肾细胞癌MSCT灌注成像研究

目的：测定正常肾脏皮质的各灌注参数,探讨肾细胞癌的多层螺旋CT灌注表现,分析不同病理亚型肾细胞癌的灌注是否有差异。方法：73例肾细胞癌,其中透明细胞癌65例、乳头状癌3例、嫌色细胞癌5例。术前行多层螺旋CT灌注扫描,分别测量肾癌病灶、患侧肾脏及对侧肾脏正常皮质的血容量（BV）、血流量（BF）、平均通过时间（MTT）和表面通透性（PS）,并进行统计学分析。结果：正常肾脏皮质BV、BF、MTT及PS分别为（23．53±5．71）ml／100g、（454．32±110．90）ml／（min·100g）、（3．62±1．38）S、（63．95±18．85）ml／（min·100g）。肾癌病灶BV、BF、MTT及PS分别为（17．17±8．34）ml／100g,（261．96±175．86）ml／（min·100g）、（7．08±3．42）s、（25．07±13．20）ml／（min·100g）。其中透明细胞癌BV、BF、MTT及PS分别为（17．97±8．30）ml／100g,（279．61±177．02）ml／（min·100g）、（6．85±3．39）S、（25．78±12．94）ml／（min·100g）;乳头状癌BV、BF、MTT及PS分别为（4．82±2．93）ml／100g,（52．00±51．77）ml／（min·100g）、（11．74±3．63）s、（11．90±5．12）ml／（min·100g）;嫌色细胞癌BV、BF、MTT及PS分别为（14．22±3．21）ml／100g,（158．49±49．79）ml／（min·100g）、（7．26±1．77）s、（23．69±17．41）ml／（min·100g）,肾细胞癌BV、BF、PS较正常肾脏皮质减低（P〈0．01）,MTT较正常肾皮质增加（P〈0．01）。透明细胞癌BV、BF均较乳头状癌高（P〈0．05）,透明细胞癌MTT较乳头状癌低（P〈0．05）,透明细胞癌BV、BF均较嫌色细胞癌高（P〈0．05）,透明细胞癌BV、BF均较非透明细胞癌高（P〈0．05）,余各病理亚型间各参数无差异。结论：多层螺旋CT灌注扫描可以直观地反映肾细胞癌与正常肾脏组织的灌注差异,且各病理亚型的血流灌注有明显的差异。     

基于原发性肝癌血流再分布的胰腺灌注变化的CT研究

目的：探讨基于原发性肝癌血流再分布状态下的胰腺血流灌注特点。方法：90例患者按纳入标准分为 A、B、C 三组,其中 A 组（正常对照组）49例,B 组（原发性肝癌组）21例,C 组（原发性肝癌合并门脉癌栓组）20例。所有患者均行常规 CT 平扫和增强扫描以及 CT 灌注成像。测量每例患者胰腺实质的灌注参数值,包括血流量（BF）、血容量（BV）、表面通透性（PS）和平均时间（MTT）。对3组间各灌注参数值的差异进行统计学分析（方差分析法或秩和检验）。结果：A、B、C 三组中胰腺的 BF、BV、PS 和 MTT 的测量值：A 组分别为（159．60±68．14）mL／（100g·min）、（49．00±18．89）mL／100g、（221．52±51．55）mL／（100g·min）和（28．16±7．25）s;B 组依次为（106．48±24．63）mL／（100g·min）、（37．63±21．67）mL／100g、（232．07±78．38）mL／（100g·min）和（30．33±6．83）s;C 组依次为（105．14±26．13）mL／（100g·min）、（39．44±18．65）mL／100g、（212．48±43．53）mL／（100g·min）和（25．78±8．12）s。三组中 A 组的 BF 值与 B、C 组之间的差异具有统计学意义（Z 值分别为－4．428和－4．722,P ＜0．05）;三组间 BV、MTT 和 PS 值的差异无统计学意义（P ＞0．05）。结论：原发性肝癌无论有无门静脉癌栓形成,都可能导致肝脏周围血流再分布并进而影响胰腺的血流灌注,使胰腺的血流量降低;MSCT 灌注成像能较敏感地显示胰腺血流灌注的改变。     

