| Background and Objective:Primary hepatic carcinoma which incidence increasing recently is one of the most common malignant tumors. year after year. The treatments of primary hepatic carcinoma include interventional chemoembolization, surgical intervention, liver transplantation, etc. The hepatic vessels have many variation, especially the hepatic artery. Before the clinical treatment, it is very important to sufficiently comprehend the anatomy of the hepatic, as well as the relationship between the tumor and surrounded blood vessels. Digital subtraction angiography (DSA) has been considered as the golden standard diagnosing hepatic vascular diseases. However, DSA is an invasive examination and is complex and costly; for hepatic diseases, it only shows the shape of the blood vessels and is poor for the hepatic parenchyma. Multi-slice spiral CT angiography (MSCTA) can not only shows the hepatic parenchyma but also obtains three-dimensional images and the hepatic arterial anatomy, which is the important basis for treatment.The aim of the investigation include two aspects:one is to assess the value of 64-detetor spiral CT angiography for hepatic arterial anatomy and vascular variants,another is to assess the CTA performance in primary hepatic carcinoma before and after interventional treatment, to investigate the clinical application of CTA by comparins DSA and CTA,Materials and methods:Between August 2008 and August 2009,76 primary hepatic carcinoma (66 males and 10 femals; range of age; 33-82 years; mean age 50years) performed a contrast enhanced scan with GE 64-deetor spiral CT and were diagnosed by digital subtraction angiography.76 cases had one times enhanced 64-detetor CT examination before DSA treatment, while 33 cases had two or more times enhanced 64-detetor CT examination.GE Light speed VCT scanner was used to performed the examination for patients. Scan parameter:120 KV, automatic tube current, screw-pitch 0.984:1, scan time 0.35s/r, and collimation 64×0.625mm. All the patients performed a plain scan of the abdomen first then a contrast enhanced scan was performed after being injected a contrast medium (100ml,350mgI/ml) with a high pressure syringe. Smart Prep scanning technology was used. All the original data were reconstructed with slice thickness of 0.625mm and then were transmitted to ADW 4.3 workstation where the three-dimensional images of hepatic blood vessels, parenchyma and collection system were reconstructed with the techniques of VR(volume rendering), MIP(maximum intensity projection),CPR(curved planer reformation) or MPR(multiplanar reformation). DSA was performed on SHIMADZU-DIGITEX or Artis zeego or Allura Xper FD20 digital subtraction angiography. Using modified Seldinger puncture technology, guide wire and catheter was inserted into the hepatic artery. Injecting 4～6ml/s non-ionic iodine contrast, super-selective hepatic arteriography was done.The main content of evaluation:hepatic arterial anatomy and vascular variants, the source and count of tumor-feeding artery, types of blood supply, artery patterns, portal vein emboli, portal hypertension, arterio-venous fistula, strengthened lesions, tumor size, scope and the transfer of surrounding violations. For the treatment of the latter:whether the original lesion had new blood vessels, iodized oil deposition and were new lesions.SPSS 13.0 software package appliyed for statistical analysis. Measurement date use chi-square test., significant level was set as a=0.05.Results:1. Appraisement on the quality of images:CTA images for 76 patients were compared with DSA, there is certain gap between 64-deteor CTA and DSA in displaying hepatic peripheral vasculature; there is no significant difference in displaying the following of three branches.2. Evaluation of hepatic blood vessels:(1) hepatic arterial anatomy and vascular variants:in all 76 cases, the frequency of variation hepatic artery was 22,3 of typeⅡ,5 of typeⅢ,3 of type V,5 of typeⅨ,1 right hepatic artery from gastroduodenal artery,1 superior mesenteric artery from the celiac axis,1 accessory right hepatic artery come from gastroduodenal artery,1 left hepatic artery from gastroduodenal artery,1 common hepatic artery divergence into right hepatic artery, left hepatic artery, gastroduodenal artery, common hepatic artery from the celiac trunk. Compare with the DSA diagnostic rate of CTA is 100%. (2) MIP and VR technology display of hepatic artery:There is no significant difference in the display following of three branches, significant difference for four and four or more hepatic artery. MIP and VR have no significant difference in the tumor feeding arteries, significant differences displaying the tumor blood vessels. There is no difference between MIP and DSA.3. Evaluation of primary hepatic carcinoma blood supply:(1) Type of tumor blood supply:in all 76 cases,54 single artery,14 two artery,3 three arterys,1 four arterys.8 left hepatic artery blood supply,52 right hepatic artery blood supply, 13 right and left hepatic artery blood supply,4 other.62 rules of the blood supply, 11 variability in blood supply,3 parasitic blood supplies,1 originated in the right diaphragmatic artery not display in CTA. (2) Artery patterns:4 diffuse hepatic arteries were "dry tree" sign,56 obvious thickening of hepatic artery,57 tortuous blood vessls like spiral,9 apparent shift,27 tumor blood vessels were "hold ball" sign.4. Primary hepatic carcinoma lesions and other performance:in all 76 cases,97 lesions were detected,47 exist pseudocapsule,11 arteriovenous fistulas,72 liver cirrhosis and splenomegaly,61 portal hypertension,17 portal vein cavernous transformation,24 portal vein tumor thrombus.5. Evaluation of primary hepatic carcinoma by interventional treatment:in 33 cases, 5 lipiodol deposition was complete type,6 defective type,20 plaque type,2 sparse type; 5 pro-focus of infection embolism-phile; 4 after intervention chemoembolization and another line of surgical resection, there was no abnormality; 3 pro-focus of infection embolism-phile but new lesions had been discovered; 21 pro-focus of infection still had blood suply; 3 the original blood supply of the distal right hepatic artery had been occluded but it had the collateral circulation supply; 6 the original is still the blood supply feeding artery, while the right side of the diaphragm are also involved in arterial blood supply.1 of the original lesion and recurrence of lesions in the third review found that embolization was good, there was no new lesions.11 after the embolization, still used radiofrequency catheter ablation,5 no new lesions.1 repeated after treatment of the original artery and bilateral diaphragmatic artery had been remobilized but arrounded little collateral circulation can supply blood. DSA found recurrent lesions 25, new lesions 16, is slightly higher than the CTA.Conclusions:1.64-slice spiral CT can clearly show the hepatic arterial anatomy and vascular variants, tumor feeding arteries, tumor staining, tumor blood vessels, lesion location, measure the lesions, portal vein tumor thrombosis and arteriovenous fistulas.2. CTA is very important in detecting primary hepatic carcinoma lesions and tumor feeding arteries.3. Three-dimensional images formed by 64-detetor spiral CT can guide the interventional therapy effectivly.
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