原位肝移植术前受体血管和肝实质的一次性MRI评价  

One Step MRI Evaluation of the Hepatic Vascular Anatomy and Parenchyma for OLT Recipients

作　　者：徐鹏举[1,2] 严福华[1,2] 王建华[1,2] 纪元[3] 樊嘉[4,5] 陈财忠[1,2] 沈继章[1,2] 张利军[1,2] 李韧晨[1,2] 

机构地区：[1]复旦大学附属中山医院放射科,上海市枫林路180号上海200032 [2]上海市影像医学研究所 [3]复旦大学附属中山医院病理科,上海市枫林路180号上海200032 [4]复旦大学附属中山医院肝外科,上海市枫林路180号上海200032 [5]复旦大学肝癌研究所

出　　处：《中国医学计算机成像杂志》2009年第1期46-51,共6页Chinese Computed Medical Imaging

基　　金：2004年卫生部临床学科重点项目(卫规财发(2004)468号)~~

摘　　要：目的:探讨在MR3D序列中应用GRAPPA技术对原位肝移植受体血管及肝实质实行一次性评价的可行性及临床应用价值。方法:20例接受原位肝移植的受体术前接受MR检查,常规2D平扫后,利用GRAPPA技术一次屏气完成3DFLASH和3DVIBE增强扫描,利用3DFLASH原始图像和重建图像分析肝动脉、门脉及肝静脉解剖及病理情况,与手术结果对照,利用3DVIBE序列图像评价肝实质强化及病灶检出情况,结果与手术标本对照。结果:19例患者检查成功。肝动脉解剖变异2例,9例可见门脉病理改变(包括侧支循环形成,门脉癌栓),4例患者可见下腔静脉及肝静脉内栓子形成,2例可见右副肝静脉,上述血管情况与手术结果符合;20例患者于3DVIBE序列中有16例达到优化动脉期的要求,HCC病灶检出准确率达到80%。结论:联合应用GRAPPA技术和3D序列对原位肝移植受体血管及肝实质实行一次性评价是可行的,并且为临床前选择合适受体提供了更多有价值的信息。Purpose： To determine the feasibility of using GRAPPA technique in 3D MR sequence to implement one step evaluation of the hepatic vascular anatomy and parenchyma for orthotopic liver transplantation （OLT） recipients and evaluate its value for clinical application. Methods： MR examinations were performed in 20 OLT recipients. After conventional 2D plain scan, 3D fast low angle shot imaging sequence （FLASH） and 3D volume interplorated breath - hold exmination（VIBE） were subsequently performed with one breath - hold using GRAPPA technique before and after contrast . The vascular anatomy and pathology of OLT recipients were analyzed by using source images and reconstructive images acquired with 3D FLASH sequence, the hepatic parenchyma and lesions were assessed on 3D VIBE images. The imaging findings were correlated with intraoperative findings and surgical specimens. Results： All examinations were successfully performed except one patient due to inability tolerance of breath - hold. The arterial anatomy variant was displayed in 2 cases according to the Michel＇ s classification. The pathology change of portal vein was demonstrated in 9 patients（including collateral vessels and portal vein tumor thrombus）, the tumor thrombus in inferior vein cava and hepatic vein were detected in 4 patients. Right inferior hepatic vein was displayed in 2 patiens. The results were well correlated with intraoperative findings. Optimized late arterial phase was achieved in 16 patients on 3D Vibe images. The accuracy rate for HCC detection was 80% for patient.Conclusion： It is feasible to implement one step evaluation of the hepatic vascular anatomy and parenchyma for OLT recipients with combined use of GRAPPA technique and 3D sequence and can provide more valuable information for operation and selection for appropriate OLT recipients.

关 键 词：并行采集技术 磁共振成像 原位肝移植 影像学评价 

分 类 号：R445.2[医药卫生—影像医学与核医学]