Renovascular impedance correlates with portal pressure in patients with liver cirrhosis

PURPOSE: To prospectively evaluate, in patients with liver cirrhosis, the correlation between the renovascular impedance measured by using color flow and pulsed wave Doppler ultrasonography (US) and the portal pressure measured by using the hepatic venous pressure gradient (HVPG). MATERIALS AND METHODS: The study was approved by the senior staff committee (comparable to institutional review board) of the university hospital, and written informed consent was obtained from all patients. Thirty-one patients with cirrhosis (22 men, nine women; mean age, 57.6 years +/- 8.8 [standard deviation]) and esophageal varices were consecutively enrolled in the study. Having fasted, the patients underwent color flow and pulsed wave Doppler US of the right interlobar renal artery (RRA) and the left interlobar renal artery (LRA). The resistance index (RI) and pulsatility index (PI) were determined. On the same day, with fluoroscopic guidance, a 5-F balloon-tipped catheter was advanced, via the right basilic vein, into the right hepatic vein; HVPG was calculated as the difference between the wedged and free hepatic pressures. All measurements were performed in triplicate, and permanent tracings were recorded. Correlations were made by using the Pearson test. The positive predictive value of renovascular impedance for detection of severe portal hypertension was determined. RESULTS: Mean RI and PI values were 0.67 +/- 0.07 and 1.21 +/- 0.25, respectively, for the RRA, and 0.68 +/- 0.07 and 1.24 +/- 0.26, respectively, for the LRA. All patients had portal hypertension (mean HVPG, 19.3 mm Hg +/- 4.7; range, 11.5-33.5 mm Hg). Neither portal pressure nor renal impedance correlated with Child-Pugh score for cirrhosis. Renal artery impedance indexes correlated with the HVPG (for RRA RI: R = 0.424, P = .03; for RRA PI: R = 0.402, P = .04; for LRA RI: R = 0.352, P = .05; for LRA PI: R = 0.393, P = .02). A higher-than-normal renal impedance had a high positive predictive value (RRA RI and PI, 100%; LRA RI, 92%; LRA PI, 84%) for the detection of severe portal hypertension. CONCLUSION: Renovascular impedance had a direct correlation with HVPG.     

Effect of verapamil on portal and splanchnic hemodynamics in patients with advanced posthepatitic cirrhosis using duplex Doppler ultrasound

Purpose: To assess the effect of verapamil (80 mg) oral administration on portal and splanchnic hemodynamics in patients with advanced posthepatitic cirrhosis using duplex Doppler ultrasound (US). Methods: Fourteen patients with post-hepatitic liver cirrhosis were included in the study. Duplex Doppler sonographic examinations were performed before, and 2–3 h after, 80 mg verapamil oral administration. Portal and splanchnic hemodynamics including vessel diameters (mm), mean flow velocities (cm/s), blood flows (ml/min), Doppler indices such as pulsatility and resistive indices (PI and RI), were investigated before and after verapamil administration. Results: After verapamil administration; diameter of portal vein, splenic vein, and superior mesenteric artery (SMA) showed increase of 8%, 10%, and 7% (P < 0.05 to < 0.001), respectively. Increases of 20%, 38%, and 47% were found in blood flows (P < 0.05 to < 0.0001) with respect to the above vessels. Decreases of 17%, 10%, 11%, and 7% were found in SMA PI, SMA RI, splenic artery (SA) PI, and SA RI, respectively (P < 0.05 to < 0.0001). Conclusions: Verapamil appears to have splanchnic, portal, splenic, portocollateral and probably intrahepatic vasodilator effects in patients with advanced posthepatitic liver cirrhosis. Verapamil should be further investigated in the treatment of patients with advanced liver cirrhosis with prospective studies measuring portal and wedged hepatic pressure.     

