原发性肝细胞癌供血动脉的能谱CTA与DSA的比较研究-论文.pdf

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1、医学影像学杂志2O13年第23卷第11期JMedImagingVo1．23No．112Ol3原发性肝细胞癌供血动脉的能谱CTA与DSA的比较研究孙奕波，毛定飚，李铭，白爱国，陈武飞，齐琳，任庆国，高丰，杨艳丽，陆芳，滑炎卿(复旦大学附属华东医院放射科上海200040)【摘要】目的比较宝石能谱CT血管成像与DSA对原发性肝癌供血动脉的判定价值。方法选取我院拟行经导管化疗栓塞术的患者49例，术前均行能谱CT肝脏动脉血管成像和DSA检查。4位独立的审阅医师按照5分评分法分别对能谱CTA和DSA影像对原发性

2、肝癌供血动脉的把握程度进行评分，并采用受试者特性曲线(ROC)分析两者的区别。以手术医师综合分析能谱CTA、DSA影像及术后1周平扫CT影像后的诊断为标准，记录两种不同检查方法对原发性肝癌供血动脉显示的敏感度、特异度、准确度和阳性预测值。结果49例患者中共选取了83例可疑为肿瘤供血动脉的血管，其中52例被证实为肿瘤供血动脉，31例被证实为非肿瘤供血动脉。能谱CTA的ROC曲线下面积(AZ=0．9954)明显高于DSA(AZ=0．8492)，差异具有统计学意义(P

3、判定的敏感度为96．63，特异度为96．77，精确度为96．69，阳性预测值为98．O5，明显高于DSA(75，73．39，74．40，82．54)(P<0．05)。结论能谱CT血管成像对原发性肝癌供血动脉的显示优于DSA。【关键词】双能量CT；肿瘤供血动脉；原发性肝癌；血管成像中图分类号：R755．7；R814．42文献标识码：A文章编号：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