肝癌導管肝動脈栓塞手術血管攝影流速分析

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题名:	肝癌導管肝動脈栓塞手術血管攝影流速分析 Peri-therapeutic quantitative flow analysis of liver cancer with transcatheter arterial chemoembolization on angiography
作者:	張慕白;Chang, Mu-Bai
贡献者:	臨床醫學研究所碩士班
关键词:	肝癌導管肝動脈栓塞手術;光流法;流速估測;TACE;optical flow method;flow estimation
日期:	2012-07-05
上传时间:	2012-08-31 16:35:34 (UTC+8)
出版者:	中國醫藥大學
摘要:	肝細胞癌 ( Hepatocellular Carcinoma, HCC ) 為世界上最常見的肝臟腫瘤，導管肝動脈栓塞手術 ( Transarterial Chemoembolization, TACE ) 為不能開刀切除肝腫瘤病例最常使用的緩和治療方法，專業放射醫師透過專業經驗觀察血管攝影影像內像素濃度變化流動情形，以進行報告製作與手術評估，在客觀科學上缺乏標準。本實驗目的為利用光流法 ( Optical Flow Method, OFM ) 從顯影劑對時間的變化率求得血管內流速和血流量，建立血管攝影血液定量流速計算方法，並利用都普勒超音波進行驗證。本實驗收集40例肝動脈栓塞手術病患，統計分析肝硬化程度 ( Child-Pugh Score ) 與肝門靜脈流速的相關性及手術前後肝門靜脈血流速變化。在光流法與都普勒超音波流速相關性分析結果中，R-square為0.69，相關係數為0.83；栓塞手術前後流速分析中，明顯看到術後流速呈現下降趨勢，且p-value < 0.01；Child-Pugh Score與肝門脈流速相關性分析中，發現隨著肝硬化嚴重程度增加，肝門脈流速呈現下降的趨勢，且p-value < 0.01；在ROC分析中，AUC為0.9688。本實驗使用光流法於血管攝影流速估測，結合血液動力學於傳統血管攝影影像，提供血液流速和血流量變化資訊，於臨床醫師的診斷有很大的助益。 Digital subtraction angiography (DSA) is the most commonly used technique in diagnosis, image guidance in the interventional treatment of vascular lesions. We applied optical flow method (OFM) to quantify relative velocities of blood flow using angiography in the vascular analysis of hepatocellular carcinoma (HCC) patients who underwent transarterial chemoembolization (TACE) treatment. The calculated velocity was compared with the Doppler measurement. The velocity in the portal vein was compared between before and after TACE. The relationship between the Child-Pugh score and the flow velocity in the liver portal vein was also analyzed. A total of 40 HCC patients treated by TACE were analyzed in this study. DSA imaging with a 12-inch field of view, 1024 × 1024 pixels and 4 frames/second was acquired. OFM developed for motion estimation is applied for blood flow estimation. The relationship between the OFM and Doppler measurements was found linear with R2=0.69. Quantitative blood flow distribution images of the portal vein region were presented. After TACE, the minimum, maximum and mean velocities in the portal vein all decreased (p<0.05). Additionally, the velocity in the portal vein is significantly lower with a higher Child-Pugh score (p<0.01). The present technique provides add-on quantitative information of flows to DSA. The presented study is the first report of hemodynamic analysis in relative quantifications of blood flow in portal vein of hepatocellular carcinoma patients using DSA.
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