Comparing contrast-enhanced breath-hold MR angiography and conventional angiography in the evaluation of mesenteric circulation

OBJECTIVE: Our aim was to compare the results of gadolinium-enhanced breath-hold MR angiography with those of conventional angiography for the study of mesenteric circulation. SUBJECTS AND METHODS: MR angiography and digital subtraction angiography were prospectively performed in 33 patients referred for hepatic, pancreatic, or mesenteric disease. MR angiography was performed with four three-dimensional acquisitions at 0, 30, 60, and 90 sec after injection of 0.1 mmol/kg of gadolinium. Selective conventional angiography was used as the standard of reference. RESULTS: A pure arterial angiogram (one on which veins could not be visualized) was obtained in 27 patients during the second or third acquisition. By subtracting the arterial phase from an arteriovenous phase (third or fourth acquisition) we obtained a pure venous angiogram (one on which arteries could not be visualized) in 28 patients. Agreement was good or excellent for the hepatic artery (kappa = 0.78), the superior mesenteric artery (kappa = 0.65), the splenic artery (kappa = 0.70), the portal vein (kappa = 1.0), the superior mesenteric vein (kappa = 0.88), and the splenic vein (kappa = 0.75). Agreement was poor, and vessels were better shown by conventional angiography, for the intrahepatic arteries (kappa = 0.006) and the branches of the superior mesenteric artery (kappa = 0.14). MR angiography and conventional angiography revealed 29 and 27 portosystemic collaterals, respectively. CONCLUSION: Dynamic breath-hold contrast-enhanced MR angiography compared favorably with conventional angiography in preoperative assessment of the proximal mesenteric arteries and in the evaluation of portal hypertension; however, conventional angiography is still necessary to evaluate distal arteries.     

Doppler and gray-scale ultrasound evaluation of morphological and hemodynamic changes in liver vascualture in alcoholic patients

OBJECTIVE: The aim of this study is to search sonographically for morphological and hemodynamic changes in hepatic and splanchnic vasculature of alcoholic patients having no signs of hepatic damage, and compare these with normal healthy subjects. METHODS: Thirty alcohol-dependent patients and 30 control subjects with no alcohol problem or hepatic impairment were included in the study. All patients were evaluated by gray-scale and spectral Doppler ultrasound. The diameter of the portal vein, portal venous velocity, peak systolic and end diastolic velocities of hepatic and superior mesenteric arteries were assessed. RI, PI and systolic/diastolic velocity ratios were also calculated. RESULTS: Portal vein cross-sectional area was greater in alcoholic patients compared to control group (P = 0.0012). Portal vein velocity, hepatic artery peak systolic and end diastolic velocity, superior mesenteric artery peak systolic and end diastolic velocity were significantly greater in alcoholic patients than in control group (P < or = 0.001). No statistically significant difference was detected between other parameters evaluated. CONCLUSION: In alcohol-dependent patients, some hemodynamic and morphologic changes occur in hepatic and splanchnic circulation, even before the signs of hepatic damage develop. These changes can be detected by means of Doppler and gray-scale sonogrsphy.     

三维动态增强磁共振血管成像在肝移植术前的应用

 目的探讨三维动态增强磁共振血管成像(3D DCE MRA)三期扫描技术,评价其在肝移植术前的诊断价值.方法对拟进行肝移植的183例患者进行术前3D DCE MRA成像扫描,采用Siemens Symphony 1.5T超导MRI扫描机,圆形极化相控阵体线圈,3D DCE MRA三期(动脉期、门脉期和静脉期)扫描技术,即对所得图像进行综合评价.结果全部病例均获得了满意的血管成像图像,肝动脉可显示2～3级分支,门静脉可显示2～5级分支,肝静脉可显示1～2级分支.183例肝移植患者,5例显示肝动脉变异,其中2例起自肠系膜上动脉,2例直接起自腹腔干,1例起自胃左动脉.单纯肝硬化门脉高压103例,其中,冠状静脉和食道胃底静脉曲张23例、脐周静脉曲张5例、肠系膜静脉曲张2例、脾门周围静脉曲张30例,门静脉玻璃样变性1例;原发性肝癌79例,5例肝动脉包埋、僵直、推移,2例肝内动-静脉瘘,门静脉右支癌栓23例,门静脉左支癌栓7例,门静脉主干癌栓3例,同时发生门静脉左右支癌栓的2例,MRA表现为门静脉呈半月形或杯口形缺损或不显影.7例肝静脉出现栓塞,5例下腔静脉受压推移,1例下腔静脉瘤栓.结论 3D DCE MRA三期扫描能很好的显示肝动脉、门静脉、肝静脉及下腔静脉系统病变,肝移植术前应用3D DCE MRA,基本达到临床要求,是术前血管评估的有效方法.     

