多层螺旋CT血管成像评价肝移植受者移植前后血管结构

背景：多层螺旋CT具有先进的扫描技术和强大的图像后处理功能，其亚秒级的扫描速度及各向同性的成像功能，在血管成像上有很多优势。 目的：探讨多层螺旋CT血管成像技术对肝移植受者移植前后血管结构评价的应用价值。 设计、时间及地点：回顾性分析，以肝移植受者肝脏血管为观察对象，自身对照观察，于2003-10/2006-12在中山大学附属第五医院放射科完成。 对象：选择拟行原位肝移植患者27例，年龄31~67岁，男17例，女10例。 方法：轴位螺旋扫描范围为膈顶上方2 cm至双肾下极以下。电压120 kV，动脉期准直0.75 mm，平扫、门脉期、肝静脉期准直1.5 cm；使用非离子型对比剂优维显，注射速度为3 mL/s，三期增强扫描延迟时间分别为20~25 s，50~55 s，75~80 s。重建增强的薄层图像序列，动脉期层厚1 mm，间隔0.7 mm；门脉期、肝静脉期层厚2 mm，间隔1 mm。将图像序列传入后处理工作站，以MIP、VR等方式显示腹腔干系、门脉系、肝静脉及下腔静脉血管的三维结构。 主要观察指标：肝移植前后患者血管三维结构。 结果：移植前所有患者腹腔干系均得到良好显示，21例肝动脉走形正常，6例患者肝动脉变异，其中门静脉海绵样变2例，门脉多发血栓1例，因不适宜手术此3例未进行肝移植。24例患者第二肝门及下腔静脉肝内段血管结构显示清楚，肝右静脉单独汇入下腔静脉、肝左静脉和肝中静脉先汇合后再注入下腔静脉18例，肝右静脉、肝中静脉及肝左静脉分别单独汇入下腔静脉6例，下腔静脉肝后段狭窄2例。17例肝移植后CT血管成像发现肝动脉吻合口部狭窄2例，门脉高压侧支迂曲缓解10例，另7例患者因检查费用问题选择B超检查。 结论：多层螺旋CT血管成像能够清晰显示肝移植患者移植前后血管结构，对适宜手术的病例筛选、指导手术方案及移植后血管结构的评价具有重要意义。

Evaluation of vascular structure using multi-slice spiral CT angiography prior to and after liver transplantatio

BACKGROUND: Multi-slice spiral CT (MSCTA) has advanced scanning and image post-processing techniques, which exhibits great advantage in angiography due to its subsecond scan and isostropic resolution. OBJECTIVE: To investigate the clinical value of MSCTA in evaluating the hepatic vessels of liver recipients prior to and after liver transplantation. DESIGN, TIME AND SETTING: Retrospective analysis, auto-control observation on hepatic vessels of liver recipients. The experiment was performed at the Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University from October 2003 to December 2006. MATERIALS: Twenty-seven patients underwent the liver transplantation was collected, which ranged in age from 31 to 67 years, including 17 males and 10 females. METHODS: All cases were adopted the axial scan, scanning ranged from diaphragm upper aspect 2 cm to lower renal pole below. Scanning voltage was 120 Kv, with collimation of 0.75 mm/1.5 mm. The nonionic contrast media (Ultravist) was applied with injection speed of 3 mL/s. Arterial phase, portal phase and hepatic vein phase scanning delay time were 20-25 s, 50-55 s and 75-80 s, respectively. The thickness of image layer was reconstructed with 1 mm with interval 0.7 mm in arterial phase, or 2 mm with interval 1 mm in portal venous phase and hepatic vein phase. The image sequence was input later processing, and three dimensional reconstruction of celiac artery, portal vein, hepotic vein and inferior vena cava was displayed with maximum intensity projection and volume rendering. MAIN OUTCOME MEASURES: The three dimensional structure of hepatic vessels prior to and after operation. RESULTS: Preoperative CT angiography could clearly show the celiac artery of all cases, which exhibited that the hepatic arterial arranged regularly in 21 cases, hepatic artery variant in 6 cases, including 2 cases with portal vein sponge degeneration, 1 case with portal vein multiple thrombosis, which failed to operation. The structure of second hepatic portal and blood vessel at inferior vena cava were clearly exhibited in 24 cases, the right hepatic veins jointed inferior vena cava, and there was a common trunk of the middle and left hepatic veins before joining the inferior vena cava in 18 cases, right hepatic veins, venae hepaticae intermediate and left hepatic veins jointed inferior vena cava separately in 6 cases, and stenosis in inferior vena cava in 2 cases. Postoperative CT angiography showed that there were 2 cases had hepatic artery anastomotic stenosis, 10 cases relieved collateral circulation in portal hypertersion, and 7 cases replaced with-Ultrasound due to cost problem. CONCLUSION: Multi-slice spiral CT angiography can evaluate the hepatic vessels of liver recipients globally prior to and after the liver transplantation, which has important significance in screening the receipts of liver transplantation, guiding surgical planning, as well as evaluating the hepatic vessel structures after liver transplantation.