肝动脉解剖变异的64层螺旋CT血管成像研究

目的：评价64层CT血管成像（MSCTA）对显示肝动脉解剖变异的价值。方法：回顾性分析100例行肝脏4期增强扫描患者的影像学资料,对动脉早期增强扫描图像进行后处理,结合原始横断面、最大密度投影（MIP）、容积再现（VR）及曲面重组（CPR）图像观察患者肝动脉解剖变异。结果：28例患者显示有肝动脉解剖变异,6例为肝总动脉起源于肠系膜上动脉,9例替代肝右动脉起源于肠系膜上动脉,4例肝左动脉起源于胃左动脉,4例副肝右动脉起源于肠系膜上动脉,2例替代肝左动脉起自腹腔干,2例替代肝右动脉起自胃十二指肠动脉,1例替代肝右动脉起自腹腔干。有DSA对照的10例,MSCTA对肝动脉解剖变异的诊断符合率为100％。结论：MSCTA可以准确地显示肝动脉的解剖变异,对肝脏病变的介入治疗及外科手术具有重要的临床意义。     

肝动脉及门静脉三维CT血管造影在肝移植肝门血管重建中的意义

目的 评价肝动脉、门静脉双期多层螺旋CT扫描及三维CT血管造影（3DCTA）在肝移植肝门血管重建术式选择中的应用价值。方法 25例拟行肝移植的受者进行肝动脉及门静脉双期3DCTA，根据术前3DCTA所显示的肝门血管情况，初步计划术中肝门血管重建方案，最后与实际手术情况相比较。结果 25例肝移植受者中15例为正常肝动脉解剖；10例有肝动脉解剖变异，占40％，其中以替代肝右、替代肝左、副肝左和副肝右动脉血管变异出现的情况居多。变异组中1例经DSA间接门静脉造影证实为门静脉海绵样变而放弃肝移植手术。其余24例接受肝移植手术的受者中，1例合并脾动脉瘤，术中行脾动脉结扎脾切除术；1例腹腔干起始部狭窄，3例经术前CT测量发现受者肝脏主要供养动脉直径〈3mm，上述4例患者接受肝-主动脉间移植架桥血管重建供肝血供。1例有门静脉主干内血栓形成，术中门脉取血栓术后行标准门脉吻合。经DSA及手术证实，3DCTA对肝门区血管诊断符合率达100．0％；术前根据CTA预制定的手术方案和术中实施方案相比，符合率正常肝动脉解剖组可达93．3％（14／15例），肝动脉变异组可达77．8％（7／9例）。结论 3DCTA能准确评价肝门区血管的变异和病变情况，对于术前准确合理地预制定肝门重建方案及术中准确快速地进行肝门血管吻合有着重要的意义。     

MSCTA和DSA对肝脏肿瘤血管评估的比较

目的：评价肝脏肿瘤多层螺旋CT血管成像（MSCTA）的临床价值。方法：对30例肝脏肿瘤患者采用MSCT血管成像（MSCTA）和数字减影血管造影（DSA）两种方法,对肝动脉、门脉及重要的肝脏血管变异进行比较分析。结果：30例中MSCTA观察到12例动脉变异,包括8例肝右动脉的改变,3例肝左动脉的改变,1例腹腔干过早分叉。动脉门脉瘘4例,门脉癌栓3例。30例同时行DSA检查,动脉的数量和所有动脉血管的变异均与MSCTA的结果相一致（准确度96.7%,敏感度92%,特异度100%）。结论：MSCTA能提供有价值的肝脏血管信息,在肝脏肿瘤外科手术或介入术前可作为一种无侵袭性的首选检查方法。     

