影像诊断及评估在儿童肝移植中的初步应用

Preliminary Investigations into the Role of Diagnostic Imaging in Pediatric Liver Transplantation

目的研究影像诊断在儿童肝移植中的作用。方法对2004年12月-2005年8月本院4例儿童肝移植的影像诊断资料和手术记录进行回顾性分析比较,所有病例手术前后均行影像学检查,包括超声、CT、MRI和核素肝胆动态显像。结果4例经病理证实,1例为肝母细胞瘤,2例为门静脉海绵状变性,1例为胆管闭锁。4例术前术后均行超声检查（包括多普勒）,2例术前、1例术后行多层螺旋CT（MSCT）检查,1例术前行MRI检查,1例术前行核素肝胆动态显像（DRHI）扫描。超声在检出肝脏及肝脏血管病变的同时,还能动态显示肝脏血流,术后随访中作用尤其突出。MSCT、MRI与超声检查相比,图像视野大、三维立体感强,同时MSCT血管成像（MSCTA）及磁共振血管成像（MRA）均能清晰显示血管结构,DRHI在胆管闭锁的诊断中具有特异性。结论所有病例的影像学诊断和临床表现在肝移植术的各期均高度一致,影像学诊断在肝移植术前手术计划的制订和术后随访中起重要作用。

Objective：The aim of our study was to determine the role of diagnostic imaging in pediatric liver transplantation. Methods：Between December 2004 and August 2005 ,pediatric liver transplantations were performed in 4 cases in our hospital. All patients underwent diagnostic imaging assessment before and after operation. The operative notes and diagnostic imaging reports were reviewed retrospectively. The diagnostic imaging methods were composed of ultrasound （US）, multislice computed tomography （MSCT） ,magnetic resonance imaging （MRI） ,and dynamic radionuclide hepatobiliary imaging （DRHI）. Results：Four cases verified by pathology were hepatoblastoma,cavernous transformation of the portal vein, and biliary atresia. All cases underwent US pre- and postoperation, including Doppler. MSCT were performed on 2 cases preoperatively and 1 case postoperatively. 1 case underwent MRI examination and 1 case underwent DRHI examination. The hepatic lesions as well as the abdomen vessel structures could be demonstrated by US. Doppler is the best choice for displaying the blood vessels dynamically in the pre- and postoperative stage. The advantages of MSCT and MRI were based on their superior big field of view and three dimensional displaying modes. The vessel structures could be depicted by MSCTA as well as MRA. DRHI could be used in making the diagnosis of biliary atresia exclusively. Conclusion： There exists good correlation in all cases between diagnostic imaging and clinical findings in all stages of liver transplantation. Diagnostic imaging plays an important role in improving planning and follow-up of pediatric liver transplantation.