Arterioportal fistulas in patients with liver cirrhosis: usefulness of color Doppler US for screening

PURPOSE: To evaluate the usefulness of routine ultrasonographic (US) evaluation of the hepatic arterial resistive and pulsatility indexes and of the direction of portal venous blood flow for the diagnosis of intrahepatic arterioportal fistulas (APFs) in patients with liver cirrhosis. MATERIALS AND METHODS: In all patients with cirrhosis examined at one center over 4 years, the resistive (RI) and the pulsatility (PI) indexes in the right and left branches of the hepatic artery were evaluated with Doppler US. An APF was suspected when an RI decrease of at least 20% and a PI decrease of at least 30% were present in one hepatic lobe relative to values in the other lobe and portal blood flow in the lobe with the decreased values was reversed. The RI and PI in patients with an APF were compared with those in 75 patients with cirrhosis and without APFs at angiography. RESULTS: Seven patients with an APF were identified. APFs suspected at Doppler US were always confirmed with angiography. The percent differences +/- SD in the RI and the PI between the two intrahepatic branches of the hepatic artery in patients with versus in patients without an APF were as follows: RI, 35% +/- 6 (range, 27%-42%) versus 5% +/- 4 (range, 0%-15%) (P: <.001); PI, 50% +/- 5 (range, 41%-58%) versus 11% +/- 7 (range, 0%-26%) (P: <.001). CONCLUSION: The intrahepatic arterial resistive and pulsatility indexes and the direction of portal blood flow should be evaluated in routine screening for APFs in patients with liver cirrhosis.     

CT features of abdominal manifestations of primary antiphospholipid syndrome.

PURPOSE: The purpose of this work was to evaluate the CT features of the abdominal manifestations of primary antiphospholipid syndrome (PAPS). METHOD: Of the 32 patients who were confirmed to have PAPS among 751 patients with elevated antiphospholipid antibodies during a 2 year period, we retrospectively reviewed the 14 patients who underwent abdominal CT. The clinical indications for abdominal CT included abdominal pain, abdominal distension, or lower leg swelling. CT findings were analyzed with regard to the abdominal vascular system and abdominal organ involvement patterns as well as ancillary findings. RESULTS: Of the 14 patients with PAPS, 10 had involvement of the venous system (72%), 2 of the arterial system (14%), and 2 of both systems (14%). Of the 12 patients who had venous system involvement, 4 had thrombosis in the inferior vena cava (IVC), 2 in both the IVC and the hepatic vein, 1 in the IVC and splenic and portal veins, 1 in the IVC and hepatic and adrenal veins, 1 in the hepatic, portal, and renal veins, and 3 in the portal and superior mesenteric veins. Budd-Chiari syndrome developed in five of the nine patients who had thrombosis of the IVC or hepatic vein. Arterial thrombosis was noted in four patients, hepatic artery in two, aorta in one, renal artery in one, pancreatic arcade in one, and splenic artery in one, with infarct of multiple organs including the liver, jejunum, colon, kidney, and adrenal gland. Seven of the 14 patients (50%) manifested thrombosis or infarct of multiple extra-abdominal organs. CONCLUSION: PAPS should be included in the differential diagnosis when CT demonstrates infarcts in multiple organs or patients have recurrent episodes of venous or arterial thrombosis.     