肝总动脉变异的多层螺旋CT血管造影表现

目的 应用64层螺旋CT血管造影技术评价肝总动脉变异.方法 对1 129例受检者的64层螺旋CT腹部血管造影检查(CTA)进行回顾性分析,评价肝总动脉变异及分类.结果 1 129例受检者的CTA显示肝总动脉变异46例,占4.1%(46/1 129).肝总动脉变异分为3组:(1)肝总动脉起源变异31例.包括肠系膜上动脉起源23例,腹主动脉起源6例,胃左动脉起源2例.(2)肝总动脉路径变异4例.表现为肝总动脉起源正常,自腹腔干发出后在胰腺上、门静脉后走行,在发出胃十二指肠动脉后延续为肝固有动脉.(3)肝总动脉缺如11例.此型变异的胃十二指肠动脉均独立起源于腹腔干,肝动脉起源包括肠系膜上动脉起源4例;替代右肝动脉和左肝动脉分别起自腹主动脉、胃左动脉4例;替代右肝及左肝动脉分别起自肠系膜上动脉、胃左动脉3例.结论 64层螺旋CT血管造影检查可准确判断肝总动脉起源和解剖路径变异,对变异的范围及与邻近器官的关系也能进一步评估,弥补了血管造影(DSA)的不足.     

副胃左动脉在肝癌介入治疗中的意义

目的探讨副胃左动脉在肝细胞癌介入治疗中的临床意义。方法对387例确诊原发性肝细胞癌患者行64层螺旋CT检查,动脉期采用容积再现(VR)及最大密度投影(MIP)技术重建肠系膜上动脉及腹腔动脉分支起源及走行,并与血管造影对比。结果 387例均清楚显示腹腔动脉、脾动脉、胃左动脉、肝总动脉、肝固有动脉、肝左动脉、肝右动脉及胃十二指肠动脉;282例清楚显示胃右动脉起源。共发现副胃左动脉50例,其中46例发自肝左动脉远端,1例发自副肝左动脉远端,1例发自肝右动脉近端,2例发自肝固有动脉。三维重建结果与血管造影一致。结论副胃左动脉多起源于肝左动脉远端,正确认识副胃左动脉可以避免肝细胞癌介入治疗过程中异位栓塞的发生,减少并发症具有实用意义。     

胃右动脉起源变异在肝癌介入治疗中的意义

目的探讨胃右动脉起源变异在肝细胞癌介入治疗中的指导意义。方法对72例原发性肝细胞癌患者行64层螺旋CT肝脏动态增强扫描,动脉期采用容积再现（VR）及最大密度投影（MIP）重建技术,追踪重建显示胃右动脉的起源与肝动脉的关系,并与血管造影结果对比。结果在72例原发性肝细胞癌患者中,VR及MIP清楚显示胃右动脉起源者43例,显示率为59.8%。胃右动脉起源于肝固有动脉19例,肝左动脉17例,胃十二指肠动脉4例,肝右动脉2例,肝总动脉1例。三维重建结果显示与血管造影一致。结论胃右动脉起源变异多发自肝左动脉,64层螺旋CT三维重建可提供胃右动脉血管影像资料,对介入治疗具有实用意义。     

肠系膜上动脉供血型肝癌的血管造影分析及介入治疗

目的：研究肠系膜上动脉供血型(即变异肝动脉起源于肠系膜上动脉)肝癌的血管造影表现及插管技术。方法：回顾分析41例肠系膜上动脉供血型肝癌的DSA及介入治疗资料，统计血管解剖变异的发生率，对其起源、走行、分支、分布等解剖学特征及其与血管插管的关系进行描述和分析。结果：350例肝癌中肠系膜上动脉供血型41例(11．9％)，其中副肝右动脉15例(36．5％)，替代肝右动脉16例(39．0％)，肝总动脉8例(19．5％)，腹腔动脉干起源于肠系膜上动脉2例(5％)。31例肠系膜上动脉发出替代或副肝右动脉者，29例(94．0％)腹腔动脉造影表现为肝右动脉细小或缺如，肝右叶出现无血管区。RH导管超选择性插管成功25例(61％)，未成功者改用Cobra、Simmon导管以及结合微导管技术后获得成功。结论：肠系膜上动脉供血型肝癌是一种比较常见的肝动脉变异性供血，熟忿其血管变异的特点对肝动脉化疗栓塞术具有重要的意义。     

