基于64层螺旋CT血管成像右半肝肝动脉的应用解剖

目的应用64层螺旋CT血管成像(64-MSCTA)探讨活体右半肝肝动脉在肝内分布情况,为右半肝肝脏疾病的诊疗提供形态学资料。资料与方法采集120例受试者肝脏CT图像,经容积再现(VR)技术重组肝动脉。测量右半肝肝动脉相关数据进行统计分析。结果肝右动脉起源变异发生率为13.3%,变异的肝右动脉可起自肠系膜上动脉、胃十二指肠动脉或腹腔干;肝右动脉主干长度为(57.19±24.61)mm;肝右动脉主干起始处、中点(1/2处)、分叉处内径分别为(3.61±0.77)mm、(3.33±0.72)mm、(3.21±0.65)mm;肝右动脉发出左内叶支的出现率为35.0%,其起始处距肝右动脉主干起点处的长度为(22.18±13.63)mm;在肝右叶实质内肝右动脉主干分为2支型、3支型、4支型、5支型的出现率分别为75.8%、3.3%、13.3%、1.7%;肝右动脉右前叶支与右后叶支主干的夹角为(72.70±20.28)°,二者主干长度和起点处内径分别为(27.31±16.13)mm、(2.41±0.67)mm和(33.41±26.48)mm、(2.20±0.64)mm。结论 64-MSCTA可真实、准确地提供活体肝右动脉的...     

门静脉高压患者多层螺旋CT在体测量研究

目的 通过多层螺旋CT门静脉血管成像,探讨门静脉高压患者门静脉系统管径、肝脾体积、肝实质强化与病因及肝功能之间的关系.资料与方法 采用16排多层螺旋CT对126例临床和实验室指标提示门静脉高压患者和47例非门静脉高压者进行门静脉CTA,并进行胃左静脉、门静脉、脾静脉、肠系膜上静脉内径测量,肝脏、脾体积测量及门静脉期肝实质和门静脉主干CT值的测量,并用SPSS 11.0统计软件包对获得数据进行分析.结果 门静脉高压患者与正常对照组相比,门静脉内径分别为(13.73±3.36) mm和(13.61±1.90) mm,脾静脉内径分别为(10.30±3.28) mm和(9.23±1.39) mm,肠系膜上静脉内径分别为(10.83±2.03) mm和(10.46±1.32) mm,胃左静脉宽度分别为(5.10±3.49) mm和(1.48±1.59) mm,肝脏体积分别为(1189.46±305.36) cm3和(1322.40±283.81) cm3,脾体积分别为(809.37±471.14) cm3和(255.53±110.35) cm3.两组间对比有统计学意义(P＜0.05).结论 多层螺旋CT门静脉血管成像在显示门静脉高压患者相关血管形态、肝脾体积及肝实质强化等多方面能提供有价值的信息,可为临床治疗方案的选择和疗效的观察评估提供影像学依据.     

肝静脉分型与测量参数的多层螺旋CT研究

目的从影像角度揭示构成活体肝后下腔静脉前间隙的肝静脉（HV）、下腔静脉（IVC）及右下肝静脉（IRHV）等血管的立体构成，为肝脏手术术前提供解剖学参考。方法对110例受检者于CT增强60～75S后行上腹部扫描，对HV、IVC及IRHV等行多平面重组（MPR）及三维立体最大密度投影（3D-MIP）成像。根据HV汇入IVC的方式进行分型，测量肝右静脉（RHV）与肝中静脉（MHV）或与共干的夹角、RHV与MHV或与共干在IVC上的距离，观察IRHV的出现几率，并测最RHV至IRHV的距离。结果在110例受检者中3支型（肝的3支静脉分别汇入IVC）6例（5．45％），中、左支共干或合干型（肝中、左支静脉共干或合干后汇入IVC）98例（89．10％），中、右支共干型（肝中、右支静脉共干后汇入IVC）6例（5．45％）。RHV与MHV或与共于的夹角为（55±18）°；RHV与MHV或与共干在IVC上的距离为（21±7）mm。30例出现IRHV，出现几率为27．27％；IRHV至RHV的距离为（53±11）mm。结论利用MPR成像可准确地测量构成此间隙的各相关参数值，对指导手术有帮助。     