CT arterial portography: causes of technical failure and variable liver enhancement.

OBJECTIVE. We studied the causes of technical failure and enhancement variability encountered during CT arterial portography. MATERIALS AND METHODS. CT arterial portograms and digital arteriograms were obtained via the superior mesenteric artery before partial liver resection in 43 patients with malignant tumors. These studies were reviewed for causes of technical failure and variable enhancement. RESULTS. Eleven (26%) of 43 procedures were technical failures. Causes of failure included aortic injection after catheter dislodgement (four), dense hyperenhancement associated with laminar flow in the portal vein produced by rapid venous return from a selective injection into a proximal branch vessel of the superior mesenteric artery (two), premature scanning beginning at the iliac crest (two), reflux into a replaced right hepatic artery (one), hepatic arterial enhancement via the pancreaticoduodenal arcade (one), and portal hypertension (one). Of the 32 remaining studies, 28 showed areas of parenchymal hypoenhancement or hyperenhancement. Causes of variable enhancement included impaired portal vein perfusion from mass effect of the tumor, laminar flow in the portal vein, and focal fatty infiltration. CONCLUSION. Technical failures and enhancement variability are common in CT arterial portography. Factors leading to technical failure include catheter choice and position, portal hypertension, and operator error.     

Dynamic CT scanning of the normal canine liver: interpretation of time density curves resulting from an intravenous bolus injection of contrast material

Seven adult male mongrel dogs were monitored by electromagnetic flow probes and string occluders around the hepatic artery and portal vein. Then, time density curves of the liver, aorta and portal vein were recorded using dynamic CT scanning following the bolus injection of contrast material into a peripheral vein (n = 7) and a mesenteric vein branch (n = 5). Information on total hepatic blood flow could not be obtained from the mesenteric vein injection. The hepatic time density curve could, however, be broken into its two components, hepatic arterial and portal venous flow contribution, by selective ligation of the hepatic artery or portal vein. It could be demonstrated that the arterial component of liver enhancement reached its peak at the end of the aortic wash-out of contrast material. Thus, the hepatic time-density curve could be broken in its two components by superimposing the aortic time density curve onto the hepatic curve. An attempt was made to estimate relative portal venous blood flow by using the slopes or the peaks of both components of the hepatic curve. Using the slopes of the hepatic curve resulted in a consistent underestimation of portal venous blood flow, whereas the peaks gave an estimate of portal venous flow with an accuracy within +/- 8%.     

血管性介入在肝脏移植中的应用

目的探讨血管性介入技术在肝脏移植前后诊治中的应用。方法对2003年1月~2005年2月对拟行肝脏移植的30例患者术前行肝动脉、肠系膜上动脉选择造影及经肠系膜上动脉间接门静脉造影;并对6例肝脏移植术后怀疑血管并发症的患者行造影及介入下溶栓及内支架治疗。结果30例患者术前造影中提示肝癌11例;4例患者动脉造影显示动脉血管变异。29例患者间接门脉造影成功,其中2例肝癌患者发现门脉癌栓,26例存在不同程度的静脉曲张。对6例怀疑胆道和血管并发症的患者作血管造影及相关介入治疗。其中2例成功行狭窄动脉吻合口金属内支架治疗,1例行动脉溶栓治疗,造影显示肝动脉血流恢复通畅;其他3例介入治疗效果不满意。结论血管造影能够提供准确的动脉和门静脉解剖和变异信息;血管介入技术有助于对肝移植术后早期血管并发症诊断和处理。     