分析260例肝动脉的走行形态,分支变化及其对肝癌的临床意义

本文观察分析２６０例肝动脉造影动脉像上肝动脉的走行形态及其分支变化。肝动脉呈水平向右或微向上、下走行者２１９例（８４．２％）；肝动脉本身卷曲或曲折成角者４１例（１５．８％），其中肝总动脉与肝固有动脉间明显曲折成角者１９例，占７．３％。２６０例中肝总动脉起始于腹腔动脉者２５６例（９８．５％），有４例（１．５％）起始于肠系膜上动脉。肝固有动脉有９２．６％系肝总动脉的直接延续。肝右动脉大多发自肝固有动脉     

胃左与胃右动脉的变异及其在肝胃肿瘤诊断和化疗栓塞中的意义

本文复习了208例腹腔动脉造影片,统计了胃左、胃右以及迷走肝左动脉的变异。发现国人迷走肝左动脉为10.4%,骨右动脉主要起自肝固有动脉以远的肝动脉。强调在肝左叶肿瘤行腹腔动脉造影为阴性时,应行骨左动脉造影,同时还要行胃左动脉的化疗栓塞治疗。在胃肿瘤胃出血栓塞治疗时,也要注意迷走的肝左动脉存在,适当地选择栓塞剂,注意保护肝脏。另外也要留意观察胃右动脉的起始变异,在?永久性液体或细颗粒栓塞肝动脉时,要注意避开胃右动脉,以防胃出血等并发症发生。     

右膈下动脉的多层螺旋CT表现

目的显示正常人和肝细胞癌患者的右膈下动脉（RIPA），为经导管肝动脉化疗栓塞（TACE）提供有价值的解剖信息。方法对行腹部双期增强扫描的440例患者，包括133例肝细胞癌进行评价。采用16层螺旋CT（MSCT）对动脉期原始数据进行后处理重组，获得多平面重组（MPR）、曲面重组（CPR）和最大密度投影（MIP）图像。薄层和MPR、MIP图像由2名CT室诊断医生评阅并对RIPA进行确认。结果所有440例患者的RIPA均能显示，显示率为100％。在218例（49．5％）起源于主动脉的RIPA中，140例发自主动脉右侧，56例发自主动脉前壁，22例发自主动脉左侧，36例RIPA于左侧膈下动脉共同起源。RIPA起源均在腹腔干动脉上下1cm水平。在138例起源于腹腔干动脉的RIPA中，95例为单独起源，10例与胃左动脉共同起源，33例与左膈下动脉共同起源。78例发自右肾动脉的RIPA均为独立发出，与左膈下动脉无关。133例肝细胞癌中，16例（12．0％）可见RIPA肝外供血，CT显示RIPA较左侧增粗，并供血至肿瘤内部。结论MSCT能很好地显示正常人和肝细胞癌患者的RIPA，可作为TACE术前、术后了解肝细胞癌肝外供血首选的非创性影像手段。     

Variant hepatic arterial anatomy revisited: digital subtraction angiography performed in 600 patients

PURPOSE: To evaluate and describe the prevalence of hepatic arterial variants seen at digital subtraction angiography in a large series of patients. MATERIALS AND METHODS: Data were collected prospectively by using an arterial anatomy database questionnaire that was completed at the time each visceral angiographic examination was performed from May 1996 to October 2000. RESULTS: Six hundred patients underwent at least one visceral angiographic examination at one institution during the study period. Three hundred sixty-eight (61.3%) patients had the standard hepatic arterial anatomy. One hundred nineteen (19.8%) patients had variant left hepatic arteries (LHAs), and 89 (14.8%) had variant right hepatic arteries (RHAs). Twenty-eight (4.7%) patients had a variant anatomy involving both the LHA and the RHA. Twenty-four (4.0%) patients had a variant origin of the common hepatic artery (CHA) arising from either the superior mesenteric artery (SMA) or the aorta. In two patients, the proper hepatic artery (PHA) was the first branch of the SMA and the gastroduodenal artery (GDA) was a branch of the celiac axis. Double hepatic arteries were seen in 22 (3.7%) patients. Trifurcation or quadrifurcation of the GDA was seen in 50 (8.3%) patients, and the GDA originated distal to one hepatic artery in 25 (4.2%) patients in whom both hepatic arteries originated from the CHA. CONCLUSION: A replaced LHA was less common than has been previously reported, and in two cases, the PHA arose from the SMA. Digital subtraction visceral angiographic results are comparable to results of seminal angiographic studies in which the cut-film technique was used.     

