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作 者:王劲[1] 谢斯栋[1] 罗琳[1] 张建生[1] 刘凌云[1] 徐川[1] 姜在波[1] 杨扬[1] 张亚琴[1] 邝思驰[1] 胡冰[1] 单鸿[1]
机构地区:[1]中山大学附属第三医院放射科,广州510630
出 处:《中华医学杂志》2010年第3期165-168,共4页National Medical Journal of China
基 金:基金项目:广东省自然科学基金(05200177);广东省科技计划项目(20088060600034)
摘 要:目的探讨320排CT的低对比剂4DDSA对肝移植后肝动脉并发症的临床应用价值。方法回顾性分析2008年11月至2009年1月中山大学器官移植中心15例肝移植病例,患者均采用TOSHIBA320排CT-Aquilion One扫描机,造影剂流速6ml/s,总剂量50ml,动态容积扫描模式,利用4DDSA成像软件,测量纯肝动脉的强化峰值时间、CT值。选取最佳纯肝动脉期的图像,进行容积(VR),最大密度投影(MIP),多层面重建(MPR)图像重建。结果肝动脉的强化峰值时间为20(10.0~24.2)s,强化CT峰值为373(310~440)HU。肝动脉吻合口假性动脉瘤2例,肝动脉吻合口轻度、中度狭窄各为3例、4例,肝动脉吻合口闭塞、重度狭窄各l例,肝动脉吻合口未见异常4例。其中肝动脉闭塞、重度狭窄者伴有肝门部侧支动脉形成,伴有肝动脉分支局限性与节段性狭窄、肝动脉一门静脉瘘及肝动脉迂曲、肝内动脉小分支开放各4例,其他包括9例伴有肝内动脉小分支稀疏,3例供受体肝动脉管径粗细不一致,1例移植肝血管瘤,呈“挂果征”,脾动脉瘤、脾动脉瘤样扩张各1例。结论320排CT低对比剂的4DDSA成像可获得准确的纯动脉期肝动脉图像,对于肝移植术后肝动脉病变的诊断具有安全、无创、准确的优点,可作为肝移植术后对肝动脉并发症进行随访的有效手段。Objective To evaluate the value of low-dose contrast-enhanced 4D DSA acquired from 320-detector row CT on the diagnosis of the hepatic artery complications after liver transplantation. Methods 320-detector row CT were performed in fifth patients with liver dynamic enhanced using volume CT body- perfusiou protocol, hepatic artery phase images obtained after intravenous injection of 50 ml of contrast at a rate of 6 ml/s were acquired based on 4D DSA. The time-density curve (TDC) of the hepatic artery was delineated. The time to peak, peak contrast enhancement were recorded. The data of artery phase were sent to workstation to reconstruct the hepatic artery with VR, MIP and MPR. Results The delay mean time and the peak CT value of hepatic artery was 20 (10. 0-24. 2) s and 373 (310-440) HU; 4D DSA revealed hepatic artery, pseudo-aneurysm ( n = 2 ), and hepatic artery mild steuosis ( n = 3 ), moderate stenosis ( n = 4 ), severe stenosis( n = 1 ) and occlusion (n = 1 ). Compensatory circulation was seen in 2 cases. 4 patients were appeared segmental stenosis and hepatoportal arteriovenous fistulas(HPAVF). Hepatic arterial branch are decreased and opened in 9 cases and 4cases. 4D DSA also displayed other signs including hepatic hemangioma and the splenic artery aneurysms (SAA) and ectasi ( n = 1 ), donor-recipient hepatic artery mismatch (n = 3 ). Conclusion 4D DSA provided a safe, noninvasive and accurate method for guiding the diagnosis of hepatic artery complication and play an effective role after liver transplantation.
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