肝移植术前MSCT评估

MSCT evaluation of pre-operation of liver transplantation candidates

目的:探讨MSCT三期扫描及三维血管造影在肝移植受体术前评估的应用价值。方法:63例肝脏病人行动脉期、门静脉期和延迟期增强扫描(扫描时间为注射造影剂后22～25s、60s和120s,注射速率为3mlFs)。用VR法重建动脉期和门脉期血管,测量肝癌病灶大小、肝总动脉和腹腔动脉干直径,依据Michel’s标准对肝动脉分型。测量门静脉血栓的范围、肝脏容积,观察脾动脉瘤及静脉血管吻合情况。结果:63例中肝细胞肝癌15例(其中小肝癌3例),胆管癌2例,胆囊癌1例。MichelsIX型肝动脉2例,腹腔干狭窄3例,脾动脉瘤2例,肝动脉细小2例。门静脉癌栓12例(长段癌栓7例)。肝脏平均容积为1114.41cm3。结论:MSCT三期扫描及三维血管造影能明确肝脏病变的性质,显示肝脏供血动、静脉解剖结构及病变,可测量肝脏的容积,能为肝移植受体提供综合的术前评估。

Objective： To study the value of three-phase ee-MSCT with 3D-MSCTA（P） for evaluation of pre-operation of orthotopie liver transplantation candidates. Methods： Sixty-three potential candidates for liver transplantation were evaluated with three-phase ee-MSCT scanning（intravenous contrast medium was administered at the rate of 3ml/s. Three-phase scanning acquisition at 22-25s, 60s and 120s respectively after initiation of contrast medium injection）. Arterial phase and portal venous phase scan information was used for volume rendering CTA（P）. All images were analyzed to define the parenehymal liver disease and the size of hepatoeellular carcinoma, as well as the diameter of common hepatic artery and celiac axis. The hepatic arterial blood supply was categorized according to Michel＇s classification. Portal vein thrombosis was defined. Hepatic volume was measured by CT as well as eollateralization stage of the hepatic venous system and splenic artery aneurysms. Results： Masses were pathologically proven as hepatoeellular carcinoma in 15 eases（small hepatoeellular carcinoma in 3 eases）, cholangioeellular eareinoma in 2 eases, eholeeystie carcinoma in 1 ease in all of the 63 patients. Miehels IX anatomy in 2 eases, celiac axis stenosis in 3 cases, small-caliber hepatic arterial vessels in 2 eases, SA aneurysms in 2 eases. Portal vein thrombosis in 12 eases（long segment in 7 eases）, the mean hepatic volume was 1114.41cm^3. Conclusions： Three-phase ee-MSCT with CTA（P） can define parenehymal liver disease, show the anatomy of hepatic artery and hepatic vein as well as vascular diseases, hepatic volume can be measured. MSCT can provide comprehensive preoperative liver evaluation for transplantation candidates.