腹腔内脏血管动脉瘤的介入治疗方法探讨

目的 探索腹腔内脏动脉动脉瘤的介入治疗方法.方法 进行介入治疗的9例内脏动脉动脉瘤患者,总共11枚动脉瘤,其中1例为肠系膜上动脉主干部动脉瘤合并右侧结肠动脉动脉瘤,1例为2枚脾动脉瘤,另外还有5例各1枚脾动脉瘤,1例胃右动脉瘤,1例肝动脉假性动脉瘤.使用弹簧圈分别成功对6例脾动脉瘤患者的7枚脾动脉瘤及1枚右侧结肠动脉瘤,1枚胃右动脉瘤,1枚肝动脉假性瘤进行了栓塞,1例肠系膜上动脉动脉瘤的使用覆膜支架植入隔离动脉瘤.结果 所有患者均治疗成功,未出现相关并发症.肠系膜上动脉动脉瘤植入支架后瘤腔被完全封闭,肠系膜上动脉主干通畅.结论 介入栓塞技术可以成功栓塞大部分内脏动脉动脉瘤,对于部分栓塞困难者可以使用覆膜支架隔绝动脉瘤.     

MSCT肝脏血管成像对肝脏移植受体的临床应用价值

目的:探讨64层螺旋CT腹腔干、门静脉及下腔静脉成像技术对肝脏移植受体血管结构评价的临床价值方法:对30例拟行肝脏移植手术的患者行增强后动脉期、门静脉期及下腔静脉期扫描。对每一例病例均行腹腔干、门静脉及下腔静脉三维重建及二维重组并与轴位图像结合分析患者血管情况。根据受体肝脏血管情况筛选出其中24例适宜手术的患者,初步拟定手术方案行肝移植手术,并在手术后与肝移植手术医师的术中探查结果相比较,探讨术前CT血管重建的准确性。结果:腹腔干成像可发现3例腹腔干狭窄,1例腹腔干动脉瘤,2例脾动脉瘤,2例肝脏主要供血动脉直径<3mm,10例肝动脉走行变异。门静脉成像发现2例肝门静脉海绵样变;12例肝门静脉栓塞,其中5例肝内门静脉栓塞,5例肝外门静脉主干栓塞(其中3例合并肠系膜上静脉栓塞);2例肝内门静脉及肝外门静脉主干均有栓塞。2例肝门静脉海绵样变及3例肝外门静脉主干及肠系膜上静脉广泛栓塞的患者因不适宜手术而未能行肝移植手术。下腔静脉成像发现2例下腔静脉癌栓,其中1例栓子接近右心房入口处,不适宜手术未能行肝移植手术;2例下腔静脉肝后段狭窄。30例中24例均成功行肝移植手术,术中所见与CT血管成像所见完全相符合。结论:64层螺旋CT血管成像适合用来全面准确评价拟行肝脏移植的受体的血管状态,对筛选适宜手术的病例并协助手术方案的制定有重要价值。     

胰腺癌血管侵犯的不同CT诊断标准的研究

目的:研究胰腺癌血管侵犯的不同CT诊断标准的优劣。材料和方法:回顾性收集我院经多层螺旋CT三期动态增强扫描并经手术病理证实为胰腺导管细胞癌的36例患者。CT轴位图像结合CTA(以MIP和VR方法重建)以及多平面重建(MPR)分别对这些血管以Loyer和Lu血管分级CT标准进行分级,并和手术结果进行对照,分别作出受试者工作特性曲线(ROC),比较曲线下面积的差异。另外,运用Lu的CT诊断标准分别评价胰周动脉和静脉受侵的准确性、灵敏度、特异度、阳性预测值、阴性预测值、Youden指数,研究Lu的CT诊断标准对动静脉分级的差异。结果:Loyer和Lu的CT诊断标准所得的灵敏度、特异度分别为84.5%、86.0%、81.4%、91.8%,两个诊断标准的ROC曲线下面积分别为0.886、0.912,经统计学检验无明显差异。应用Lu的CT诊断标准,胰周动静脉受侵的阳性预测值分别为57.1%和71.0%。结论:分别以Loyer和Lu血管分级CT标准对胰腺癌胰周血管侵犯进行分级,两者的诊断价值相同,Lu的CT诊断标准的最佳诊断分界点应在90°-180°之间,此外,它对胰周动脉的价值要比静脉差。     

Collateral pathways in patients with celiac axis stenosis: angiographic-spiral CT correlation.

