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.     

肝动脉正常解剖及变异的DSA研究

目的 研究数字减影血管造影（DSA）下肝动脉正常解剖及变异。方法 回顾分析我院从1994年11月至2003年6月的1200份,常规腹腔动脉干造影和（或）选择性肝动脉造影DSA片,部分病例同时作肠系膜上动脉、胃左动脉等处的造影。结果 873例（72．8％）患者具有正常的肝血管起源,156例（13．0％）患者存在变异的肝左动脉,120例（10．0％）患者存在变异的肝右动脉,而21例（1．8％）肝左及肝右动脉同时存在变异。1200例患者中肝总动脉起源于腹腔动脉干者1170例（97．5％）;肝固有动脉有92．0％系肝总动脉的直接延续;肝右动脉大多数发自肝固有动脉（89．8％）;肝中动脉的变异较大,发自肝左动脉较多（62．2％）;肝左动脉可直接发自肝固有动脉（44．6％）,也可来源于肝右动脉（30．2％）或其他动脉（25．2％）。结论 DSA了解肝动脉的解剖变异对指导肝脏疾病的介入治疗以及肝脏外科临床具有重要的意义。     

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。     

迷走肝动脉的DSA研究及临床意义

目的 研究迷走肝动脉的解剖特征，探讨其临床意义。资料与方法 回顾分析1000例肝动脉DSA资料，将直接起自腹腔干及胃肠道供血动脉的变异肝动脉称之为迷走肝动脉（aberrant hepatic artery,AbHA)，并根据其在肝内的走行方向和分布范围不同，进一步将其分为迷走肝右动脉（aberrant right hepatic artery,AbRHA），迷走肝左动脉（aberrant left hepatic artery,AbLHA)，迷走肝中动脉（aberrant middle hepatic artery,AbMHA)，迷走肝固有动脉（aberrant proper hepatic artery,AbPHA)及迷走肝总动脉（aberrant common hepatic artery,AbCHA）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，共发现210例存在AbHA，占21％，其中12例分别显示2支AbHA，共发现222支AbHA，其构成如下：AbRHA 102支（45.95%,102/222)，AbLHA88支（39.64%,88/222)，AbMHA 4支（1.80%,4/222),AbPHA 3支（1.35%,3/222)，AbCHA 25支（11.26%,25/222)。222支AbHA中，起于肠系膜上动脉114支（51.35%,114/222)，起于胃左动脉83支（37.39%，83／222），起于胃十二指肠动脉13支（5.86%,13/222)，起于腹腔干10支（4.50%,10/222)，起于胃右动脉2支（0.90%,2/222)。结论 AbHA是一种比较常见的肝动脉变异，熟悉这种血管变异对肝癌的动脉内化疗栓塞具有极其重要的临床意义。     

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。     

Right Gastric Artery Embolization Prior to Treatment with Yttrium-90 Microspheres

Purpose Intra-arterial infusion of yttrium-90 microspheres is a form of radiation treatment for unresectable hepatic neoplasms. Misdeposition of particles in the gastroduodenal area such as the right gastric artery (RGA) may occur with serious consequences. We present a series of patients who underwent a detailed vascular study followed by RGA embolization. Special emphasis is placed on anatomic variations and technical considerations. Methods In a 1 year period, 27 patients were treated. Initial vascular evaluation was performed, with careful attention to anatomic variants or extrahepatic arterial supply, especially to the gastroduodenal area. Embolization of such arteries was planned if needed. RGA embolization was performed antegradely from the hepatic artery or retrogradely via the left gastric artery (LGA). Postprocedural follow-up included clinical interview and gastroscopy if necessary. Results RGA embolization was performed in 9 patients presenting with primary (n = 3) or metastatic liver tumors (n = 6). Six patients underwent antegrade RGA embolization and 3 had embolization done retrogradely via the LGA. Retrograde access was chosen for anatomic reasons. None of the patients complained of gastroduodenal symptoms. Conclusion RGA embolization can help minimize the gastroduodenal deposition of radioactive particles. RGA embolization should routinely be carried out. The procedure can be performed, with similar technical success, by both anterograde and retrograde approaches.     

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.     

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.     

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.     

Hepatic falciform artery. Angiographic findings in 25 patients

Purpose: To determine the frequency of hepatic falciform artery (HFA) occurrence on celiac or hepatic angiograms and elucidate the anatomy and clinical importance.Material and Methods: Among 1,250 patients who underwent celiac or hepatic arteriography, we encountered 25 patients (2%) with a HFA. Prospectively, CT hepatic falciform arteriography (CTHA) was performed in 4 patients. Indigocarmine dye was injected into the HFA in 6 patients to evaluate whether the abdominal skin was stained. Embolization of the HFA before chemoembolization for hepatocellular carcinoma was performed in 4 patients to prevent abdominal wall injury.Results: Among 25 patients, the HFA arose as a terminal branch of the middle hepatic artery in 14 patients (56%) and of the left hepatic artery in 11 patients (44%). The vessel was single in 18 patients (72%) and double in 7 patients (28%). Two vessels ran side by side along the hepatic falciform ligament. On CTHA, the HFA ran within the hepatic falciform ligament and the branches were connected with the liver around the hepatic falciform ligament. After indigocarmine dye injection, the stain of abdominal skin was recognized in all 6 patients. No abdominal wall injury occurred in any of the 4 patients who were subjected to hepatic chemoembolization.Conclusion: HFA is an extrahepatic pathway which runs to the abdominal wall. Before chemoembolization of the middle or left hepatic artery for hepatic malignancy, the HFA should be recognized.     