Multislice CT angiography through an implantable catheter and port system: early experience in detection of vascular complications during hepatic arterial infusion chemotherapy

OBJECTIVE: The purpose of this study was to evaluate the use of multislice CT in the evaluation of vascular patency in patients during hepatic arterial infusion chemotherapy of liver tumors. MATERIALS AND METHODS: Thirty-three patients were prospectively examined by CT angiography through the indwelling catheter and port system. Visibility of hepatic arteries and vascular patency were graded 0 to 3 and were compared with digital subtraction angiography (DSA). RESULTS: Average visualization scores of CT angiography and DSA were 1.7 and 2.5, respectively, in common hepatic artery (CHA) and proper hepatic artery (PHA), 2.5 and 2.3 in right hepatic artery (RHA), 2.6 and 2.6 in left hepatic artery (LHA), 2.3 and 2.2 in segmental RHA, and 2.1 and 2.0 in segmental LHA. Stenoses were found in proximal hepatic arteries in 9 on CT angiography and 13 on DSA. Stenoses were found in branches of the hepatic artery in 21 on CT angiography and 16 on DSA. CONCLUSION: The authors' results indicate that multislice CT angiography of the hepatic arteries is equivalent to DSA and may demonstrate vascular complications of hepatic arterial infusion chemotherapy.     

Nonhepatic arteries originating from the hepatic arteries: angiographic analysis in 250 patients

PURPOSE: To investigate the prevalence and patterns of origin of nonhepatic arteries originating from the proper hepatic artery (PHA) or its distal branches and to assess their relation to anatomic variations. MATERIALS AND METHODS: Digital subtraction celiac arteriography and selective left hepatic arteriography was performed in 250 patients with hepatocellular carcinoma. Three interventional radiologists interpreted the angiograms on the monitor by consensus. If necessary, further superselective arteriography was performed. The prevalence of nonhepatic arteries, their sites of origin, and the influence of underlying anatomic variants were analyzed. RESULTS: Nonhepatic arteries were found in 205 patients. The most common nonhepatic artery was the right gastric artery (RGA; n = 196), followed by the hepatic falciform artery (HFA; n = 129), accessory left gastric artery (LGA; n = 43), posterior superior pancreaticoduodenal artery (PSPDA; n = 18), and left inferior phrenic artery (LIPA; n = 5). The left hepatic artery (LHA) was the most frequent origin of nonhepatic arteries (170 of 250). Regardless of anatomic variation, the most common origins of the RGA and HFA were the PHA and the segment IV hepatic artery, respectively. In patients with an aberrant LHA from the LGA, no accessory LGAs or LIPAs were found. PSPDAs preferentially arose from variant hepatic arteries arising from the gastroduodenal artery. CONCLUSIONS: Nonhepatic arteries commonly arise from the hepatic arteries, especially the LHA and PHA. Moreover, variants of the celiac and hepatic arteries influence the prevalence and sites of origin of nonhepatic arteries.     

Dual-phase 3D CT angiography during a single breath-hold using 16-MDCT: assessment of vascular anatomy before laparoscopic gastrectomy

