64层螺旋CT在活体肝移植供体术前评估中的价值

目的：探讨64层螺旋CT在活体肝移植供体术前评估中的临床应用价值。方法：活体肝移植术前对拟捐肝者257例行64层螺旋CT检查。扫描序列包括碘浓度监测扫描,自动触发技术进行的肝动脉期、门脉期以及肝静脉期等3期扫描。延迟扫描时间,动脉期22-25 s（中位数23 s）,门脉期42-53 s（中位数47 s）,肝静脉期65-75 s（中位数70 s）。对比剂注射模式为5 mL/s生理盐水20 mL＋暂停＋4-5 mL/s对比剂70-120 mL＋5 mL/s生理盐水30 mL。图像后处理包括肝脏管道系统重组和肝体积测量。用多平面重组、最大密度投影和容积再现等方法,显示肝动脉、门脉和肝静脉。活体肝体积测量有全肝体积,包括肝中静脉的右半肝体积和不包括肝中静脉的右半肝体积。在同一扫描时相上,测量肝脏和脾脏的CT值,并计算肝脾CT值比值。结果：拟捐肝者257例中,184例行肝移植手术。其中,179例供体接受不包含肝中静脉的右半肝移植。4例双供肝,1例合肝。全部捐肝供体术后恢复良好,无重大并发症和死亡发生。利用64层螺旋CT可对肝脏进行多时相扫描,以及二维、三维图像重组和肝体积测量。结论：64层螺旋CT多时相扫描,二维、三维图像重组和肝体积测量,可为临床活体肝移植术前的供体影像学评估,提供准确、全面的信息。

The Value of 64-slice Spiral CT in Preoperative Assessment of Living Donor in Liver Transplantation

Objective：To investigate the clinical value of 64-slice spiral CT in preoperative assessment of living donor in liver transplantation.Methods：Two hundred fifty-seven living related donor livers underwent preoperative 64-slice spiral CT examination.CT protocol included inspecting and measuring scanning of iodic concentration,tri-phasic scanning（arterial,portal venous and hepatic venous phases） with CT value auto-triggering technique of contrast materials that delayed scanning time was respectively 22-25s（median 23s） in arterial phase,42-53s in portal venous phase（median 47s）,65-75s in hepatic venous phase（median 70s）.Injection mode of contrast material was as follows：20mL normal saline at a flow rate of 5mL/s first,then 70-120mL iodic contrast material at a flow rate of 4-5mL/s after fugacious pausing,and 30mL normal saline at a flow rate of 5mL/s finally.Anatomy of liver arteries,portal veins and liver veins was shown by imaging reconstruction that include multi-plane reconstruction（MPR）,maximum intensity projection（MIP） and volume rendering technique（VRT）.Volume of the living whole liver,the right half-liver including middle hepatic vein and the left half-liver excluding middle hepatic vein was measured respectively.Besides,CT value of liver and spleen was measured respectively,and ratio of liver/spleen CT value was calculated in same scanning phase.Results：In 257 living hepatic donors,184 cases were performed liver transplantation operation that included 179 right half-liver transplantation excluded middle hepatic vein,4 double donor liver and 1 compounding donor liver.All of 184 donors postoperatively got well without serious complications and death.Sixty-four slice spiral CT multi-phasic scanning could provide comprehensive and exact imaging data by two dimensional and three dimensional imaging reconstruction and measurement of hepatic volume.Conclusion：Sixty-four slice spiral CT multi-phasic scanning can provide comprehensive and exact