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。     

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。     

Multidetector CT arteriography with volumetric three-dimensional rendering to evaluate patients with metastatic colorectal disease for placement of a floxuridine infusion pump

OBJECTIVE: We sought to evaluate the usefulness of multidetector CT (MDCT) arteriography with volumetric three-dimensional (3D) rendering to depict the hepatic vascular anatomy. Our study population was patients who had undergone arterial mapping in preparation for placement of a hepatic arterial floxuridine infusion pump for treatment of metastatic hepatic colorectal carcinoma. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 26 patients with hepatic colorectal metastases who had been scheduled for implantation of a hepatic artery pump. Before surgery, all patients underwent MDCT arteriography with volumetric 3D rendering of the hepatic vessels. The axial and 3D arteriograms were evaluated for their usefulness in depicting hepatic arterial anatomy. Subsequently, three patients also underwent catheter angiography. Twenty-two of the 26 patients imaged had a hepatic artery floxuridine infusion pump implanted. Results of the CT arteriography were correlated with findings at surgery or on catheter angiography if surgery was not performed. RESULTS: MDCT arteriography correctly revealed hepatic arterial anatomy in all 25 patients with angiographic or surgical confirmation. One patient with aberrant hepatic arterial anatomy did not have angiographic or surgical confirmation. Classic hepatic arterial anatomy was identified in 16 (64%) of 25 patients. The following hepatic arterial variants were found in one patient each: the common hepatic artery arising directly from the aorta; a replaced left hepatic artery; an accessory right hepatic artery; a replaced left hepatic artery and accessory right hepatic artery; a replaced right hepatic artery; a right hepatic arterial branch arising early (before the origin of the gastroduodenal artery); and replaced right and left hepatic arteries. Three patients were not suitable candidates for placement of a hepatic artery floxuridine pump. The patient who had no angiographic or surgical confirmation was also not considered a good surgical candidate because of replaced right and left hepatic arteries. Two patients (8%) had an accessory left hepatic artery. CONCLUSION: MDCT arteriography with volumetric 3D rendering is an accurate, noninvasive method of depicting hepatic arterial anatomy and, therefore, of selecting patients with colorectal metastatic disease who could benefit from hepatic artery pump implantation. Catheter angiography provides no additional information, and we have eliminated it as a routine preoperative imaging examination.     

Hepatic falciform artery: is prophylactic embolization needed before short-term hepatic arterial chemoinfusion?

OBJECTIVE: The purpose of this study was to assess the need for prophylactic embolization of the hepatic falciform artery (HFA) to prevent supraumbilical skin rash before short-term hepatic arterial chemoinfusion with or without subsequent embolization. MATERIALS AND METHODS: Transcatheter arterial chemoinfusions or chemoembolizations were performed on 127 consecutive patients with hepatocellular carcinoma between August 1997 and September 1997. Hepatic angiography findings regarding the anatomic variations of the hepatic artery and the presence and origin of the HFA were analyzed. The patients were followed up for 35-143 days (mean, 78 days). The incidence of supraumbilical skin rash was assessed for two groups of patients, those with an HFA and those without. We also evaluated other factors that seemed closely related to the presence of an HFA. RESULTS: An HFA was identified in 16 (13%) of 127 patients. Each HFA originated either in the left hepatic artery (n = 14) or the middle hepatic artery (n = 2). In the 16 patients with an HFA, serum bilirubin levels were significantly higher than in patients without one (p < .05), whereas serum albumin levels and prothrombin times were significantly lower (p < .05) and more prolonged (p = .02) than in patients without one. Portal venous collateral vessels were more frequently seen in patients with an HFA (50%) than in those without one (31%), but the frequency was not significant (p = .157). However, supraumbilical skin rash was not seen in any patient. CONCLUSION: We found no need for prophylactic embolization of the HFA to prevent supraumbilical skin rash before short-term hepatic arterial chemoinfusion with or without subsequent embolization.     

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.     