OBJECTIVE: In this study, we evaluated the efficacy of dual-phase 3D CT angiography (CTA) during a single breath-hold using 16-MDCT in the assessment of vascular anatomy before laparoscopic gastrectomy. MATERIALS AND METHODS: The study involved 20 consecutive patients (10 men, 10 women; mean age, 59 years) scheduled for laparoscopic gastrectomy for the treatment of early gastric cancer. A dual-phase contrast-enhanced CT scan using 16-MDCT was obtained before laparoscopic gastrectomy. After rapid infusion of a nonionic contrast agent, arterial and venous phase scans were obtained serially with an interval of 15 sec during a single breath-hold of 31 sec. Three-dimensional CTA images in the arterial phase (3D CT arteriography) and venous phase (3D CT venography) were individually reconstructed using the volume-rendering technique, and then the images were fused together. We evaluated the detectability of the celiac trunk, left gastric artery (LGA), right gastric artery (RGA), left gastric coronary vein (LCV), Henle's gastrocolic trunk, right gastroepiploic vein (RGEV), and accessory right colic vein on 3D CTA to compare with surgical findings. RESULTS: In all 20 patients, 3D CT arteriography and venography clearly showed the celiac trunk, LGA, RGA, Henle's gastrocolic trunk, RGEV, and accessory right colic vein, which were correctly identified during surgery. The branching pattern of the celiac trunk was classified as Michels type I in 19 patients and Michels type II in one patient. Imaging showed the RGA originating from the proper hepatic artery (PHA) in nine patients; from the gastroduodenal artery (GDA) in seven patients; and from the left hepatic artery (LHA) in four patients. In 12 patients, the LCV joined the portal vein (PV) and in eight, the splenic vein (SV). In all patients, the accessory right colic vein joined the RGEV, and Henle's gastrocolic trunk proximal to the joining point flowed to the superior mesenteric vein (SMV). In all 20 patients, the fused image simultaneously showed arteries and veins around the stomach, with no mismatch between the arterial and venous phase images. In 10 patients, the LCV joined the PV after running along the dorsal side of the PHA, common hepatic artery (CHA), or splenic artery (SA). In eight patients, the LCV joined the SV after running along the ventral side of the PHA, CHA, or SA. In two patients, the LCV joined the PV after running along the ventral side of the CHA, which correlated with the surgical findings. Both the sensitivity and positive predictive values of 3D CTA revealed 100% correct identification of the celiac trunk, LGA, RGA, LCV, Henle's gastrocolic trunk, RGEV, and accessory right colic vein. CONCLUSION: Dual-phase 3D CTA using 16-MDCT clearly revealed individual arteries and veins around the stomach before laparoscopic gastrectomy. The fused image of 3D CT arteriography and venography during a single breath-hold enabled the simultaneous assessment of arteries and veins before laparoscopic gastrectomy.     

Multidetector-row computed tomography angiography for planning intra-arterial chemotherapy pump placement in patients with colorectal metastases to the liver

PURPOSE: The purpose of this study was to evaluate the use of multidetector computed tomography (MDCT) in the preoperative arterial evaluation of patients scheduled to undergo intra-arterial chemotherapy pump placement. METHODS: Computed tomography scans of 30 patients with hepatic malignancies who were imaged with multiphase MDCT angiography for intra-arterial chemotherapy pump placement were retrospectively analyzed. Dual-phase helical CT was performed, and the arterial phase images were processed to depict the arterial anatomy and to identify pertinent anomalies. All findings were compared and correlated with surgical findings or catheter angiography if surgery was contraindicated. RESULTS: Arterial anomalies identified on CT angiography in 20 of 30 patients included a replaced right hepatic artery (RHA; n = 6) or left hepatic artery (LHA; n = 8), a replaced common hepatic artery (n = 1), an accessory RHA (n = 2) or LHA (n = 6), a replaced gastroduodenal artery (GDA; n = 2), an extrahepatic connection between the accessory RHA and the replaced RHA (n = 1), and a common origin composed of the GDA and RHA and LHA (n = 2). There were no additional arteries or anomalies identified by catheter angiography, when available, or during surgery. Only 1 variant, an accessory hepatic artery, was not located during surgery. In 2 patients, the surgical team decided that pump placement was not feasible because of overly complex anatomy as determined by CT angiography. Computed tomography angiography showed an overall sensitivity of 100% and specificity of 97%. CONCLUSIONS: Multidetector computed tomography angiography is accurate for the preoperative evaluation of normal and aberrant hepatic vasculature in patients under consideration for intra-arterial chemotherapy pump placement. Axial images alone permit recognition of vascular anomalies, including complex anatomy. Nevertheless, 3-dimensional rendering is useful to evaluate complex vascular anatomy and does not require catheter angiographic confirmation. In addition to aiding in selecting patients ideal for pump placement, MDCT permits noninvasive planning of their surgical approach.     

