CBCT技术在钇90放射介入术治疗肝癌中的 应用价值

The Application Value of CBCT Technology in Yttrium-90 Radiointerventional Therapy for Liver Cancer

摘要: 目的：探讨基于锥形束CT (CBCT)的三维重建技术在钇90微球选择性内放射治疗(SIRT)术前评估中，对于识别肿瘤供血动脉的应用价值。方法：回顾性分析2022年7月至2024年2月期间行钇90 SIRT术前评估的24例肝脏恶性肿瘤患者资料。对比常规数字减影血管造影(DSA)与CBCT三维成像在识别肿瘤供血血管及微小病灶方面的检出率与准确性。结果：24例患者中共检出25个大肿瘤病灶及14个微小病灶。常规DSA检出肿瘤供血血管的阳性率为41.7% (10/24)，而CBCT检出率为100% (24/24)，差异具有统计学意义(P = 0.0016)。14例在常规DSA下难以明确供血动脉的病灶，均通过CBCT获得确诊。结论：在钇90微球介入治疗前，将CBCT三维重建技术与常规DSA结合，能显著提高肿瘤供血动脉及微小病灶的检出率，有助于优化靶向治疗策略，降低异位栓塞等并发症风险。

Abstract: Objective: To explore the application value of three-dimensional reconstruction technology based on cone-beam CT (CBCT) in identifying tumor-feeding arteries during the pre-operative evaluation of yttrium-90 microsphere selective internal radiation therapy (SIRT). Methods: A retrospective analysis was conducted on the data of 24 patients with liver malignancies who underwent pre-evaluation for yttrium-90 SIRT between July 2022 and February 2024. The detection rates and accuracies of conventional digital subtraction angiography (DSA) and CBCT three-dimensional imaging in identifying tumor-feeding vessels and tiny lesions were compared. Results: A total of 25 large tumor lesions and 14 tiny lesions were detected in 24 patients. The positive detection rate of tumor-feeding vessels by conventional DSA was 41.7% (10/24), while that by CBCT was 100% (24/24), and the difference was statistically significant (P = 0.0016). All 14 lesions for which it was difficult to identify the feeding arteries under conventional DSA were diagnosed by CBCT. Conclusion: Combining CBCT three-dimensional reconstruction technology with conventional DSA before yttrium-90 microsphere interventional therapy can significantly improve the detection rates of tumor-feeding arteries and tiny lesions, which is helpful for optimizing targeted treatment strategies and reducing the risks of complications such as ectopic embolization.