双源CT灌注成像在活体肝移植后对移植肝的评价作用

 目的 探讨双源CT灌注成像在活体肝移植后对移植肝的评价作用。方法 招募解放军总医院第三医学中心2013-06至2018-11进行活体肝移植术后1个月经超声及CTA检查肝动脉无狭窄患者25例;术后3个月患者61例,其中肝动脉无狭窄25例,轻度狭窄13例,中度狭窄12例,重度狭窄11例;同时收集同时期因怀疑有肝脏肿瘤行CT灌注扫描,后经临床及影像证实无肿瘤的患者(25例)作为对照组。上述所有研究对象均行双源CT全肝灌注成像检查并测量肝动脉灌注量(hepatic artery perfusion,HAP)、门静脉灌注量(portal vein perfusion, PVP)、肝总灌注量(total liver perfusion, TLP)及肝动脉灌注指数(hepatic perfusion index, HPI)。同时补充检测肝动脉狭窄人群的谷丙转氨酶(alanine transaminase, ALT)。结果 与对照组人群[(0.28±0.13) ml/(min·ml)]相比,肝移植术后1个月无肝动脉狭窄人群HAP[(0.36±0.17) ml/(min·ml)]显著增高(P<0.05),术后3个月中度及重度肝动脉狭窄人群HAP显著降低[(0.12±0.09)ml/(min·ml),(0.06±0.03) ml/(min·ml),P<0.05]。中度及重度肝动脉狭窄人群HPI较对照组显著降低(0.07±0.05、0.03±0.02 vs. 0.23±0.16, P<0.05)。重度肝动脉狭窄人群PVP较对照组显著升高[(1.81±0.36)ml/(min·ml) vs. (1.23±0.62) ml/(min·ml),P<0.05])。在肝动脉狭窄患者中,ALT对数与HAP对数成线性相关。结论 双源CT能对活体肝移植患者术后的移植肝进行血流灌注评价,能够为临床提供更为精准的信息,提高患者后续治疗的准确性。     

成人-成人间活体右半肝移植

目的 报道东京大学16例成人终末期肝病患者进行活体右半肝移植的经验。方法 统计自2000年10月到2001年4月，对16例成人终末期肝病患者进行了活体右半肝移植，供体和受体的平均体重分别为55kg（42－78kg）和57kg (41-81kg）。结果 供体手术的平均失血量为800ml（300－1600ml），供体的平均住院时间为12d（6－38d）。14你供体未输血，1例供体术后发生并发症。移植肝的平均重量为719g(450-1050g），所有移植肝均立即恢复功能，病人精神状态康复，凝血酶原时间恢复正常。2 受体需要再次手术探查。2例患者死亡，1例在术后16d死于全身性念球菌感染，另1例在术后26d死于门静脉栓塞。结论 认为行右半肝的活体肝移植能达到较好的结果，采用右半肝的活体肝移植可以提供足够体积和功能的肝脏，为成年患者的肝移植提供了新的选择。     

CT对不同海拔成人肝脏血流动力学及体积研究

目的：通过多层螺旋CT肝脏灌注成像探讨在不同海拔高度正常成人肝脏血流灌注及体积的变化,以评估正常人肝脏在缺氧状态下的灌注状态,为肝脏疾病的诊断及治疗提供依据。资料与方法60例志愿者按海拔高度分为3组：A组22例来自海拔2260~3100 m,B组20例海拔3260~4100 m,C组18例海拔4260~5260 m,以肝门区为中心,绘制感兴趣区时间-密度曲线,采用去卷积法计算肝动脉灌注量（HAP）、门静脉灌注量（PVP）、肝脏总灌注量（TLP）、肝动脉灌注指数（HPI）;采用点圈法人工测量肝脏体积。结果 A、B、C组HAP分别为（10.50±3.62）ml/（100 ml · min）、（15.03±4.27）ml/（100 ml · min）、（18.39±7.20）ml/（100 ml · min）,其中A组与C组差异有统计学意义（P<0.05）;3组PVP分别为（138.78±14.29） ml/（100 ml · min）、（80.42±16.80）ml/（100 ml · min）、（63.78±7.79）ml/（100 ml·min）,两两比较差异均有统计学意义（P<0.05）;3组TLP分别为（149.30±15.55） ml/（100 ml · min）、（95.57±18.75）ml/（100 ml · min）、（82.19±10.56）ml/（100 ml · min）,两两比较差异均有统计学意义（P<0.05）;3组HPI分别为7.00±2.17、16.27±4.22、22.05±7.90,两两比较差异均有统计学意义（P<0.05）。3组肝脏体积分别为（1173.5±155.2）cm3、（1282.9±362.2）cm3、（1525.4±352.2）cm3,其中A组与C组差异有统计学意义（P<0.05）。结论海拔高度直接影响肝脏的血流灌注,随着海拔增高,HAP、HPI逐渐升高,PVP、TLP逐渐降低,肝脏体积逐渐增大,提示高原低氧环境对肝脏有一定的损伤。多层螺旋CT肝脏灌注成像可以反映肝组织的血流动力学变化,有助于肝脏疾病的诊断及治疗。     