64层CT增强扫描对胃癌患者胃供血动脉的显示

目的 探讨64层CT增强扫描对胃癌患者胃供血动脉的显示及血管变异的检出情况.方法 回顾性分析行CT检查的连续66例胃癌患者资料.CT扫描根据目标血管管径及跨层走行情况,凋节滑块间距得到胃供血动脉薄层滑块最大密度投影图像(STS-MIP),4周后利用血管追踪生长技术获得同一组病例的三维容积重组图像(AVVR).分析胃的直接和间接供血动脉显示率及来源.采用McNemar检验(精确概率法)比较STS-MIP、AVVR对胃供血动脉的显示率,采用独立样本t检验比较AVVR重组上胃供血动脉显示与动脉强化CT值的关系,分析血管分支变异情况.结果 AVVR及STS-MIP对胃间接供血动脉的显示率均达到100%(66/66).对胃左动脉(LGA)和胃网膜右动脉(RGEA)的显示率分别为98.5%(65/66)、100.0%(66/66)及97.0%(64/66)、100.0%(66/66);AVVR对胃右动脉(RGA)、胃网膜左动脉(LGEA)、胃短动脉(SGA)及胃后动脉(PGA)的显示率分别为68.2%(45/66)、53.0%(35/66)、7.6%(5/66)和18.2%(12/66),低于 STS-MIP的显示率,分别为98.5%(65/66)、97.0%(64/66)、59.1%(39/66)和63.6%(42/66),差异有统计学意义(P<0.01).采用AVVR重组方法,显示的LGEA、RGEA及SGA分别为35、64和5支,腹腔干强化CT值分别为(272±44)、(256±44)和(298±39)HU,未显示的上述血管支数分别为31、2、61支,腹腔干强化CT值分别为(229±42)、(141±26)和(249±47)HU,差异有统计学意义(t值分别为4.043、3.641和2.278,P值均<0.05).检出迷走肝左动脉13例(发生率19.7%),腹腔干大血管分支变异7例(变异率10.6%).结论 64层CT可清晰显示胃周供血动脉及其相关变异,为胃癌术前方案的制定提供参考.     

Anatomic variation in the origin of the main renal arteries: spiral CTA evaluation

The aim of this study was to provide quantitative data on the origin and trajectory of the main renal arteries using spiral CT angiography and arteriography. Normal renal artery anatomy was assessed on spiral CT angiography (axial transverse sections and shaded-surface-display reconstructions) in 100 patients referred for renal arteriography who had no significant renal artery stenosis. Two hundred major renal arteries were studied. The vast majority of right (88 %) and left (87 %) renal arteries originated between the lower third of the first lumbar vertebra and the lower border of the second lumbar vertebra. In 50 patients both ostia were at the same level; in the remaining 50 patients, the right ostium was located above the left in 37 patients. On the right, the angle of origin varied from –10 to + 55 ° (mean + 24 °). On the left, the angle of origin varied from + 30 to –55 ° (mean –11 °). Spiral CT angiography provides additional anatomic data, notably regarding the angle of origin of the renal arteries, that is potentially useful for planning interventional procedures. Received: 11 August 1998; Revision received: 30 November 1998; Accepted: 12 February 1998     

MDCT Anatomic Assessment of Right Inferior Phrenic Artery Origin Related to Potential Supply to Hepatocellular Carcinoma and its Embolization

Purpose To prospectively assess the anatomic variation of the right inferior phrenic artery (RIPA) origin with multidetector computed tomography (MDCT) scans in relation to the technical and angiographic findings during transcatheter arterial embolization of hepatocellular carcinoma (HCC). Methods Two hundred patients with hepatocellular carcinomas were examined with 16-section CT during the arterial phase. The anatomy of the inferior phrenic arteries was recorded, with particular reference to their origin. All patients with subcapsular HCC located at segments VII and VIII underwent arteriography of the RIPA with subsequent embolization if neoplastic supply was detected. Results The RIPA origin was detected in all cases (sensitivity 100%), while the left inferior phrenic artery origin was detected in 187 cases (sensitivity 93.5%). RIPAs originated from the aorta (49%), celiac trunk (41%), right renal artery (5.5%), left gastric artery (4%), and proper hepatic artery (0.5%), with 13 types of combinations with the left IPA. Twenty-nine patients showed subcapsular HCCs in segments VII and VIII and all but one underwent RIPA selective angiography, followed by embolization in 7 cases. Conclusion MDCT assesses well the anatomy of RIPAs, which is fundamental for planning subsequent cannulation and embolization of extrahepatic RIPA supply to HCC.     

US, CT, and MR evaluation of accessory renal arteries and proximal renal arterial branches

RATIONALE AND OBJECTIVES: The purpose of this study was to compare color Doppler ultrasound (US), computed tomographic (CT) angiography, and magnetic resonance (MR) angiography for the evaluation of accessory renal arteries and proximal branches of the main renal artery. MATERIALS AND METHODS: Fifty-six subjects who had undergone conventional arteriography of the renal arteries participated in a prospective comparison of Doppler US (45 patients), CT angiography (52 patients), and nonenhanced MR angiography (28 patients). Conventional arteriography depicted 28 accessory renal arteries and 21 proximal branches of the main renal artery within 2 cm of the aorta. RESULTS: US depicted five of 24 accessory renal arteries seen at arteriography but no proximal arterial branches. CT angiography depicted 24 of 26 accessory renal arteries and 13 of 17 proximal arterial branches, as well as 15 additional accessory renal arteries not seen at conventional arteriography. MR demonstrated 11 of 15 accessory arteries, as well as four additional accessory arteries not seen at conventional arteriography. MR did not depict any of nine proximal arterial branches seen at conventional arteriography. CONCLUSION: When compared with US or nonenhanced MR angiography, CT is the preferred method for evaluation of accessory renal arteries and proximal branches of the renal artery.     

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。