多层螺旋CT在活体肝右叶移植供体术前肝静脉评估中的应用

目的探讨多层螺旋CT(multi-slice spiral computed tomography,MSCT)在活体肝右叶移植供体术前评估中的应用。方法60例被分为2组,平扫后以100ml对比剂用量,3.5ml/s流率经肘静脉注入对比剂后,分别于70s,75s延迟时间行增强扫描。扫描完成后对运用表面遮盖显示法(SSD),部分加用容积重建法(VR)或最大密度投影法(MIP)对数据进行图像后处理。分析穿过位于肝中静脉(MHV)右侧肝切除面的大静脉;肝右下副静脉的出现、直径及其汇入下腔静脉处与肝右静脉汇入下腔静脉处的距离;分析各组肝中静脉主干CT值、肝中静脉主干与肝实质CT值差值之间的关系。结果60例中,引流第Ⅴ、Ⅷ段的大静脉(直径>5mm)穿过手术切面汇入肝中静脉的有30例(50%);发现22例(36.7%)共25支右下副静脉,3例(5%)有2支右下副静脉;25支中,有14支直径超过5mm;有18支右下副静脉汇入下腔静脉处到肝右静脉汇入下腔静脉处之间的冠状面距离超过40mm。70s组与75s组对肝静脉的显示差异无显著性。结论运用MSCT技术,能模拟肝右叶活体肝移植预期手术切面,清晰显示手术相关的肝静脉变异,解剖类...     

肠系膜上动、静脉病变64层螺旋CT血管成像探讨

目的探讨64层螺旋CT血管成像在肠系膜上动、静脉病变的诊断和临床应用价值。资料与方法回顾性分析经CT增强血管造影诊断肠系膜上动、静脉病变45例。采用Philips 64层螺旋CT容积扫描,增强扫描于注射对比剂后延迟25~30 s扫描动脉期、65~75 s扫描门静脉期。在工作站采用多平面重组(multi-planar reformat-ting,MPR)、最大密度投影(maximum intensity projection,MIP)及容积再现(volumetric rendering,VR)重组肠系膜上动、静脉图像,分析肠系膜上动、静脉血管成像对肠系膜血管病变的诊断价值。结果 45例患者均清晰显示肠系膜上动、静脉主干及其分支,共发现肠系膜上动、静脉病变49处,其中累及肠系膜上动脉23处,肠系膜上静脉13处,肠系膜上动、静脉同时累及13处。结论 64层螺旋CT血管成像能清楚显示肠系膜上动、静脉解剖结构,对肠系膜动、静脉病变有确诊价值,为临床诊断和治疗节省宝贵时间。     

活体肝移植术后肝淤血的多层螺旋CT评价及原因分析

目的 探讨CT双期增强扫描对活体右半肝移植(LDLT)受体术后肝淤血的诊断价值,并对比供体术前CT图像分析肝淤血的原因.资料与方法回顾性分析48例不包含肝中静脉LDLT术后2～4周的CT增强扫描图像,观察原肝中静脉引流区域肝实质密度、肝中静脉属支显影情况,并对照不同的手术方式--肝中静脉属支重建或结扎,比较两种处理方式肝淤血发生率有无差异,分析肝淤血的原因.结果 16例(33.3%)显示Ⅴ/Ⅷ段肝实质密度异常.门静脉期淤血区域肝中静脉属支未见显影12例(75.0%),显影4例(25.0%).原肝中静脉Ⅴ/Ⅷ段属支重建和结扎两种手术方式肝淤血发生率差异无统计学意义(P＞0.05).16例淤血区域肝体积为(44.75±1.6)～(126.76±1.8)cm3中位体积(84.62±1.7)cm3,移植肝总体积为(1064.81±6.9)～(1547.37±8.3)cm3中位体积(1183.14±7.5)cm3,两者之比为(5.2±2.3)%(3.1%～12.4%),1个月后复查,肝静脉属支均显影,13例淤血区基本消失,3例淤血区范围缩小.结论多层螺旋CT双期增强扫描有助于LDLT术后受体肝淤血的诊断,测量肝淤血的范围可评价淤血的程度,门静脉期淤血区肝中静脉属支显影情况与患者预后相关.     