临床Ⅰ期非小细胞肺癌CT灌注成像临床意义

目的：探讨多层螺旋CT灌注成像评价临床Ⅰ期非小细胞肺癌（NSCLC）病理特征的价值.方法：对129例NSCLC患者行MSCT灌注扫描,采用多元相关分析探讨灌注参数与病理特征的关系,再分组进行趋势检验.结果：灌注参数与NSCLC病理特征具有相关性,高、中和低分化肿瘤的血流量（BF）值分别为（58.3±20.5）、（38.5±15.7）和（30.3±6.7）ml/（100g·min）,强化峰值（PEI）分别为（26.1±11.7）、（23.6±6.9）和（16.2±4.9）HU,血流量和强化峰值随分化程度减低而降低（P值分别为0.01和0.023）;有淋巴结转移组的BF[（28.4±9.8）ml/100g·min）]和PEI[（10.9±8.4）HU]明显低于无淋巴结转移组（分别为[（47.3±16.5）ml/（100g·min）和（24.0±8.7）HU],差异有极显著性意义（P值分别为〈0.001和0.002）;术后转移组BF值[（22.6±3.2）ml/（100g·min）]明显低于未转移组[（45.0±16.4）ml/（100g·min）].差异有极显著性意义（P〈0.001）;不同病理类型灌注参数的差异无显著性意义（P〉0.05）.结论：MSCT灌注成像通过无创性评价血管生成的方式和程度,间接反映肿瘤分化程度,从而预测淋巴结转移和术后转移的可能性,是判断NSCLC生物学行为及预后的良好指标.     

肝动脉栓塞术前、后肝脏血流动力学的实验研究

目的采用CT灌注成像及多普勒血流计测定肝脏血流量,研究肝动脉栓塞术对肝脏血流动力学的影响。材料与方法10头猪麻醉后,行肝左动脉栓塞术。于肝左动脉栓塞术前及术后,采用CT灌注成像测定肝右叶肝动脉灌注量（HAP）、门静脉灌注量（PVP）、总肝血流量（THBF）、肝动脉灌注指数（HPI）,采用多普勒血流计分别测定肝门静脉、肝固有动脉、肝左动脉及肝右动脉血流量,并进行对比分析。结果肝左动脉栓塞术前和术后肝脏右叶HAP、PVP、THBF及HPI分别为0．3376ml·min^-1·ml^-1和0．4023ml·min^-1·ml^-1、0．9237ml·min^-1·ml^-1和0．8263ml·min^-1·ml^-1、1．2613ml·min^-1·ml^-1和1．2286ml·min^-1·ml^-1、26．80％和32．74％;肝左动脉栓塞术前和术后肝门静脉、肝固有动脉、肝左动脉、肝右动脉血流量分别为793．04ml／min和987．6ml／min、316．59ml／min和188．90ml／min、164．10ml／min和10．13ml／min、158．83ml／min和186．64ml／min。与肝左动脉栓塞术前相比,栓塞术后肝右动脉血流量及灌注量增加,肝门静脉的血流灌注量减少;术后肝固有动脉血流量明显减少;肝门静脉血流量明显增加,具有统计学意义;随着肝动脉栓塞面积增加,门静脉血流灌注量逐渐增加。结论CT灌注成像可准确地定量测量肝脏血流量;肝动脉栓塞术后,通过肝动脉缓冲效应,门静脉血流量增加,维持全肝血流量基本平衡。     

