中文摘要：

目的准确判断肿瘤供血动脉是实现肝癌超选择性肝动脉化疗栓塞（TACE）的基础。本研究探讨原发性肝癌TACE术中,锥体束CT三维肝动脉造影（cone-beam computed tomography hepatic arteriography,CBCT-HA）对比DSA肝动脉造影（DSA-HA）在判断肿瘤供血动脉的价值。方法 23例原发性肝癌患者入组研究。术中分别进行DSA-HA、CBCT-HA、碘油-TACE（Lip-TACE）、碘油CBCT（LipCBCT）。2名有经验的介入科医师共同分析DSA-HA和CBCT-HA影像学资料,判断肿瘤供血动脉。卡方检验进行统计学分析。结果 75个肿瘤通过金标准确定肿瘤供血动脉。DSA-HA确认肿瘤供血动脉（阳性）40个,其中真阳性32个,假阳性8个。CBCT-HA确认肿瘤供血动脉（阳性）72个,其中真阳性68个,假阳性4个。CBCT-HA对肿瘤供血动脉判断的灵敏度为68/75（90.7%）,明显高于DSA-HA（32/75,42.7%）（P〈0.001）;阳性预测值（68/72,94.4%）,亦高于后者（32/40,80.0%）（P=0.040）。结论 CBCT-HA对肝癌肿瘤供血动脉的判断明显优于传统DSA-HA,对超选择性TACE治疗有明显的临床指导意义。

英文摘要：

Objective To accurately judge the tumor-feeding artery is the most important basis for a successful treatment of hepatocellular carcinoma（HCC） with super-selective hepatic arterial chemoembo lization therapy. This study aims to assess the clinical value of cone-beam CT hepatic arteriography（CBCTHA） in detecting tumor-feeding arteries during the performance of conventional transarterial chemoembo lization（TACE）, and to compare the diagnostic effects between CBCT-HA and non-selective hepatic DSA.Methods Twenty-three consecutive patients with inoperable HCC were enrolled in this study. TACE was carried out in all patients. During the performance of TACE, the DSA-HA, CBCT-HA, Lipiodol-TACE and Lipiodol-CBCT were performed separately. The imaging materials, including DSA-HA and CBCT-HA, were analyzed by two experienced interventional physicians together to judge the tumor-feeding arteries. Statistic analysis was conducted by using chi square test. Results Tumor stain and lipiodol accumulation were regarded as the ＂gold standard＂ of the presence of tumor-feeding artery, based on which the tumor-feeding artery was confirmed in 75 lesions. DSA-HA demonstrated positive tumor-feeding artery in 40 lesions, among which true-positive tumor-feeding artery was seen in 32 and false-positive one in 8. CBCT-HA showed positive tumor-feeding artery in 72 lesions, which included true-positive tumor-feeding artery in 68 and false-positive one in 4. The sensitivity of CBCT-HA in judging tumor-feeding artery was 90.7%（68/75）, which was much higher than that of DSA-HA（42.6%, 32/75）, the difference was statistically significant（P〈0.001）.The positive predictive value of CBCT-HA in detecting tumor-feeding artery was also higher than that of DSA-HA（94.4% vs. 80.0%; P =0.040）. Conclusion Cone-beam CT hepatic arteriography is obviously superior to DSA hepatic arteriography in identifying tumor-feeding arteries, which is very helpful in guiding super-selective TACE for HCC.