CT血管成像与超声评估肝移植术前血管的对比  

CT Angiography and Ultrasound in Evaluating Blood Vessels Before Liver Transplantation: A Comparative Study

作　　者：李彦[1] 黄文起[1] 柴亚茹[2] LI Yan;HUANG Wenqi;CHAI Yaru(Department of Ultrasound,the First People’s Hospital of Shangqiu,Shangqiu 476100,China)

机构地区：[1]商丘市第一人民医院超声科,河南商丘476100 [2]郑州大学第一附属医院影像中心,河南郑州450052

出　　处：《中国医学影像学杂志》2018年第4期280-284,共5页Chinese Journal of Medical Imaging

摘　　要：目的探讨三期CT血管成像(CTA)和超声评估肝移植患者术前血管解剖变异及管腔通畅性的价值。资料与方法收集郑州大学第一附属医院收治的126例行肝移植患者的临床及影像资料,术前均行动脉期、门静脉期、静脉期CT扫描及CTA后处理重建和超声检查。CTA重建图像包括容积再现(VR)、最大密度投影(MIP)、曲面重组(CPR)和多平面重组(MPR)。观察患者肝动脉、门静脉系统、肝静脉和下腔静脉解剖变异及管腔通畅情况,以术中探查和术后病理结果为标准,比较CTA和超声对肝移植患者血管评估的准确性。结果 126例肝移植患者中,肝动脉管腔均通畅,解剖正常98例,存在解剖变异28例(22.2%);其中Michel II型7.1%(9/126),III型6.3%(8/126),IV型3.2%(4/126),V型2.4%(3/126),VI型0.8%(1/126);Michel分型未包括在内2.4%(3/126)。CTA对动脉解剖变异的诊断准确率为100.0%;超声对管腔通畅性诊断与术中一致,无法评估解剖变异。126例患者中,门静脉管腔通畅94例;门静脉栓子32例,其中血栓21例,瘤栓11例。CTA和超声对门静脉栓子的诊断准确率分别为93.7%、96.0%,差异无统计学意义(P>0.05),其中血栓的诊断准确率分别为96.0%、91.3%,差异有统计学意义(P<0.05);CTA和超声对瘤栓的诊断准确率分别为97.6%、92.1%,差异有统计学意义(P<0.05);CTA可显示门静脉周围侧支循环。CTA和超声对静脉通畅性的诊断准确率均为99.3%;CTA和超声对肝静脉合干解剖情况的诊断准确率分别为99.2%、95.2%,差异无统计学意义(P>0.05)。结论 CTA可以准确评估肝移植动脉解剖变异,对门静脉栓子的定性诊断准确率较高,且能显示侧支循环情况,整体术前诊断价值优于超声。Purpose To discuss the value of phase III CT angiography （CTA） and ultrasound in evaluating the preoperative vascular anatomical variation and the lumen patency of the patients with liver transplantation. Materials and Methods The clinical and imaging data of 126 patients with liver transplantation in the First Affiliated Hospital of Zhengzhou University were collected. CT scan in arterial phase, portal venous phase, venous phase and CTA reconstruction and ultrasound examination were performed before surgery. CTA images included volume rendering （VR）, maximum intensity projection （MIP）, curve plane reformation （CPR）, and multi-plane reformation （MPR）. The anatomical variations and lumen patency of the hepatic artery, the portal vein system, the hepatic vein and the inferior vena cava were observed. The accuracy of CTA and ultrasound of the evaluation of blood vessels in patients with liver transplantation was compared with the criteria of intraoperative exploration and postoperative pathological results. Results Among 126 patients with liver transplantation, all the hepatic artery lumen was unobstructed, with 98 cases of normal anatomical structure and 28 cases （22.2%） of anatomical variation, including Michel type II 7.1% （9/126）, type III 6.3% （8/126）, type IV 3.2% （4/126）, type V 2.4% （3/126）, type VI 0.8% （1/126）; 2.4% （3/126） of Michel classification was not included. The diagnostic accuracy of CTA for arterial anatomical variations was 100.0%, and the patency diagnosis of the lumen was consistent with the operation, and the anatomical variation cannot be evaluated. In 126 patients, there were 94 cases of portal vein patency, and 32 cases of portal vein embolus, including 21 cases with thrombus and 11 cases with tumor embolus. The diagnostic accuracy of CTA and ultrasound for portal vein embolus was 93.7% and 96.0%, respectively; and there was no statistical significance （P〉0.05）. The diagnostic accuracy of them for thrombosis was

关 键 词：肝移植 体层摄影术 X线计算机 超声检查 门静脉造影术 血管造影术 肝动脉 肝静脉 图像处理 计算机辅助 

分 类 号：R445.3[医药卫生—影像医学与核医学]