肝癌肝内血管系统三维重建及整合的X线解剖学研究及临床意义

X-ray Anatomy Study and Clinical Significance of Three Dimensional Reconstruction and Image Fusion between Liver Focal Lesions to the Hepatoma Vessel System

目的:探讨三维动态增强多层螺旋CT血管造影(three dimensional dynamic contrast enhance multislice spiral compute tomography angiography,3D DCE MSCTA),以及肝内血管系统重建并与肝癌病灶进行整合技术在临床治疗中的指导作用。方法:对16例肝癌患者采用上腹部3D DCE MSCTA扫描技术采集影像资料,经最大密度投影(maximum intensity projection,MIP)、容积再现(volume rendering,VR)和表面遮盖(surface shaded display,SSD)法重建肝内血管及肝癌病灶,并与三维数字减影血管造影(three dimensional digital subtraction angiography,3D DSA)对照。结果:肝内血管与肿块关系:肝内血管系统主分支未见异常5例,由肝动脉发出供血动脉11例,肝内血管主干受压移位10例,其中门静脉或下腔静脉癌栓3例。MIP法在显示重建血管级数方面高于SSD法,VR法显示图像的立体感优于MIP法和SSD法,3D DSA显示肝动脉及门静脉优于VR、MIP和SSD。结论:肝脏血管系统和肝癌病灶三维重建与整合技术可以较好的显示血管和病灶的立体解剖关系,有助于临床医生确定能否手术及手术的方式、范围。

Objective： To reconstruct hepatic blood vascular system and integrate it with hepatoma by using three dimensional dynamic contrast enhance muhislice spiral compute tomography angiography （3D DCE MSCTA）, and discuss the effects of its clinic therapy. Methods： 16 hepatoma patients were undergone the scan of 3D DCE MSCTA on midsection which using the methods of maximum intensity projection（MIP） ,volume rendering（VR） ,surface shaded display（SSD） to reconstruct heparhepatic blood vascular system and hepatoma fo- cal lesions, then integrate them and compare with three dimensional digital subtraction angiography （3D DSA）. Results： The main branch of heparhepatic blood vascular system was found normal in 5 cases ,and supply artery from artery hepatica propria were found in 11 cases, the main branch of heparhepatic vascular was pressed and shifted in 10 cases, carcinoma embolisms in portal vein or inferior vena cava in 3 cases. MIP is much better than SSD in reconstructing vascular progressions and VR is better than MIP and SSD in displaying three-dimensional images. 3D DSA is the best in revealing reconstruction of vascular progressions. Conclusion： The technology of three-dimensional reconstruction and integration can display well the anatomy relationship of heparhepatic blood vascular system and hepatoma focal lesions, which was useful for clinician to determine operation or not and methods of the operation.