Although celiac axis stenosis is a frequently encountered occlusive vascular disease, clinically significant ischemic bowel disease caused by celiac axis stenosis is rarely reported due to rich collateral circulation from the superior mesenteric artery (SMA). The most important and frequently encountered collateral vessels from the SMA in patients with celiac axis stenosis are the pancreaticoduodenal arcades and the dorsal pancreatic artery. Subtypes of collateral pathways via the dorsal pancreatic artery include a longitudinal pathway between the celiac branches and the SMA or its branches and a transverse pathway to either the splenic or gastroduodenal artery. A communicating channel between the right hepatic artery and the SMA can be a route for collateral circulation. Hepatic artery variants cause the development of unique collateral pathways that have different characteristics depending on the type of variant. These collateral pathways include intrahepatic interlobar collateral vessels, right gastric to left gastric arterial anastomoses, left hepatic to left gastric arterial anastomoses, and peribiliary arterial plexuses. Major collateral pathways in patients with celiac axis stenosis can be identified with spiral CT, and knowledge concerning this collateral circulation may be important for certain medical procedures such as interventional procedures for the management of hepatic tumors, pancreaticobiliary surgery, and liver transplantation.     

Insulinomas: localization with selective intraarterial injection of calcium

To facilitate the noninvasive preoperative localization of islet cell tumors less than 15 mm in diameter, the authors examined the use of calcium as an insulin secretagogue in an arterial stimulation venous sampling (ASVS) technique. In four patients with episodic hypoglycemia, calcium gluconate (0.01-0.025 mEq Ca2+/kg) was injected directly into branches of the celiac plexus (gastroduodenal, splenic, and hepatic arteries) and the superior mesenteric artery. In all patients, serum levels of insulin rose abruptly in blood samples taken from the right hepatic vein 30 and 60 seconds after the infusion of calcium into the artery supplying the tumor; injection into an artery not supplying the tumor did not result in a similar rise. Accurate localization of the insulinomas was verified at surgery in three patients. In the fourth patient, who did not undergo surgery, arteriographic results were positive for insulinoma at the predicted site. On the basis of these results, the authors believe noninvasive ASVS may replace invasive portal venous sampling as the most effective method for the localization of occult insulinomas.     

肠系膜上动脉超声成像与脑动脉DSA造影相关性研究

目的 通过对脑动脉狭窄患者进行肠系膜上动脉CDFI超声成像,分析肠系膜上动脉与脑动脉狭窄的关系.方法 采用彩色多普勒超声仪对30例正常老年人和30例脑血管供血不足的老年人的SMA血流情况进行观测,同时行脑动脉DSA造影进行对比分析.观察:①肠系膜上动脉硬化狭窄病变范围与脑动脉硬化狭窄的关系;②脑梗死患者中肠系膜上动脉狭窄者分布的特点.结果 有脑血管供血不足的老年人的SMA的血流量和血管直径比正常老年人相应参数明显减小,收缩峰值流速(PSV)、舒张末期流速(EDV)、搏动指数(P1)和阻力指数(RI)明显增大(P＜0.05);脑动脉损害越严重,肠系膜上动脉血流动力学改变越严重.结论 老年人脑动脉与肠系膜上动脉病变之间有紧密相关性,脑动脉损害越严重,肠系膜上动脉损害越严重,应重视脑血管供血不足的老年人并发肠缺血的存在.     

Infantile hepatic hemangioendotheliomas: significance of portal venous and systemic collateral arterial supply.