肝-胰动脉的DSA研究及其在肝癌经导管动脉内化疗栓塞术中的意义

目的　研究肝 胰动脉的DSA解剖学特征 ,探讨其在肝癌经导管动脉内化疗栓塞术中的意义。方法　回顾分析 10 0 0例肝动脉DSA造影片。将发自肝固有动脉以远的各级肝动脉分支的供应胰腺的变异血管命名为肝 胰动脉 ,分析其起源、走行、分支、分布等解剖学特征 ,并统计其发生率。结果　共发现 16例存在肝 胰动脉 ,占 1.6 % ,其中 1例可见 2支 ,共显示 17支肝 胰动脉。其中起源于肝固有动脉 7支 ,占 41.2 % (7/ 17) ;起源于肝右动脉 6支 ,占 35 .3 % (6 / 17) ;起源于肝左动脉 4支 ,占 2 3.5 %(4/ 17)。结论　肝 胰动脉是一种少见的血管变异 ,TACE时避免将其误栓对有效地预防术后胰腺受损等并发症的发生具有重要的临床意义。     

肝-胃动脉的解剖学基础及其在肝癌经导管动脉内化疗栓塞中的意义

目的：研究肝－胃动脉（hepatogastric,artery,HGA的DSA表现特征,探讨其在肝癌经导管动脉内化疗栓塞（transcatheter arterial chemoembolization,TACE)术中的意义。方法：回顾分析1000例肝动脉DSA造影片,将起源于肝固有动脉（proper hepatic artery,PHA)以远各级肝动脉的胃及十二指肠的供血动脉命名为HGA,并根据其走行方向及分布范围的不同,进一步将其分为胃右动脉（right gastric artery,RGA),迷走胃左动脉（aberrant left gastric artery,AbLGA),迷走胃十二指肠动脉（aberrang gastroduodenal artery,AbGDA),迷走胃网膜右动脉（aberrant right gastroepiploic artery,AbRGEA),十二指肠上动脉（superior duodenal artery,SDA)及其他不易明确命名的HGA等。分别统计其发生率,描述其起源,走行,分支,分布等解剖学特征。结果：1000例中,740例存在1支以上的HGA,占74％,共显示839支HGA,其中RGA682支（81．29％,682／839）,AbLGA84支（10．01％,84／839）,SDA45支（5．36％,45／839）,AbGDA21支（2．50,21／839）,AbRGEA1支（0．12％,1／839）,其他HGA6支（0．72％,6／839）。839支HGA中,起源于PHA412支（49．11％,412／839）,起源于肝左动脉（left hepatic artery,LHA)314支（37．43％,314／839）,起源于肝右动脉（right hepatic artery,RHA）98支（11．68％,98／839）,起源于肝中动脉（middle hepatic artery,MHA)15支（1．79％,15／839）。结论：HGA是比较常见的肝－胃,十二指肠间的血管变异,研究HGA的解剖变异对预防肝癌TACE术后胃肠道并发症的发生具有重要的临床意义。     

Woodchuck Hepatic Anatomy and Vascular Alterations Due to Hepatocellular Carcinoma with Angiographic Atlas of the Abdomen and Pelvis

PurposeTo characterize the hepatic and abdominal angiographic anatomy of woodchucks and vascular changes associated with hepatocellular carcinoma (HCC).Materials and MethodsTwenty-nine woodchucks (23 with viral-associated HCC, 6 without) underwent multiphasic computed tomography (CT). Fourteen woodchucks (8 with HCC) also underwent diagnostic angiography. Hepatic arterial diameters were measured on the CT scans. Woodchucks were divided into 3 groups: non–tumor-bearing, largest tumor supplied by the right hepatic artery (RHA), and largest tumor supplied by the left hepatic artery (LHA). Statistical analysis with a repeated measures model was performed to determine the effects of tumor location (right, left), vessel measured (RHA, LHA), and interaction between the 2 on vessel diameter. Lobar arteries supplying HCC were compared with those that did not.ResultsCT anatomy and normal and variant vascular anatomy were defined. In woodchucks with HCC, LHA and RHA supplying tumors had mean diameters of 2.0 mm ± 0.3 and 1.6 mm ± 0.3 versus 1.5 mm ± 0.3 and 1.1 mm ± 0.2 for non–tumor-supplying arteries (P = .0002 and P < .0001), respectively. Lobar arteries supplying tumors were similarly ectatic. The right lateral lobe artery had the most profound increase in the mean diameter when supplying tumors, measuring 1.7 mm ± 0.1 versus 1.0 mm ± 0.1 in the non–tumor-supplying artery (P < .0001). There were no differences in the diameters of the aorta and celiac, common, and proper hepatic arteries between tumor- and non–tumor-bearing woodchucks. An angiographic atlas of the abdominal vessels was generated.ConclusionsHCC tumoral vasculature in woodchucks was ectatic compared with normal vasculature. This phenomenon recapitulates human HCC and may facilitate investigation of transcatheter and drug delivery therapies in an HCC animal model.     

