilateral punctures of the femoral artery with selective placement of catheters in the hepatic artery and superior mesenteric artery. CT scans were performed first during injection of contrast media into the superior mesenteric artery, followed by repeated imaging of the liver during injection of contrast media into the hepatic artery. Delayed CT (DCT) was also obtained 5 min after CTA.
The detection rates for all 144 lesions were 73.6% with conventional contrast enhanced CT, 90.3% with CTAP, 95.8% with CTA, 87.5% with DCT, and 98.6% with combined CTAP and CTA. Of early HCC lesions (n = 18), 88.9%, 33.3%, 77.8%, 100%, and 88.9% were detected by conventional contrast enhanced CT, CTAP, CTA, DCT, and combined CTAP and CTA, respectively. Of classical HCC lesions (n = 126), 71.4%, 98.4%, 98.4%, 85.7%, and 100% were detected by conventional contrast enhanced CT, CTAP, CTA, DCT, and combined CTAP and CTA, respectively.
Combining CTAP and CTA improved the radiologist's ability to detect lesions with confidence and to differentiate perfusion abnormalities of HCCs.
本研究旨在阐明联合动脉门静脉造影CT（CTAP）和CT血管造影（CTA）对肝细胞癌诊断的临床应用价值。
对58例患者共144个肝细胞癌（HCC）病灶进行了CTAP和CTA检查。通过双侧股动脉穿刺获得动脉血管通路，将导管选择性地置于肝动脉和肠系膜上动脉。先在向肠系膜上动脉注射造影剂期间进行CT扫描，随后在向肝动脉注射造影剂期间对肝脏进行重复成像。CTA检查后5分钟还进行了延迟CT（DCT）扫描。
144个病灶的检出率分别为：传统增强CT为73.6%，CTAP为90.3%，CTA为95.8%，DCT为87.5%，CTAP与CTA联合为98.6%。早期HCC病灶（n = 18），传统增强CT、CTAP、CTA、DCT以及CTAP与CTA联合检查的检出率分别为88.9%、33.3%、77.8%、100%和88.9%。经典HCC病灶（n = 126），传统增强CT、CTAP、CTA、DCT以及CTAP与CTA联合检查的检出率分别为71.4%、98.4%、98.4%、85.7%和100%。
联合CTAP和CTA提高了放射科医生自信地检测病灶以及鉴别HCC灌注异常的能力。
