原發(fā)性肝細(xì)胞癌供血?jiǎng)用}的能譜CTA與DSA的比較研究-論文.pdf

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1、醫(yī)學(xué)影像學(xué)雜志2O13年第23卷第11期JMedImagingVo1．23No．112Ol3原發(fā)性肝細(xì)胞癌供血?jiǎng)用}的能譜CTA與DSA的比較研究孫奕波，毛定飚，李銘，白愛國，陳武飛，齊琳，任慶國，高豐，楊艷麗，陸芳，滑炎卿(復(fù)旦大學(xué)附屬華東醫(yī)院放射科上海200040)【摘要】目的比較寶石能譜CT血管成像與DSA對(duì)原發(fā)性肝癌供血?jiǎng)用}的判定價(jià)值。方法選取我院擬行經(jīng)導(dǎo)管化療栓塞術(shù)的患者49例，術(shù)前均行能譜CT肝臟動(dòng)脈血管成像和DSA檢查。4位獨(dú)立的審閱醫(yī)師按照5分評(píng)分法分別對(duì)能譜CTA和DSA影像對(duì)原發(fā)性

2、肝癌供血?jiǎng)用}的把握程度進(jìn)行評(píng)分，并采用受試者特性曲線(ROC)分析兩者的區(qū)別。以手術(shù)醫(yī)師綜合分析能譜CTA、DSA影像及術(shù)后1周平掃CT影像后的診斷為標(biāo)準(zhǔn)，記錄兩種不同檢查方法對(duì)原發(fā)性肝癌供血?jiǎng)用}顯示的敏感度、特異度、準(zhǔn)確度和陽性預(yù)測(cè)值。結(jié)果49例患者中共選取了83例可疑為腫瘤供血?jiǎng)用}的血管，其中52例被證實(shí)為腫瘤供血?jiǎng)用}，31例被證實(shí)為非腫瘤供血?jiǎng)用}。能譜CTA的ROC曲線下面積(AZ=0．9954)明顯高于DSA(AZ=0．8492)，差異具有統(tǒng)計(jì)學(xué)意義(P

3、判定的敏感度為96．63，特異度為96．77，精確度為96．69，陽性預(yù)測(cè)值為98．O5，明顯高于DSA(75，73．39，74．40，82．54)(P<0．05)。結(jié)論能譜CT血管成像對(duì)原發(fā)性肝癌供血?jiǎng)用}的顯示優(yōu)于DSA?！娟P(guān)鍵詞】雙能量CT；腫瘤供血?jiǎng)用}；原發(fā)性肝癌；血管成像中圖分類號(hào)：R755．7；R814．42文獻(xiàn)標(biāo)識(shí)碼：A文章編號(hào)：1006—9011(2013)l1—1718一O6ThevalueofCTangiographybeforetranscatheterchemoemboliza

4、tionofhepatocellularcarcinomausingdual—energyCTSUNYi—bo，MAODing—biao，L1Ming，BAIAi—guo，CHENWu—fei，QILin，RENQing—guo，GAOFeng，YANGYan—li，LUFang，HUAYan—qingTheDepartmentofRadiology，HuadongHospitalA．ffiliatedtoFudanUniversity，Sanghai200040，P．R．China[Abstrac

5、t]ObiectiveThisstudycomparesthediagnosticvalueofDual—energycomputedtomographyangiography(DECTA)withdigitalsubtractionangiography(DSA)beforetranscatheterchemoemboliazationofhepatocellularcarcinoma．MethodsFourtynineconsecutivepatientswithhepatocellularca

6、rcinoma(HCC)underwentDECTAandDSAbeforesuperselectiveTACE．Angiographicoperatorsdeterminedwhichfeedingarterieswerepotentiallysupplyingthetargettumor．FourindependentobserversseparatelyviewedtheDSAandDECTAimagesanda5-pointgradingscalewasasedtodeterminewhet

7、herastudiedarterysuppliedthetargettumor．Diagnosticperformancewascomparedusingreceiveroperat—ingcharacteristic(ROC)analysis．Sensitivity，specificity，accuracyandpositivepredictivevalue(PPV)werecalculatedforarteriesratedasdefiniteorprobabletumorfeedingarte

8、ries．Thejudgmentofangiographicandiodizedoilaccumulationonfollow-upCTwerethereferencestandard．ResultsWechose83possiblefeedingarteriesin49patients．Amongthestudiedarteries，52wereverifiedtumorfeedingarteries，andremaining31werenot．DECTAresul