320排螺旋CT双入口灌注技术在肺结核的临床应用

目的：探讨320排螺旋CT双入口灌注技术在定量评估活动性肺结核血流灌注中的临床应用价值,比较不同类型肺结核病灶的血流灌注情况。方法：23例肺结核病例按形态学分3组：结核球8例,空洞型病灶4例,浸润型病灶11例。所有患者均行全肺CT动态容积扫描,利用灌注软件获取兴趣区的灌注参数值：肺动脉血流量（PF）、支气管动脉血流量（BF）及灌注指数（PI）,并对不同类型肺结核病灶的血流灌注参数进行统计学分析。结果：结核球病灶PF（41．51±10．32）ml／（rain·100m1）、BF（11．87±5．76）ml／（min·100m1）、PI（0．72±0．09）;浸润型病灶PF（82．53±51．57）ml／（min·100m1）、BF（40．20±19．06）ml／（min·100m1）、P10．66±0．07;空洞型病灶PF（36．15土12．88）ml／（rain·100m1）、BF（23．69±4．51）ml／（min·100m1）、P10．51±0．14。3组病灶的PF值均大于BF值（P〈0．05）。浸润病灶与结核球、浸润病灶与空洞型病灶的BF和PF值差异均有统计学意义（P〈0．05）,但结核球与空洞型病灶的BF、PF值差异无统计学意义。3组病灶的PI值差异无统计学意义。结论：对肺结核的血供灌注研究表明,结核性病变同时接受肺循环和体循环供血,其中肺循环占优势。3组病灶中浸润型病灶的灌注值（PF和BF）最高,空洞型病灶的PF值最低,结核球病灶的BF值最低。     

子宫颈癌多层螺旋CT灌注成像研究

目的：分析子宫颈癌（cervical cancer）CT灌注参数的特点及其临床应用价值。方法：分析临床诊断子宫颈癌的31例患者行子宫颈CT灌注扫描,所有患者均经手术病理证实,将癌旁相对正常宫颈组织15例作为对照。根据灌注所得图像得到时间-密度曲线,分析的灌注参数包括灌注值（PF）、血容量（BV）、强化峰值时间（TTP）和强化峰值（PEI）,并结合病理结果作分组灌注参数分析。结果：宫颈癌灌注时间-密度曲线TDC特点为速升速降型．短时间达峰值,峰值高于癌旁对照组织。肿瘤组的PF、BV、PEI值分别为（42．70±27．48）ml／min·100g、（39．94±21．35）ml／100g、（37．28±13．00）HU,癌旁对照组织PF、BV、PEI值分别为（8．03±3．22）ml,／min·100g、（27．68±14．53）ml／100g、（26．17±7．75）HU,肿瘤组的TTP值为（30．51±20．79）s,癌旁对照组织TTP值为（76．11±2．91）s,各组间差异有显著性意义（P〈0．05）。PEI值腺癌组（46．49±17．01）HU高于鳞癌组（35．83±10．36）HU,淋巴结转移组（53．94±17．83）HU高于无淋巴结转移组（34．08±9．27）HU,TTP值淋巴结转移组（18．43±2．14）s低于无淋巴结转移组（32．08±21．98）s,各组差异有显著性意义（P〈o．05）。结论：子宫颈癌为高血流灌注肿瘤,CT灌注参数反映肿瘤的血流特点和肿瘤内部的灌注情况,肿瘤CT灌注参数不同于癌旁对照组织的灌注参数,肿瘤的分期不同、分化程度不同、病理分型不同、有无淋巴结转移均有部分灌注拳数的改变,因此CT灌注对肿瘤的分期和预后估计有意义。     

动脉自旋标记序列对前列腺癌血流灌注无创定量测量的可行性研究

目的：探讨基于流动敏感交替反转恢复标记技术（FAIR）结合单次激发快速自旋回波（SSFSE）成像技术的动脉自旋标记（ASL）序列无创定量测量前列腺血流灌注（PBF）的可行性。方法：15例经临床活检确诊的前列腺癌患者纳入本组研究,每例患者同时采集4个不同反转时间（1000、1200,1400和1600ms）下的ASL数据,以获得最优的标记血流到前列腺时间来估算其PBF。结果：前列腺正常组织区域测得的PBF为（52．04±8．69）ml／min／100g,前列腺癌区测得的PBF为（79．28±28．89）ml／min／100g,两者差异有统计学意义（P〈0．01,最优TI）,表明前列腺癌区有更大的血流灌注。结论：初步结果表明基于流动敏感交替反转恢复标记技术结合单次激发快速自旋回波成像技术的动脉自旋标记序列（FAIR-SSFSE—ASL）可以无创、定量测量前列腺血流灌注,可探测到由于前列腺癌而引起的血流灌注改变。     

