CT扫描三维重建技术在巨块型原发性肝癌可切除性评估中的应用*

doi:10.3969/j.issn.1672-5069.2022.01.024

摘要/Abstract

摘要： 目的探讨计算机断层扫描(CT)三维重建技术在巨块型原发性肝癌(PLC)可切除性评估中的应用价值。方法 2018年1月～2020年1月我院收治的68例巨块型PLC患者,术前行CT检查,应用三维可视化软件-MI-3DVS完成三维重建,观察肿瘤大小、形态、血供及其与周围组织的关系,评判肿瘤的可切除性。以术后组织病理学检查和实际手术为金标准,通过一致性分析CT扫描三维重建评估的效能。结果术前,68例患者均完成CT扫描三维重建,发现肿瘤累及肝动脉18例,肿瘤累及门静脉20例,淋巴结转移12例;经评估,42例(61.8%)巨块型PLC患者可行切除性手术,而在实际手术过程中,45例(66.2%)患者接受了切除性手术治疗;经一致性分析发现,CT扫描三维重建评估肿瘤累及肝动脉的灵敏度为84.2%,特异度为95.9%,准确率为92.6%,阳性预测值为88.9%,阴性预测值为94.0%,Kappa为0.814;肿瘤累及门静脉的灵敏度为86.4%,特异度为97.8%,准确率为94.1%,阳性预测值为95.0%,阴性预测值为93.8%,Kappa为0.862;评估淋巴结转移的的灵敏度为84.6%,特异度为98.2%,准确率为95.6%,阳性预测值为91.7%,阴性预测值为96.4%,Kappa为0.853;评估巨块型PLC可切除性的灵敏度为91.1%,特异度为95.7%,准确率为92.6%,阳性预测值为97.6%,阴性预测值为86.4%,Kappa为0.841。结论应用CT扫描三维重建技术能够对巨块型PLC患者肿瘤累及血管和淋巴结转移情况进行评估,对切除性手术的可行性评估具有指导意义。

关键词: 肝肿瘤, 巨块型, 计算机断层扫描, 三维重建

Abstract: Objective The purpose of this study was to investigate the application of three-dimensional (3D) computed tomography (CT) reconstruction in the evaluation of resectability of giant intrahepatic tumors in patients with primary liver cancer (PLC). Methods 68 PLC patients with giant intrahepatic tumors were encountered in our hospital between January 2018 and January 2020, and all patients underwent CT scan and 3D reconstruction with 3d visualization software -MI-3DVS before hepatectomy. The tumor size, morphology, blood supply and its relationship with surrounding tissues, the hepatic artery and portal vein involvement, as well as lymph node metastasis were observed, and the resectability of tumors was determined. Results The reconstruction was finished in all the patients, which could clearly show the tumor size, morphology, blood supply and its relationship with surrounding tissues, demonstrating hepatic artery involvement in 18 cases, portal vein involvement in 20 cases, and the lymph node metastasis in 12 cases; the resectability was made in 42 cases (61.8%) based on the 3D reconstruction of CT scan, while the hepatectomy was successfully carried out in 45 cases(66.2%); the consistency analysis showed that the sensitivity, specificity, accuracy, positive predictive value, negative predictive value and Kappa value of CT scan 3d reconstruction in the evaluation of hepatic artery involvement were 84.2%, 95.9%, 92.6%, 88.9%, 94.0% and 0.814, those of in the evaluation of portal vain involvement were 86.4%, 97.8%, 94.1%, 95.0%, 93.8% and 0.862, in the evaluation of lymph node metastasis were 84.6%, 98.2%, 95.6%, 91.7%, 96.4% and 0.853, and in the evaluation of resectability of tumors were 91.1%, 95.7%, 92.6%, 97.6%, 86.4% and 0.841. Conclusion The CT scan 3D reconstruction technology could demonstrate the intrahepatic tumor involvement of blood vessels and lymph node metastasis in PLC patients with massive tumor mass, which could tell the surgeons what tumor resectable and guide the hepatectomy in clinical practice.

Key words: Hepatoma, Giant tumors, Computed tomography, Three-dimensional reconstruction

彭楠, 马爱珍, 史展, 徐志宾. CT扫描三维重建技术在巨块型原发性肝癌可切除性评估中的应用^*[J]. 实用肝脏病杂志, 2022, 25(1): 96-99.

Peng Nan, Ma Aizhen, Shi Zhan, et al. Application of CT 3D reconstruction in the evaluation of resectability of massive intrahepatic tumors in patients with primary liver cancer[J]. Journal of Practical Hepatology, 2022, 25(1): 96-99.

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CT扫描三维重建技术在巨块型原发性肝癌可切除性评估中的应用^*

Application of CT 3D reconstruction in the evaluation of resectability of massive intrahepatic tumors in patients with primary liver cancer

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