MSCT血管成像对肝移植受体术前血管结构的评价  

The evalution of the vascular structure of preoperative liver transplantation recipients using 6~l-slice spiral CT angiography

作　　者：李妙玲[1] 刘雯雁[2] 袁会军[3] 强永乾[1] 孙兴旺[1] 赵婷婷[1] 

机构地区：[1]西安交通大学医学院第一附属医院医学影像科,陕西西安710061 [2]西安交通大学医学院 [3]西安市红十字会医院影像科

出　　处：《实用放射学杂志》2011年第11期1677-1680,1684,共5页Journal of Practical Radiology

基　　金：基金项目：陕西省科学技术研究发展计划项目（编号：2007k14-02）.

摘　　要：目的探讨64排螺旋CT血管成像对肝移植受体术前血管结构评价及对临床决策的影响。方法对32例拟行肝移植的患者行三期血管成像扫描．重建方法为最大密度投影（MIP）和容积再现（VR）．对获得的血管图像结合轴位同像进行分析。结果32例肝病患者中，无腹腔干1例，腹腔干硬化斑块致其狭窄3例，脾动脉增粗迂曲12例，脾动脉瘤2例，肝动脉（HA）变异7例；肝外门静脉（PV）栓塞3例．肝内门静脉栓塞2例，肠系膜上静脉栓塞1例，肝内外门静脉及肠系膜上静脉多发栓塞1例；32例中，肝静脉（HV）成像有诊断价值25例，其中下组肝静脉1例，HV届影差7例；32例中，显示正常下腔静脉30例．1例下腔静脉肝内段癌栓，1例下腔静脉内癌栓达右心房人口；32例肝病患者中，24例成功行肝移植，8例不适合移植手术，其中肝内癌瘤结节直径总和〉8cm者3例，多发广泛栓子1例，肝外转移4例（其中包括1例肝内癌瘤结节直径总和〉8cm．者），1例MichelsⅧ型肝固有动脉纤细，直径〈3mm。结论64排螺旋CT、三期血管成像可准确、全面显示肝脏觑管的结构变化，对筛选适宜手术的病例和对手术方案的制订具有重要的价值。Objective To evaluate the clinical significance of 64-slice spiral CT angiography for vascular structures of preoperative liver transplantation recipients. Methods Tri-phase enhanced CT scan were performed in 32 cases, All cases were post-processing with maximum intensity projection（MIP） ,volume rendering（VR） ,and all reformation images with axial images were analyzed. Results In all 32 cases,1 case with absence of celiac artery, 3 cases with stenosis of celiac artery caused by plaque, 12 cases with dilated splenic artery, 2 cases with splenic artery aneurysm, 7 cases with variation of hepatic artery. 3 cases with extrahepatic portal vein thrombosis, 2 cases with intrahepatic portal vein thrombosis, 1 case with thrombosis in superior mesenteric vein, 1 case with mutiple thrombosis in portal vein and superior mesenteric vein. In all 32 cases, 25 cases with good images of hepatic vein, 14 cases with standard hepatic vein, 11 cases with common drainage of the middle and the left hepatic vein into the inferior vena cava, and 1 case with inferior hepatic vein respectively,7 cases with poor images. In all 32 cases,30 cases with normal inferior vena cava, 1 case with embolism in inferior vena cava and 1 case with embolism near the right atrium. In all 32 cases, 24 cases received liver transplantation successfully, the other 8 cases had the contraindications of liver transplantation and gave up operation,of 8 cases, 3 cases with total diameter of cancer nodules were more than 8 cm, 1 case with mutiple thrombosis, 4 cases with extrohepatic metastasis（including 1 case with total diameter of cancer nodules were more than 8 cm）, 1 case with Miehels Ⅶ had narrowing hepatic artery and the dianaeter was less than 3 mm separately. Conclusion 64-slice spiral CT tri-phase angiography could overall evaluate structural changes of the hepatic vessels and choose the cases suitable for surgery,it has an important value for surgery program.

关 键 词：肝脏移植受体 体层摄影术 X线计算机 血管成像 

分 类 号：R657.3[医药卫生—外科学] R814.42[医药卫生—临床医学]