Budd-Chiari综合征高场强MRI与螺旋CT成像的对照分析

目的 比较高场强MRI与螺旋CT在诊断Budd-Chiari综合征中的优劣.方法 Budd-Chiari综合征(BCS)患者65例,其中行多层螺旋CT增强检查者30例(静脉期扫描、延迟期扫描),高场强MRI增强检查者35例(静脉期扫描、延迟期扫描),所有病例均经DSA证实.比较CT和MRI显示肝静脉、下腔静脉、肝内外侧枝血管的情况,并计算CT及MRI增强扫描下腔静脉及肝静脉相对组织对比度.结果 65例患者中CT及MRI增强有45例(69%) 显示下腔静脉入右心房处阻塞,11例(17%)下腔静脉内有血栓影,24例(37%)见有肝内侧枝血管呈"逗号"样或迂曲、走行无规律的血管影,13例(20%)显示有副肝静脉,47例(72%)见有肝外侧枝血管.CT增强扫描静脉期显示下腔静脉及肝静脉相对组织对比度平均值分别为1.16±0.10及1.20±0.13.MRI增强扫描静脉期下腔静脉及肝静脉相对组织对比度平均值分别为1.59±0.19、1.51±0.13,二者相对组织对比度比较有统计学意义(P＜0.05).结论 MRI增强扫描与CT相比更利于BCS病变的显示及诊断.     

肺结节的不均匀灌注

目的 利用16及64层螺旋CT评价孤立性肺结节容积灌注是否均匀.方法 85例孤立性肺结节(直径≤4.0 cm,57例恶性结节,15例活动性炎症,13例良性结节)患者,在增强前、后采用16层(30例)及64层(55例)螺旋CT进行同层动态扫描.注入对比剂后11-41 s,每秒扫描1次;90 s扫描1次.16层螺旋CT扫描层厚:病灶直径3.0～4.0 cm时8.0 mm;2.0～3.0 cm时6.0 mm;1.5～2.0 cm时4.0 mm;1.0～1.5 cm时3.0 mm;<1.0 cm时2.0 mm(其中病灶直径3.0 cm时,层厚8.0 mm;2.0 cm时,6.0mm;1.5 cm时,4.0 mm).64层螺旋CT扫描层厚:病灶直径3.0～4.0 cm时5.0mm;<3.0 cm时2.5 mm.记录孤立肺结节增强前后各时相的CT值.分别计算肺结节3个中央有效层面强化值、灌注值、结节一主动脉强化值比、平均通过时间.使用均数间方差检验进行统计学分析.结果 3个中央层面强化CT值分别为(30.95±14.53)、(25.10±13.32)、(32.37±15.85)HU、灌注值分别为(33.01±21.35)、(23.70±12.87)、(29.00±15.47)ml·min-1·100 g-1,结节-主动脉强化值比分别为(13.58±6.41)%、(10.95±5.76)%、(13.64±6.20)%,平均通过时间分别为(11.61±5.74)、(11.97±3.55)、(13.44±3.74)s,差异均有统计学意义(F值分别为5.913、6.464、5.333、3.837,P值分别为0.003、0.002、0.005、0.023).平扫的CT值差异无统计学意义(F=0.032,P=0.968).结论 孤立肺结节容积灌注是不均匀的,推荐采用CT容积灌注成像的方式对孤立肺结节血流模式进行研究.     

