CAJ | 학술논문

_目的：探讨磁共振动态增强血管成像（DCE-MRA）对显示肝癌供血血管的价值。方法：41例肝癌患者行磁共振动态增强检查并采用动脉期最大信号强度投影（MIP）技术重建肝动脉血管，增强扫描原始图像观察肿瘤部位、大小、类型，重建血管图像观察肿瘤责任血管显示情况、肝动脉有无变异起源及有无寄生血管参与肿瘤供血，并与常规 DSA 进行对照，同时观察有无肝动脉-门静脉漏的发生。结果：所有患者均清晰显示由肿瘤的解剖信息，其中巨块型21例，巨块结节型8例，多发结节型6例，弥漫型7例。32例患者显示肿瘤主要由规则血管供血，并显示血管起源、数量，并不同程度显示了肿瘤区肝动脉血管受侵犯、血管断续、肿瘤染色等征象，与 DSA 显示完全相同。DCE-MRA 显示7例患者为变异供血，并显示血管变异类型，9例巨块型和巨块结节型肝癌显示有寄生血管参与供血，3例患者动脉期轴面图像显示了肝动脉-门静脉漏。DSA 显示变异型血供8例，寄生血管参与供血21例。结论：DCE-MRA 及肝动脉重建技术能很好地显示肿瘤规则供血血管及血管变异情况，并能发现肝动脉-门静脉漏，对手术方法的选择、规范化治疗及提高疗效有重要作用，在细小的寄生血管显示上不及 DSA。
_목적：탐토자공진동태증강혈관성상（DCE-MRA）대현시간암공혈혈관적개치。방법：41례간암환자행자공진동태증강검사병채용동맥기최대신호강도투영（MIP）기술중건간동맥혈관，증강소묘원시도상관찰종류부위、대소、류형，중건혈관도상관찰종류책임혈관현시정황、간동맥유무변이기원급유무기생혈관삼여종류공혈，병여상규 DSA 진행대조，동시관찰유무간동맥-문정맥루적발생。결과：소유환자균청석현시유종류적해부신식，기중거괴형21례，거괴결절형8례，다발결절형6례，미만형7례。32례환자현시종류주요유규칙혈관공혈，병현시혈관기원、수량，병불동정도현시료종류구간동맥혈관수침범、혈관단속、종류염색등정상，여 DSA 현시완전상동。DCE-MRA 현시7례환자위변이공혈，병현시혈관변이류형，9례거괴형화거괴결절형간암현시유기생혈관삼여공혈，3례환자동맥기축면도상현시료간동맥-문정맥루。DSA 현시변이형혈공8례，기생혈관삼여공혈21례。결론：DCE-MRA 급간동맥중건기술능흔호지현시종류규칙공혈혈관급혈관변이정황，병능발현간동맥-문정맥루，대수술방법적선택、규범화치료급제고료효유중요작용，재세소적기생혈관현시상불급 DSA。
To probe into the values of dynamic contrast enhanced MR angiography (DCE-MRA)revealing the supplying blood vessels in primary hepatocellular carcinoma (HCC).Methods:41 patients with HCC underwent DCE-MRA examination followed by maximum intensity projection (MIP)for reconstruction of tumor supplying arteries.We ob-served the following manifestations on MIP images:display quality of tumor supplying vessels,variations of origin of hepatic artery,parasitic arterial supplies and hepatic artery-portal vein fistulas.All results were documented and compared with those with DSA.Results:The anatomical information of tumors in all patients was clearly revealed.The number and macro-scopic types of HCC were classified as follows:mass-forming type 21 cases,mass-nodular type 8 cases,nodular type 6 cases and confluent multinodular 8 cases.MIP clearly revealed the regular blood supply in 32 patents.It also revealed the origins and amount of supply vessels,invasions to the hepatic artery branches and tumor staining.The findings on MIP were the same on DSA.DCE-MRA revealed of variant blood supplies and their variation types in 7 patients.There were parasitic ar-terial supplies in 9 patients with mass-forming type and mass-nodular HCC.Arteriovenous fistulas between hepatic artery and portal vein were seen in three patients.While on DSA,8 patients had variant blood supplies and 21 patients had parasitic blood supplies.Conclusion:DCE-MRA with hepatic arterial MIP reconstruction is able to fully reveal the regular blood sup-ply vessels of HCC tumors and their variations.It also can clearly display the hepatic artery-portal vein fistulas.Thus,DCE-MRA can play an important role in choosing operation approaches,standardizing treatment planning and improving curative effects.However,it reveals less fine parasitic vessels than DSA does.