| PrefaceHepatocellular carcinoma ( HCC) is a major cause of morbidity and mortality worldwide, accounting for approximately 1 million deaths per year, fueled by the increase of incidence of viral hepatitis. Invasion of the portal vein is a well - known manifestation of HCC, occurring in up to 70% of cases, and once it invades portal vein, resection is impossible or the plan must be changed, even if the transcatheter intraarterial chemoembolization (TACE) is exploited, its extent and effect may be affected, so it is crucial for doctors to get information a-bout the patency of portal vein.The imaging modalities for portal vein extension are not satisfactory at present. CT is one of the primary imaging modalities to assess hepatic tumor extent and vascular involvement, CT during arterial por-tography ( CTAP) , makes portal venous system enhance greatly by delvering contrast medium selectively. Multislice CT scanner acquires multiple CT imaging data sets with each rotation of the X - ray tube, greatly improves the speed; At the same time, image quality improves markedly based on advanced decrease of reconstruction artifacts, byexploiting muti - slice cone - beam computed tomography ( MSCOT) technique. Muti - slice CT during arterial portography combines the advantages of MSCT and CTAP, so has the potential to become an excellent imaging modality in evaluating the condition of portal venous system.Since the first application of 3D - CTAP by Soyer P et al, some related studies had been reported , but there were only a few studies of 3D - CTAP used to evaluate portal vein invasion by tumor. To our knowledge, there hasn' t been any report using 3D - MSCTAP to assess portal vein invasion by tumors.The purpose of our study was to evaluate the value of 3D -MSCTAP in detecting portal vein tumor invasion by comparing the a-bility of SSD, MIP and VR as a whole and retrospectively with DSA images in detecting portal vein invasion by HCC. So as to provide subjective basis for rational treatment and promote its application.Materials and MethodsPatients79 patients with HCC (72 men and 7 women, mean age 49. 2 years, age range 20 to 82 years) were included in our study, of which 49 underwent needle biopsy or surgery, yielding a histological diagnosis , the remaining 30 were diagnosed from imaging and laboratory data. All underwent MS - CTAP and DSA examination successively in a day (with interval within 30 minutes).Imaging ProtocolMS - CTAP and DSA were performed by using standard technique by way of a femoral approach. MS - CTAP was performed withMX8000 scanner, 512X512 matrix, 40ml Omnipaque or angiographan ( 175miligram per 100ml) were transcatheter infused into superior mesenteric artery or splenic artery by means of a power injector at a rate of 4ml/sec. After a delay of 10 seconds, a set of 3. 2 - mm -thick axial sections were obtained cephalad. The acquired raw data were reconstructed at 1 - mm intervals and then transferred to workstation and the reconstruction was done on the workstation. DSA was performed with SHIMADZU DIGITEX 2400(a). A set of images were obtained during transcatheter injection of 28ml Omnipaque or angiographan (350miligram per 100ml) with a power injector at a rate of 7ml/sec, with 15 frames per second and duration of 15 seconds.Image InterpretationTwo observers evaluated the 3D - MSCTAP and DSA images separately (in consensus) . For involvement of portal vein, they identified the trunk, right and left branch. Besides, based on a four - point scoring system; IV:excellent, ffi-.good, fl ;fair, I :poor, the images were graded for their visualization of the portal vein according to six parameters: the enhancement of liver parenchyma (incorrect classification) , the highest order, smoothness, contrast, anatomy and detail of the vessels.Statistical AnalysisScores were expressed as mean + SD, comparison of 3D -MSCTAP and DSA was performed using pair rank statistics, with the pathology or the complex images as reference of standard; sensitivity, specificity, accur...
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