The Value Of Three-dimension Digital Subtraction Angiography For The Diagnosis And Treatment In Hepatic Cell Carcinoma

Objective:To exploreth value of three-dimension digital subtraction angiography (3D DSA) for the diagnosis and treatment in Hepatic Cell Carcinoma. To analyze the injury of blood vessel, radiation damage and operation time between Routine DSA Group (GroupⅠ) and combination of Routine DSA and 3D DSA Group (GroupⅡ); To compare the vasuability of images and HCC blood supply of 2D DSA with that of 3D DSA.Methods:The research retrospectively analyze 66 patients that were diagnosed or suspected HCC were performed 2 D DSA and 3D DSA examination. Two experienced interventional doctors make diagnosis for both 2D and 3D DSA randomly.All images were aquired with siemens FP DSA systems (Produced by SEMEIMS Corp. Germany) that have DynaCT function. Through modified Selding's puncturation from femoral artery, we put the catheter into the hepatic common artery, set the region of interest and aquire the image data. Parameter of high-pressure syringe: total contrast agent volumn, 20ml; Flow Rate, 4ml/s; Maximum safeguard pressure, 400PSI.3D DSA data acquisition: acquisition pattan, 3D DR-H8+3s; Flow Rate, 4ml/s; total contrast agent volumn, [4ml/s×(8+3) s] ml=44ml; Maximum safeguard pressure,400PSI. Concentration of contrast agent, 30% mixture of pure contrast and 0.9% NS. Acquisition rate, 3-30f/s (standard rate: 15f/s). Keep exposing for 8 seconds, and then scan in a complex tract ranged 220 degree. Send all the data to the X-LEONARDO workstation. Reconstruction contains MIP, VR and MPR. CT-like images direct the doctor for diagnosis and therapy. Statistical method: Single factor analysis of variance was adopted between the two groups for the operation time, X-ray exposure dosage and amount of contrast agents. Comparition among two groups about detection of tumor focus was performed by chi-square test. Data was estimated by SPSS 13.0 edition withα=0.05.Results:1,Great significances between groups were shown about the operation time with p<0.05; while X-ray exposure dosage and amount of contrast agents has no significant difference (p>0.05). Accessory injury of blood vessel rate: GroupⅠ, 3%(1/34); GroupⅡ, 0(0/32).2,32 patients were underwent 2D DSA and 3D DSA as well in the study. Analyse the Level of hepatic artery branches they display. LGA were not shown because of intubation in two cases, and another two cases didn't display SA. Other study vessel include as follows: 29 LGA, 32CHA, 29SA, 33RHA, 31LHA, 32 PHA, 32GDA. 3D DSA can display the above vessel well. There are another two variable arteries: 1,aRHA and 1 aLHA. They were also shown accurately with 3D DSA. DSA is known as the golden standard way to display the hepatic artery. The display rate of 3D DSA DynaCT for the main hepatic artery segment is 100% (220/220). Both the 2D DSA and 3D DSA can display the normal hepatic artery by comparison. There are two cases with hepatic artery vaiation, they were classified as other types. By contrast, accuracy of 3D DSA is up to 100%. There are 17 variable arteries in the total 66 hepatic arteries. their origin distribution include LGA12 (70.6%), CHA2 (11.8%), abdominal aorta2 (11.8%), and GDA1 (5.9%). 3,hepatic artery trifurcate typecase are grouped into normal group.3,32 arteries were displayed in the MIP and VRT DynaCT post-processing techniques, as well as MPR. The best image was selected as criteria of each case. Above Level 3 hepatic artery branches can be displayed: MIP20 (62.5%), VRT20 (62.5%) and MIP9 (28.1%). The display degree and accuracy to the hepatic artery of 3D DSA and 2D DSA is alike. 3DDSA can observe the focus and relationship with its blood supply in special perspective, which solve the stacking problem fully and display more than 6 level hepatic artery branches.4,Through chi-square test, there is significant difference in the detection of tumor focus with 2D DSA and 3D DSA (p<0.05).Conclusion:1,Combination Group of Routine DSA and 3D DSA can save operation time greatly, improve the operation safty with similiar X-ray exposure dosage and contrast agent. The advantage is also shown about accessory injury of blood vessel. But it remains to be further research for small sample.2,there is similar display rate to the hepatic artery level of 3D DSA and 2D DSA. 3DDSA has a high accuracy view of blood vessel.3,MIP and VRT has similar display rate about hepatic artery branches above level 3. they are better than MPR. So MPR is regard as an accessory technique. 3DDSA can fully evaluate the hepatic artery segment branches, improve the speed and accuracy of intubation and increase the success rate of interventional operation.4,3D DSA has outstanding advantage in detection of tumor focus, and very helpful to the diagnosis the interventional therapy.