64层螺旋CT静脉成像在肝硬化门脉高压症早期诊断中的价值

目的 探讨64层螺旋CT在肝硬化门脉高压的早期诊断.方法 研究经病理和/或临床诊断的42例肝硬化早期、中晚期病人64层螺旋CT门静脉及肝静脉血管成像表现,测量42例患者及15例健康者门静脉和肝右静脉管径并分析64层螺旋CT门脉血管成像法在肝硬化门脉高压症的早期诊断价值.结果 所有病人的观察血管在显示较佳的基础上,测得门静脉宽度(PV)在正常对照组(＜12 mm)与其他2组比较有显著性差异,肝硬化代偿组与失代偿组之间差异无明显统计学意义;肝右静脉宽度(RHV)在代偿期内径明显增宽,＞10 mm,而失代偿期肝静脉明显变窄,血管强化密度减低;PV/RHV比值在失代偿期约1.77±0.06,正常对照组及肝硬化代偿组PV/RHV均＜1.5.利用后处理软件最大密度投影(MIP)观察门静脉及肝右静脉血管,代偿组可显示3级以上的门静脉及肝右静脉,失代偿组肝右静脉显示欠佳,最多显示1级,门静脉属支走行扭曲且最多显示3级.结论 64层螺旋CT肝、门静脉血管成像对临床肝硬化门脉高压的早期诊断有重要临床意义.     

孤立肺结节多层螺旋CT容积灌注成像的临床价值

目的 探讨多层螺旋CT容积灌注成像在孤立肺结节诊断中的价值.资料与方法 85例孤立肺结节(直径≤4cm,57例恶性,15活动性炎性,13例良性)患者,在增强(从肘静脉注入非离子型对比剂)前、后采用ToshibaAquilionMarconi16层螺旋CT(采用4×i模式,i代表扫描层厚)及GELightspeed64层螺旋CT(采用8×i或16×i模式,i代表扫描层厚)进行同层动态扫描.11～41s,每1s扫描1次;90s扫描1次.16层螺旋CT:病灶直径3～4cm时,扫描层厚8mm;2～3cm时,扫描层厚6mm;1.5～2cm时,扫描层厚4mm;1～1.5cm时,扫描层厚3mm;＜1cm时,扫描层厚2mm.64层螺旋CT:病灶直径3～4cm时,扫描层厚5mm;＜3cm时,扫描层厚2.5mm.记录孤立肺结节增强前后各时相的CT值.分别计算肺结节有效层面的强化值、灌注值、结节-主动脉强化值比、平均通过时间,有效层面参数的平均值作为肺结节的容积灌注成像定量参数.结果 恶性(36.52±11.07)HU与炎性(37.69±7.10)HU结节强化值明显高于良性(7.02±5.85)HU结节(P＜0.001;P＜0.001).恶性与炎性结节强化值无显著差异(P=0.686＞0.05).炎性结节与大动脉增强峰值比(17.49±3.78)%明显高于良性(2.78±2.23)%与恶性(14.73±4.28)%结节(P＜0.001;P=0.019＜0.05).恶性结节与大动脉增强峰值比明显高于良性结节(P＜0.001).炎性(47.83±31.29)mlmin-1100g-1结节灌注值明显高于良性(3.03±3.01)mlmin-1100g-1与恶性(31.15±9.66)mlmin-1100g-1结节(P＜0.001;P＜0.001).恶性结节灌注值明显高于良性结节(P＜0.001).炎性(33.00±8.87)HU与恶性(40.45±7.03)HU结节平扫的CT值明显低于良性(50.51±10.87)HU结节(P＜0.001;P＜0.001).炎性低于恶性结节平扫的CT值(P=0.002＜0.01).结论 多层螺旋CT容积灌注成像有助于结节鉴别诊断.     

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.     

