64层螺旋CT胆囊动脉成像的临床价值初步研究

目的探讨64层螺旋CT对胆囊动脉的显示能力及其临床价值。方法共110例患者接受了64层螺旋CT检查，将原始数据传入Advantage Workstation AW4．3工作站，利用MIP、MPR、VR等重建技术进行胆囊动脉成像，由两名高年资放射科医师分别独自仔细观察胆囊动脉的起源与变异、支数及其走行情况进行分类和统计学分析，计算百分比、可信区间及Kappa值。结果110例中106例（96％）胆囊动脉可以显示，两名高年资放射科医师的一致性较好，Kappa值为0．91。本组106例共观察到125支胆囊动脉，87例（82％）可以观察到一支胆囊动脉，19例（17．9％）可以观察到两支胆囊动脉，三支型或更多支未发现；按胆囊动脉走行分3型，I型即经胆囊三角型，89例；Ⅱ型即非胆囊三角型，19例；Ⅲ型即混合型，同时存在经胆囊三角和不经胆囊三角的胆囊动脉，本组未发现。结论64层螺旋CT检查能够充分显示胆囊动脉的起源、变异及走行情况，对于减少腹腔镜胆囊切除术中出血、胆管及血管损伤以及中转开腹有重要的临床指导意义。

Preliminary study on the clinical value of 64 - detector spiral CT in cholecystic artery angiography

Objective To study the ability and clinical value of 64 -detector spiral CT artery angiography （CTA） in displaying cystic aretery. Methods A total of 110 patients （62 male, 48 female） performed CT examination. The raw date were inputted into work station of Advantage Workstation AW 4. 3, the images were reconstructed using MIP, MPR, CPR, VR technology. Two independent radiologists evaluated the CT datas, included the origin,branches,variation,course of cholecystic arteries. Each patient was classified according to the cystic arteries and the relationship with the Calot triangle. Statistical analysis was performed, and percentages and 95% confidence intervals were calculated. Results The cystic arteries were delineated in 106 （96%） of the 110 patients. Two independent radiologists have a good agreement,the value of kappa was 0. 91. A total of 106 cases observed 125 cystic artery,87 cases （82%） can be observed in an cystic artery, 19 cases（ 17.9% ） can be observed in two cystic arteries, three types or more not found. Based on course of cystic artery, we classified cystic artery into three groups, Group I was the calot triangle type, 89 cases ; Group Ⅱ was cystic artery outside calot triangle type, 19 cases; Group Ⅲ was the compound cystic artery type, the cystic arteries exist not only in calot triangle, but also outside it, not found. Conclusions Dual - source CT for cholecystic artery angiography can accurately display the origin, branches, variation, and course of cholecystic arteries and will perform important guiding significance for laparoscopic choleeystectomy in reducing blood loss, bile duet, vascular injury and transit laparotomy probability.