Imaging evaluation of potential donors in living-donor liver transplantation

Liver transplants, originally obtained from deceased donors, can now be harvested from living donors as well. This technique, called living-donor liver transplantation (LDLT), provides an effective alternative means of liver transplantation and is a method of expanding the donor pool in light of the demand and supply imbalance for organ transplants. Imaging plays an important role in LDLT programmes by providing robust evaluation of potential donors to ensure that only anatomically suitable donors with no significant co-existing pathology are selected and that crucial information that allows detailed preoperative planning is available. Imaging evaluation helps to improve the outcome of LDLT for both donors and recipients, by improving the chances of graft survival and reducing the postoperative complication rate. In this review, we describe the history of LDLT and discuss in detail the application of imaging in donor assessment with emphasis on use of modern computed tomography (CT) and magnetic resonance imaging (MRI) techniques.     

MSCTA对活体右叶供肝血管变异分型的研究

目的：探讨活体肝移植术前多层螺旋CT血管成像对潜在供肝血管系统评估的临床运用及价值。方法：对连续108例潜在右半肝供体行3期CT增强扫描（动脉期、门静脉期和肝静脉期）。根据所有原始图像和重组图像进行供肝的血管变异分型,肝动脉、门静脉以及肝静脉系统分别进行Michels分型、Akgul分型及Nakamura分型。对其中45例行右半肝切除的供体的肝血管变异分型与术中发现进行比较。结果：108例潜在供体的肝动脉、门静脉和肝静脉系统在MSCT上均显示清晰。根据肝动脉Michels分型,Ⅰ型有64例（59.3%）,Ⅱ型9例（8.3%）,Ⅲ型13例（12.0%）,Ⅳ型4例（3.7%）,Ⅴ型11例（10.2%）,Ⅵ型3例（2.8%）,Ⅷ型和Ⅸ型各2例（1.9%）。根据门静脉Akgul分型,A型有87例（80.6%）,B型有15例（13.9%）,C型4例（3.7%）,E型3例（2.8%）。根据肝静脉Nakamura分型,Ⅰ型有73例（67.6%）,Ⅱ型24例（22.2%）,Ⅲ型11例（10.2%）。45例进行手术的供体的术前CT血管分型结果与术中发现一致。结论：多层螺旋CT血管成像可良好地显示潜在供肝的血管系统,对活体肝移植术具有重要的临床应用价值。     

活体肝移植术前CT测量供体肝右叶体积和重量的校正公式

目的：为能通过活体肝移植（LDLT）术前CT测得的肝右叶体积（RLV）精确预测其实际体积和重量而建立公式。方法：78例供体在右半肝移植术前进行增强CT扫描,利用CT测量RLV,术中再分别测量实际切下的RLV和肝右叶重量（RLW）。用统计学方法对CT测得值和术中测得值之间关系进行分析,计算直线回归方程,利用该方程校正CT预测值,比较校正前后预测值的准确性。结果：术前CT测得的肝右叶体积（RLV-CT）为（777.3±108.8）ml,术中测得的肝右叶体积（RLV-Intraop）为（689.1±97.7）ml,两者呈正相关（r=0.882,P〈0.001）,术中测得的肝右叶重量（RLW-Intraop）为（741.6±98.0）g,亦与RLV-CT亦呈正相关（r=0.909,P〈0.001）,可分别用公式RLV-Intraop（ml）=0.792×RLV-CT（ml）＋73.771和RLW-Intraop（g）=0.819×RLV-CT（ml）＋104.885来表示。CT测得的未经上述公式校正的RLV或移植肝体积和受体标准肝体积之比、RLW或移植肝重量和受体体重之比的准确率分别为11.5%和48.7%,明显低于校正后的50%和71.8%（P值均〈0.05）。结论：LDLT术前运用上述公式校正RLV-CT后,可以更准确地预测潜在右叶供肝的体积和重量。     

Evaluation of the hepatic artery in potential donors for living donor liver transplantation by computed tomography angiography using multidetector-row computed tomography: comparison of volume rendering and maximum intensity projection techniques