Multi-detector row CT of relevant vascular anatomy of the surgical plane in split-liver transplantation

PURPOSE: To evaluate relevant arterial and venous anatomy of the hepatectomy plane lateral to segment IV by using multi-detector row computed tomography (CT) with respect to adult living related transplantation of the right lobe of the liver. MATERIALS AND METHODS: In potential liver donors, 100 consecutive hepatic CT angiograms were obtained after intravenous bolus administration of 150-180 mL of nonionic contrast material. Arterial phase images (1.25-mm collimation, 7.5 mm/ 0.8-second table speed) were acquired after test dose injection. Portal phase images were acquired at 60 seconds (2.5-mm collimation, 15 mm/0.8-second table speed). Postprocessing depicted arterial, portal, and hepatic vein anatomy traversing the anticipated surgical hepatectomy plane to the right of the middle hepatic vein (MHV) and separating the right and left lobes of the liver. Two radiologists interpreted the images, and data were agreed on by consensus. Data collected included intrahepatic anatomy and origin of the artery and vein supplying segment IV; the venous drainage from segments V and VIII; and the presence, size, and distance from the right hepatic vein (RHV) confluence of accessory hepatic veins in the surgical plane. RESULTS: Thirty-one donors had conventional hepatic vascular anatomy. Vessels that traversed the hepatectomy plane included the artery supplying segment IV in seven (7%) patients, dominant portal vein supply to segment IV from the right portal vein in two (2%) patients or from both right and left portal vein branches in three (3%) patients, segment VIII draining into the MHV in 67 (67%) patients or both the MHV and RHV in 18 (18%) patients (the major draining vein was >7 mm in diameter in 23%), segment V draining into the MHV in 10 (10%) patients, or both the MHV and RHV in 19 (19%) patients (the major draining vein from segment V was 7-10 mm in diameter in 70 patients, and larger than 10 mm in five). Forty-four accessory hepatic veins were identified in 40 patients; seven drained segment V, while the majority drained segments VI and VII. The mean diameter was 5.3 mm and 45% were larger than 6 mm. The average distance to the RHV-inferior vena cava confluence was 28.7 mm. Of 70 patients with drainage from segment V into RHV, 22 (31%) had an accessory RHV. However, atypical drainage into the MHV was noted in seven (70%) of 10 patients and into the MHV and RHV in 11 (58%) of 19 patients. CONCLUSION: In the majority of potential donors, CT angiography depicted a wide range of vascular anatomic variations that traverse the hepatectomy plane.     

MSCT选择性VR及其肝脏门脉系统成像

目的:评估改进后MSCT的VR技术,即选择性VR(selected volume rendering,SVR),显示活体肝脏门脉系统细小分支的效果。材料和方法:对32例腹部检查者行MSCT三期增强扫描,并选门脉流入期数据做肝脏门脉SVR成像。结果:SVR技术不同于VR切割加调阈值技术。在不增加造影剂总量及注射速度的前提下,选择性VR对肝脏门脉Ⅰ～Ⅳ、Ⅴ～Ⅵ分支显示率分别达100%,93.8%(30/32),Ⅰ～Ⅳ级、Ⅴ～Ⅵ分支显示状况较好(评价2分以上)者达分别达93.8%(30/32)和84.4%(27/32)。结论:SVR是肝脏门脉系统成像的理想方法,可较好地立体显示肝的门脉Ⅰ～Ⅵ分支。     

Ultrasonographic anatomy of veins draining the left lobe of the liver. Feasibility of live related transplantation.

The anatomic variations of the left hepatic vein (LHV) in 182 patients with normal liver functions were analyzed using ultrasonography in order to clarify the feasibility of live related hepatic transplantation (LRHT). LHV was demonstrated in 151 patients (83%). Based on the location of the confluence of the middle hepatic vein (MHV) and LHV and the ramifications of the left medial vein (LMV) and the left superior vein (LSV), the livers were classified into 3 types: a) intrahepatic confluence (42/151 livers, 27.8%); b) extrahepatic confluence (69/151 livers, 45.7%); c) separate insertion (40/151 livers, 26.5%); and 23 subtypes. The length of the common trunk and the intrahepatic common trunk of MHV and LHV and the distance from LMV or LSV to the confluence of MHV and LHV were measured. Overall, the control of LHV in situ for LRHT appeared easy in 34/151 patients (22.5%), while in 44/151 patients (29.1%), the length of free LHV and the common trunk was less than optimal for procurement of a left hepatic lobe graft with complete venous outflow and sufficient extraparenchymal length of LHV.     

