多层螺旋CT对肝包虫病累及血管或胆管的术前评价

目的 探讨MSCT对肝囊性包虫病血管和(或)胆管受累术前评估的价值.方法 搜集2008年1月至10月期间实施外囊完整摘除或大部分外囊切除术的44例肝囊性包虫病患者资料,术前均行64层螺旋CT多期扫描,进行3D血管重组;怀疑病灶破入胆管的3例患者行阴性法胆管重组.将CT轴面及3D重组图像所显示的血管和(或)胆管与病灶的空间关系与手术中所见进行对照,并进行一致性检验.结果 44例患者CT共检出46个病灶,判断病灶破入胆管3例;血管重组图像显示病灶累及门静脉一级血管14例、肝段下腔静脉18例,与术中判断完全相符;血管重组图像显示病灶累及肝动脉一级血管11例、肝动脉二级血管26例、门静脉二级血管35例、肝静脉主干34例与手术(肝动脉一级血管11例、肝动脉二级血管23例、门静脉二级血管33例、肝静脉主干31例)对照采用一致性检验,Kappa值分别为0.8805,0.6087,0.7751,0.7392;3例胆管成像所显示胆管与病灶的空间关系与术中所见相符.结论 MSCT及血管重组图像能够真实反映病灶与肝内血管和(或)胆管的毗邻关系,能为术前掌握肝囊性包虫病灶与邻近肝脏血管和(或)胆管空间关系、客观评估手术风险及决定术式提供全面的影像信息.

Preoperative multi-slice spiral CT evaluation of involvement of vessels and biliary ducts in hepatic cystic echinococcosis

Objective To analyze the MSCT imaging of vascular and biliary ducts affected by hepatic cystic enchionococcosis disease(HCD),and to evaluate the 3D image reconstruction of MSCT.Methods Forty four cases with HCD confirmed by radical surgery were collected in this study.All cases underwent multi-phase scanning with 64-slices CT,and 3D image reconstruction of hepatic vessels was performed.Three cases suspected of bile duct complications were examined with negative CT cholangiography.All the imaging data were acquired before surgery.The spatial relationships between the cysts and the neighbor vessels and(or)bile ducts were compared with the findings during operation,then consistency was tested.Results Altogether 46 lesions were detected by MSCT before surgery.All lesions were found and diagnosed correctly,including 3 lesions rupturing into biliary duct Compared with surgery findings,the spatial relationships between lesions and the vessels were entirely consistent in first grade portal vein(14 cases)and inferior macular vein(18 cases).The Kappa values were 0.8805,0.6087,0.7751,0.7392 for first grade hepatic artery,second grade hepatic artery,second grade portal vein and hepatic vein.The relationships between bile ducts and lesions also matched in 3 bile-duct fistula cases.Conclusions MSCT with its 3D technique showed a high accuracy in the assessment of spatial relationship between vessels,biliary duct and lesions.It provides comprehensive imaging information for surgery.