PURPOSE: To compare the volume rendering (VR) and maximum intensity projection (MIP) computed tomography angiography (CTA) techniques using multidetector-row CT for hepatic artery evaluation of potential donors for living donor liver transplantation (LDLT). METHOD: Over a 9-month period, CTA using multidetector-row CT and conventional angiography was performed in 62 consecutive potential donors for LDLT. Acquisition of arterial phase scans was initiated within 5 seconds after reaching enhancement of the descending aorta up to 70 HU as measured by a bolus-tracking technique (collimation = 1.25 mm, table speed = 7.5 mm, reconstruction interval = 0.625 mm). Postprocessing was performed on a commercially available workstation. Computed tomography angiography images of the hepatic artery were made using the VR and MIP techniques. A total of 10 to 30 images of various planes were generated to reveal the origins and branching patterns of hepatic arteries. With a 2-week interval, two reviewers separately evaluated CTA using VR and MIP techniques, specifically evaluating anatomic variations and hepatic arterial conspicuity. The results of conventional angiography were considered to represent the gold standard. The difference in postprocessing time between the two techniques was statistically analyzed by the Student t test, and the differences in arterial conspicuity and in the identified number of the hepatic artery to segment IV of the liver were analyzed by the chi2 test. RESULTS: Two CT examinations (3%) were technically inadequate for generating CTA because of respiratory motion artifact. The average times for postprocessing of VR and MIP images were 8.1 +/- 3.8 minutes and 5.0 +/- 0.7 minutes, respectively. Variations of hepatic arterial anatomy were present in 19 patients (32%) on conventional angiography. In 8 patients (13%), there was discrepancy in the variations of hepatic arterial anatomy between the two techniques: MIP was correct in 7 patients, and VR was correct in 1 patient. The dominant artery supplying segment IV was identified in 51 patients (85%) with MIP and in 39 patients (65%) with VR. There was no significant difference in conspicuity of the hepatic arteries using either the MIP or VR technique. CONCLUSION: In CTA techniques using multidetector-row CT, MIP is superior to VR for the hepatic arterial evaluation of potential LDLT donors in terms of depicting anatomic variations and postprocessing time.     

3D CT modeling of hepatic vessel architecture and volume calculation in living donated liver transplantation

The aim of this study was to evaluate a software tool for non-invasive preoperative volumetric assessment of potential donors in living donated liver transplantation (LDLT). Biphasic helical CT was performed in 56 potential donors. Data sets were post-processed using a non-commercial software tool for segmentation, volumetric analysis and visualisation of liver segments. Semi-automatic definition of liver margins allowed the segmentation of parenchyma. Hepatic vessels were delineated using a region-growing algorithm with automatically determined thresholds. Volumes and shapes of liver segments were calculated automatically based on individual portal-venous branches. Results were visualised three-dimensionally and statistically compared with conventional volumetry and the intraoperative findings in 27 transplanted cases. Image processing was easy to perform within 23 min. Of the 56 potential donors, 27 were excluded from LDLT because of inappropriate liver parenchyma or vascular architecture. Two recipients were not transplanted due to poor clinical conditions. In the 27 transplanted cases, preoperatively visualised vessels were confirmed, and only one undetected accessory hepatic vein was revealed. Calculated graft volumes were 1110±180 ml for right lobes, 820 ml for the left lobe and 270±30 ml for segments II+III. The calculated volumes and intraoperatively measured graft volumes correlated significantly. No significant differences between the presented automatic volumetry and the conventional volumetry were observed. A novel image processing technique was evaluated which allows a semi-automatic volume calculation and 3D visualisation of the different liver segments.     

Multidetector CT in pre- and post-operative evaluation of living-related liver transplantation

Objective

To assess the role of multi-detector CT (MDCT) in the pre and post operative evaluation of both potential donors and recipients for living related liver transplantation (LRLT).

Material and Methods

This prospective study included 26 patients for LRLT and their corresponding donors. For preoperative assessment, all subjects were evaluated by triphasic CT abdomen. CT angiography (CTA) with 3D reconstruction and CT volumetry was additionally done for donors. CT findings were compared to surgical results as gold standard reference. In post-operative evaluation, CT abdomen was performed at least once after transplantation for all recipients and for indicated donors. CTA was done for indicated recipients when US findings were inconclusive.

