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目的比较3种方法获得的肝癌病人肝动脉成像时C臂CT(CACTHA)的肿瘤-肝实质对比。方法本前瞻性研究获伦理委员会批准,并获得所有病人的知情同意。29例病人[平均年龄(68±7)岁;男性27例]共有55个肝癌病灶[平均直径为(2.6±1.5)cm],在化疗栓塞前按随机顺序使用3种不同方法进行CACTHA。先以流率4mL/s注入对比剂(100mgI/mL)至肝总动脉。肝动脉成像时C臂CT开始扫描延迟时间分别是4s(方法A)、8s(方法B)和12s(方法C)(对比剂的总注入量分别为:48mL、64mL、80mL)。通过肝癌和肝实质的感兴趣区域来评估肿瘤-肝实质对比。统计分析方法使用混合模型方差分析(ANOVA)和Bonferroni修正事后检验。结果方法A、B和C的肿瘤-肝实质对比的平均值分别为(132±3.3)HU、(186±5.8)HU和(168±2.8)HU。方法B中的肿瘤-肝实质对比明显高于方法A和C(P<0.001)。结论延迟8s的肿瘤-肝实质影像对比要高于延迟4s和12s的。要点①C臂锥形束CT(C臂CT)成像可以在肝脏介入治疗中提供更多的信息。②C臂CT肝动脉成像中肿瘤-肝实质对比在成像延迟8s后最明显。③推荐成像延迟8s作为动脉早期相。
Objective To compare the tumor-liver parenchyma of C-arm CT (CACTHA) at the time of hepatic arteriography in three kinds of liver cancer patients. Methods This prospective study was approved by the ethics committee and informed consent was obtained from all patients. There were 55 liver cancer lesions [mean diameter (2.6 ± 1.5) cm] in 29 patients (mean age 68 ± 7 years; 27 men) with CACTHA in three randomized, randomized sequences prior to chemoembolization. Contrast (100 mgI / mL) was first injected into the common hepatic artery at a flow rate of 4 mL / s. C-arm CT scan delay was 4 s (Method A), 8 s (Method B), and 12 s (Method C) respectively for hepatic arterial imaging (total contrast loading: 48 mL, 64 mL, 80 mL, respectively). Tumor-liver parenchyma contrast was assessed by regions of interest in liver cancer and liver parenchyma. Statistical analysis methods used a mixed-model analysis of variance (ANOVA) and Bonferroni correction post hoc tests. Results The mean tumor-liver parenchyma of methods A, B and C were (132 ± 3.3) HU, (186 ± 5.8) HU and (168 ± 2.8) HU, respectively. The tumor-liver parenchyma in method B was significantly higher than in methods A and C (P <0.001). Conclusion The contrast of tumor-liver parenchyma with delayed 8s is higher than delayed 4s and 12s. Key points ① C-arm cone beam CT (C-arm CT) imaging can provide more information on liver intervention. ② C-arm CT hepatic arteriovenous tumor-liver parenchyma contrast in the imaging delay of 8s after the most obvious. ③ recommended imaging delayed 8s as the arterial phase.