钆贝葡胺三维动态增强磁共振血管成像对活体肝移植供体术前血管系统的评价

目的 钆贝葡胺增强三维动态增强磁共振血管成像(3D DCE MRA)对活体肝移植供体肝动脉、门静脉、肝静脉血管解剖的显示情况.方法 32例肝移植供体,术前常规MR扫描.首先经静脉注入1 ml钆贝葡胺注射液,行testbolus测出循环至肝动脉时间,然后行冠状位三维T1加权快速扰相小角度梯度回波(3D-FLASH)序列扫描,自动脉期开始连续扫描4期,每期间隔10 s,获得肝动脉、门静脉、肝静脉等各期图像,观察原始图像及MIP重建后图像中肝动脉、门静脉、肝静脉及其分支的显示情况,确定血管的走形及有无变异.以肝移植术中观察的血管情况作为金标准,分析MRA所见.结果 MRA对于肝动脉、门静脉、肝静脉系统的显示质量均较好.MRA发现肝动脉变异5例,门静脉变异4例,肝静脉变异8例,均经过手术证实.术中发现副肝动脉1例,MRA未发现.结论 钆贝葡胺3D DCE MRA安全、无创,对肝动脉、门静脉、肝静脉显示清楚,诊断变异准确度高,有可能成为术前肝移植供体血管评价的首选影像学检查手段.

Preoperative evaluation of hepatic vasculature with gadobenate dimeglumine three dimensional dynamic contrast-enhanced MR angiography in living liver donors

Objective To observe the value of gadobenate dimeglumine three dimensional dynamic contrast-enhanced MR angiography (3D DCE MRA) in preoperative assessment of hepatic vasculature of the hepatic vasculature in living liver donors. Methods Thirty-two healthy liver transplant donor candidates were examined with MR. Gadobenate dimeglumine 1 ml was transvenously injected to infer the time of gadobenate dimeglumine reaching liver artery performing test bolus,and then three-dimensional T1-weighted fast low-angle shot sequence (3D-FLASH) was performed in the coronal plane,scanning four phases in series from arterial period to obtain imaging of the arterial,portal venous and venous systems. Original imaging and MIP reconstructed imaging were reviewed by two experienced radiographers,categorized vessel visualization on a five-point scale,recorded vascular anatomy and variations for the arterial,portal venous and hepatic venous systems,comparing with intraoperative findings. Results Overall vessel visualization assessment demonstrated good or very good ratings for the majority of liver donors. Among all 32 liver donors,5 had arterial variants,4 had portal venous variants and 8 had venous various variants proved by intraoperative findings. Accessory artery was found in operation,but it was not detected in MRA in 1 donor. Conclusion Gadobenate dimeglumine 3D DCE MRA is a highly accurate,noninvasive tool for visualizing the hepatic vasculature and variations. It is possible to serve as the first choice in preoperative evaluation of living liver donors.