This report describes four infants with hepatic hemangioendotheliomas and cardiac failure who had extensive portal venous and systemic collateral arterial supply complicating hepatic arterial embolization. One patient with diffuse hepatic hemangioendothelioma and extensive portal vein supply but minimal systemic collateral arteries showed no improvement after technically successful hepatic artery embolization and died with disseminated intravascular coagulation and sepsis. A second infant with extensive portal vein and collateral supply died without undergoing embolization. Two patients had portal vein-hepatic vein fistulas as well as an extensive systemic arterial supply. Both infants tolerated staged hepatic and collateral artery embolization, although one patient died of congestive heart failure, probably related to pulmonary hemangiomas. The authors conclude that angiographic study of the potential collateral vessels and portal venous circulation should be performed before embolization. Patients with shunting from the portal vein to the hepatic vein and minimal systemic arterial collateral circulation should not undergo hepatic artery embolization.     

Presinusoidal portal hypertension does not affect hepatic artery resistance index

We aimed to determine the mean hepatic artery resistance index (RI) in presinusoidal portal hypertension and to compare the values with those in sinusoidal portal hypertension. The hepatic artery RIs of 11 patients with presinusoidal portal hypertension, 12 patients with sinusoidal portal hypertension and 16 healthy subjects were examined with duplex Doppler ultrasound. Mean hepatic artery RIs of three groups were compared. In patients with presinusoidal portal hypertension, mean RI in the hepatic artery (0.63 ± 0.06) was significantly lower (p < 0.05) than that in the patients with sinusoidal portal hypertension (0.73 ± 0.03). There was no significant difference (p > 0.05) in the mean RIs of the hepatic artery between the patients with presinusoidal portal hypertension (0.63 ± 0.06) and the controls (0.67 ± 0.05). Mean RI value in patients with sinusoidal portal hypertension (0.73 ± 0.03) was significantly higher (p < 0.05) than the mean values in the control group (0.67 ± 0.05). Hepatic arterial resistance does not change in presinusoidal portal hypertension, whereas it increases in sinusoidal portal hypertension. However, there are some overlaps in the RI values which raise difficulties in the differentiation of these two forms of portal hypertension. Received: 1 December 1997; Revision received: 12 May 1998; Accepted: 28 September 1998     

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。     

Value of an early arteriographic acquisition for evaluating the splanchnic vessels as an adjunct to biphasic CT using a multislice scanner

Our objective was to assess the clinical value of an early arterial scan for assessing the hepatic and mesenteric vasculature in patients with suspected primary or metastatic hypervascular liver disease undergoing multislice computed tomography. In 42 patients a very early arteriographic scan was performed before standard arterial and portal venous scans. Technical parameters of the very early acquisition were: 2.5-mm image thickness; table speed 15 mm/s; pitch 6; 120 kVp; 300 mA; 8.9-s scan time; cranio-caudal acquisition direction; 1.25-mm image interval reconstruction;16-s delay after injection of 110 ml of iodinated contrast agent at 5 ml/s; scan volume focused to image hepatic, splenic, and superior mesenteric arteries (SMA). Standard arterial and portal venous phases were performed with 5-mm image thickness, 15-mm/s table speed, pitch 6, 8- to 10-s scan time, 30- and 70-s delay. The three phases were performed during three different breath-holds. Axial, multiplanar reformatted, maximum intensity projection, and volume-rendering images were evaluated. Image quality was scored, and vascular abnormalities were recorded. Digital subtraction angiography (DSA) was performed in 17 patients. In 36 of 42 patients good-quality CT angiograms were obtained. In 9 patients 12 vascular abnormalities were found, all confirmed at DSA: 3 right hepatic arteries originating from the SMA, 2 left hepatic arteries from the gastric artery, 2 stenoses of the SMA, 1 independent origin of the hepatic and splenic arteries, 2 arteriovenous fistulas, and 2 aneurysms of the common hepatic artery and the SMA. This technique could add important information about vascular splanchnic anatomy which would be particularly useful for surgeons and interventional radiologists. Electronic Publication