原发性肝癌所在部位与肝动脉血流分配的差异探讨

本文对４１例原发性肝癌（其中单发肝右叶病变２１例，肝左、右叶同时受累２０例），肝动脉造影片的肝固有动脉（ＰＨＡ）、肝左动脉（ＬＨＡ）、肝右动脉（ＲＨＡ）的直径进行了测量，并计算了ＬＨＡ／ＰＨＡ、ＲＨＡ／ＰＨＡ、ＬＨＡ／ＲＨＡ的比值。研究结果表明ＬＨＡ／ＲＨＡ与ＬＨＡ／ＰＨＡ在上述两种情况下具有非常显著性差异（Ｐ＜０．０１），说明肝内瘤体所在部位不同存在肝动脉血流分配上的差异，尤其位于左叶时更为明显。提供了统计学处理结果。     

Evaluation of Intrahepatic Perfusion on Fusion Imaging Using a Combined CT/SPECT System: Influence of Anatomic Variations on Hemodynamic Modification Before Installation of Implantable Port Systems for Hepatic Arterial Infusion Chemotherapy

BACKGROUND: In some patients with hepatic tumors, anatomic variations in the hepatic arteries may require hemodynamic modification to render effective hepatic arterial infusion chemotherapy delivered via implantable port systems. We used a combined CT/SPECT system to obtain fused images of the intrahepatic perfusion patterns in patients with such anatomic variations and assessed their effects on the treatment response of hepatic tumors. METHODS: Using a combined SPECT/CT system, we obtained fused images in 110 patients with malignant liver tumors (n = 75) or liver metastasis from unresectable pancreatic cancer (n = 35). Patients with anatomic hepatic arteries variations underwent hemodynamic modification before the placement of implantable port systems for hepatic arterial infusion chemotherapy. We evaluated their intrahepatic perfusion patterns and the initial treatment response of their liver tumors. The perfusion patterns on the fused images were classified as homogeneous, local hypoperfusion, and/or perfusion defect. Using the WHO criteria of complete response (CR), partial response (PR), no change (NC), and progressive disease (PD), we evaluated the patients' tumor responses after 3 months on multislice helical CT scans. The treatment was regarded as effective in patients who achieved a complete response or partial response. RESULTS: Anatomic hepatic artery variations were present in 15 of the 110 patients (13.6%); 5 manifested replacement of the left hepatic artery (LHA), 8 of the right hepatic artery (RHA), and 1 each had replacement of the RHA and LHA, and replacement of the LHA plus an accessory RHA. In 13 of these 15 patients (87%), occlusion with metallic coils was successful. On fusion imaging, the perfusion patterns were recorded as homogeneous in 6 patients (43%), as hypoperfusion in 7 (50%), and 1 patient had a perfusion defect (7.1%) in the embolized arterial region. Of the 8 patients with RHA replacement, 4 manifested a homogeneous distribution and 3 hypoperfusion. In 2 of 5 patients with LHA replacement, the distribution was homogeneous. In 1 patient with RHA and LHA replacement, and in 1 patient with LHA replacement and an accessory RHA, we noted hypoperfusion in the RHA territory. All 6 patients with homogeneous distribution were classified as PR or NC on follow-up multidetector CT. Of the 7 patients manifesting hypoperfusion, 3 were classified as PD (43%), 3 as NC (43%), and 1 as PR (14%) on follow-up CT. CONCLUSION: Hemodynamic modification of anatomic hepatic artery variations resulted in hypoperfusion on fusion images. Differences in the intrahepatic perfusion patterns may affect the response to hepatic arterial infusion chemotherapy.