Results

No statistically significant difference was found between CT volumetry and intraoperative findings. Compared to surgical findings, MDCT identified hepatic arterial and portal venous anatomy with 100% sensitivity and specificity, while for hepatic venous anatomy; it showed sensitivity and specificity of 85.7% and 84.2%. Biliary complications and fluid collections were the commonest in recipients and donors respectively.

Conclusion

MDCT is a single comprehensive non-invasive and accurate imaging modality for preoperative evaluation of liver parenchyma, hepatic vascular anatomy and graft volume and postoperative complications in donors and recipients of LRLT.     

正常肝脏低剂量CT灌注研究

目的：通过比较不同管电流扫描情况下正常肝脏的灌注参数,评价低剂量肝脏CT灌注成像（CTPI）的可行性。方法：确诊无肝脏疾病的健康志愿者32例,随机分为3组,常规剂量组（140mA）、中等剂量组（90mA）和低剂量组（50mA）。比较两种兴趣区选择方式下各组所测量的肝脏灌注参数（HBF、HBV、HPI、MTT、PS、HAP及PVP）间的差异。结果：不同管电流扫描条件下肝脏CTPI均获得了较满意的图像质量及灌注参数,不同兴趣区选择方式下各灌注参数值间的差异无显著性意义（P〉0.05）。常规剂量组测量的HPI值（t=-2.23,P=0.034）和低剂量组测量的MTT值（t=-2.25,P=0.042）在不同感兴趣区选择方式间略有差异。常规剂量、中等剂量和低剂量肝脏CTPI的有效剂量分别为19.62mSv、12.61mSv和7.01mSv,低剂量CTPI较常规剂量减少约64.27%的辐射剂量。结论：低剂量肝脏CTPI可以较常规剂量减少约2/3的辐射剂量,同时获得与常规剂量CTPI相当的灌注参数结果。     

运用CT动态灌注成像技术测定肝脏血流量的临床研究

目的 探讨CT灌注成像的测定方法和技术原理,以及肝硬化程度与肝脏血流量动态变化关系。资料与方法 肝硬化患者27例,其中Child A级12例,Child B级10例,CMld C级5例。对照组为无肝脏疾病者18例。选取同时含有肝脏、脾、主动脉和门静脉的层面进行CT动态增强扫描,绘制感兴趣区时间-密度曲线(TDC),计算肝脏血流量各参数。结果 (1)肝硬化患者的肝动脉灌注量(HAP)、门静脉灌注量(PVP)和总肝血流量(THBF)均较正常组降低,平均通过时间(MTT)较正常组延长。(2)肝硬化程度不同时,部分肝血流灌注参数存在显著性差异。(3)脾灌注量和门静脉灌注量呈正相关。结论 (1)肝脏CT灌注成像可定量测定肝血流量参数。(2)肝硬化时肝脏血流灌注的变化与疾病的严重程度相关。     

Does apparent diffusion coefficient predict the degree of liver regeneration of donor and recipient after living donor liver transplantation?

ObjectiveTo elucidate the relationship between the ADCs of the liver graft and the remnant liver and the degree of liver regeneration in LDLT.Materials and methods15 recipients and 15 corresponding donors underwent magnetic resonance imaging and computed tomography 1–2 weeks after living donor liver transplantation (LDLT). For diffusion-weighted imaging (DWI), a single-shot echo-planar sequence with b-factors of 0, 500, and 1000 s/mm² was scanned. ADCs of the liver parenchyma were calculated at b factors of 0 and 500 and 1000 (ADC 0–500–1000) or 0 and 500 (ADC 0–500) or 500 and 1000 (ADC 500–1000). The liver volume ratio at LDLT, the mean ADCs and the regeneration rate were compared between the graft and the remnant liver using paired-t tests.ResultsThe mean liver volume ratio of the recipients (41.3 ± 9.8%) tended to be smaller than that of the donors (51.8 ± 13.8%). The mean ADC 0–500 of the remnant liver (1.72 ± 0.33) was significantly higher than that of the graft (1.43 ± 0.32). The regeneration rate of the graft (2.07 ± 0.41) was significantly higher than that of the remnant liver (1.53 ± 0.49).ConclusionADC 0–500 can describe differences in blood perfusion between liver grafts and the remnant liver according to the degree of liver regeneration.