Budd-Chiari综合征:肝静脉病变的多排螺旋CT诊断

目的探讨多排螺旋CT(MSCT)对Budd-Chiari综合征(BCS)肝静脉阻塞病变的诊断价值。方法对比分析26例BCS的肝静脉血管造影和术前1周内的MSCT平扫与增强扫描表现。结果26例MSCT横断面图像和重建图像显示肝静脉共计70条,其中56条肝静脉闭塞,包括13条肝右静脉闭塞,21条肝中静脉闭塞,22条肝左静脉闭塞;另显示21条副肝静脉代偿性增粗;其中1例肝右静脉伴有血栓形成。与下腔静脉或经皮肝穿刺肝静脉造影相比,肝静脉的符合率为92.11%。结论MSCT能准确显示BCS肝静脉的血流动力学变化、阻塞部位,性质以及肝内交通支情况,诊断价值高,能可靠的指导制订治疗方案。     

多层螺旋CT对肝移植受体手术前后评估

目的探讨多层螺旋CT血管造影（MSCTA）对原位肝移植受体手术前后的评估. 资料与方法对14例临床拟行肝移植受体进行MSCT多期增强扫描,并行2D、3D血管重建,观察肝脏、血管情况.5例行原位肝移植手术患者的MSCTA图像与手术对照分析. 结果 14例患者的肝脏病变及肝动脉和门静脉系血管结构清晰显示,其中肝硬化6例,肝硬化合并肝癌5例,Budd-Chiari综合征1例,Budd-Chiari综合征合并肝硬化1例,Budd-Chiari综合征合并小肝癌1例. 肝动脉解剖走行常见型11例,变异3例,腹腔干狭窄2例,肝动脉狭窄1例,脾动脉瘤1例.显示门静脉系血栓5例,门脉高压侧支循环形成6例;胆管结石3例.5例肝移植受体术前门脉癌栓1例,门脉高压侧支循环形成3例,术后未发现并发症. 结论 MSCTA对肝移植受体术前术后提供更多准确的信息,具有很好的应用前景.     

Pre-operative hepatic vascular mapping of living donor for liver transplantation using 64-MDCT

Objective

The purpose of the present study was to assess the performance of 64-row MDCT angiography in the mapping of hepatic vascular anatomy in potential living liver donors with special attention paid to the anatomical variants, which influence the donor selection and surgical planning.

Material and Methods

Evaluation of 43 potential living donors was performed using 64-row MDCT scanner to obtain hepatic arterial and venous phases. Eleven subjects were excluded as they did not perform the transplantation surgery. The hepatic arterial (HA) anatomy was evaluated and classified according to Michel classification with special attention given to those considered relative or absolute contraindications for donation and those may alternating the surgical procedure. The origin and course of the artery to segment IV were determined. Portal venous (PV) anatomy was assessed and classified according to Cheng classification. Hepatic venous anatomy was evaluated with special attention paid to middle hepatic vein (MHV) anatomy, significant accessory branches crossing dissection line or that may require additional anastomosis.

Results

64-Row MDCT was done for 43 potential living donors. Eleven subjects were excluded as they did not perform the transplantation surgery. Thirty-two living donors for liver transplantation were enrolled in this study. Standard hepatic arterial anatomy was determined in 19 subjects (59.4%) while 13 candidates (40.6%) showed hepatic arterial variations. The replaced RHA arises from the SMA was the commonest (n = 5, 15.6%). The dominant artery to segment IV was a branch from the left hepatic artery (LHA) in 24 cases (75%) and from right hepatic artery in 8 cases (25%). Classic portal venous anatomy was found in 26 candidates (81.2%) while its variants were detected in 6 cases. Standard hepatic venous anatomy was found in 21 candidates (65.6%). A total of 11 subjects (34.4%) showed hepatic venous variants. 8 cases (25%) had single significant accessory hepatic vein while 3 subjects (9.4%) had two or more significant accessory hepatic veins. MHV confluence was late in 4 candidates (12.5%). An accessory inferior right hepatic vein was the commonest accessory hepatic vein that was detected in 7 cases (21.9%).Compared to surgical findings, MDCT correctly identified hepatic arterial and portal venous anatomy in all cases with no false positive or false negative cases. Sensitivity, specificity, PPV, NPV and accuracy of MDCT in identification of hepatic arterial and portal anatomy were all 100% while for hepatic venous anatomy, the corresponding values were 83.3%, 100%, 100%, 90.1% and 93.8%, respectively.

Conclusion

64-Row MDCT is an essential part of pre-operative evaluation of potential liver donors. It is a non-invasive comprehensive evaluation tool that can show the hepatic vascular anatomic details with precise relationship to liver parenchyma.     

多层螺旋CT在肝癌肝动脉化疗栓塞中的价值

目的 评价多层螺旋CT（MSCT）在肝癌（HCC）肝动脉化疗栓塞中的价值。方法 对54例肝癌患者分别行MSCT和DSA检查，比较病灶、合并症的显示情况和肿瘤的供血来源，MSCT观察腹腔动脉的解剖和走行应用三维容积再现（VRT）、最大信号强度投影（MIP）或多平面重组（MPR）技术。其中，12例进行了CT血管造影（CTA）检查。结果 54例肝癌患者MSCT发现病灶225个，门静脉瘤栓10例，动静脉瘘14例；DSA发现病灶216个，门静脉瘤栓形成8例，动静脉瘘18例；MSCT和DSA二者比较，MSCT对肿瘤的数目的显示率略高于DSA，但差异无统计学意义（P〉0．05）；MSCT能够显示腹腔动脉及其主要分支的三维结构，优于后前位DSA，观察与腹主动脉夹角较DSA更方便；MSCT发现肝动脉起源变异5例，与DSA完全符合。结论 MSCT对于肝癌肝动脉化疗栓塞有重要指导意义，选择最佳延迟扫描时间是显示病灶和血管的关键。     

脑静脉血管瘤16层螺旋CT及CTV诊断

目的:探讨16层螺旋CT和CTV对脑静脉血管瘤的诊断价值.方法:回顾性分析10例脑静脉血管瘤的16层螺旋CT平扫、CTA及CTV表现.结果:4例脑静脉血管瘤CT平扫表现为条状或点状略高密度影,1例伴发出血仅发现呈高密度的小脑血肿影,另5例CT平扫未见明显异常.5例动脉期CT血管扫描(CTA)未发现明显异常,5例病灶仅部分显示,且密度淡.10例CTV均清晰显示放射状排列的髓静脉及中央静脉,整个形态似海蛇头.结论:CT平扫对脑静脉血管瘤的诊断价值有限,静脉期的16层螺旋CT血管扫描(CTV)能清晰显示脑静脉血管瘤的影像特征,是诊断本病的可靠方法.     

多层螺旋CT在肝细胞肝癌肝动脉化疗栓塞中的表现及介入治疗中的意义

目的探讨多层螺旋CT(MSCT)在肝细胞癌(HCC)肝动脉化疗栓塞中的表现特点及其介入治疗中的指导意义。方法45例肝癌患者行肝动脉化疗栓塞前同期分别行MSCT和DSA2种检查。MSCT应用三维容积再现(VRT)、最大密度投影(MIP)或多平面重组(MPR)技术观察腹腔动脉的解剖及走行分支,比较CT与DSA对病灶、合并症的显示情况及肿瘤的血供情况等。结果45例患者,MSCT发现病灶167个、门静脉癌栓11例、动脉静瘘12例;DSA发现病灶172个、门静脉癌栓8例,动静脉瘘15例。MSCT与DSA比较,DSA对肿瘤的数目显示率略高于MSCT,但差异无统计学意义。MSCT能够显示腹腔动脉及其主要分支的三维结构,优于DSA,观察与腹主动脉夹角较DSA更方便;MSCT发现肝动脉起源变异4例,与DSA完全符合。结论MSCT对肝细胞肝癌肝动脉化疗栓塞有重要指导意义。