肝动脉三维灰阶超声造影在肝移植中的临床应用

Visualizing the hepatic arteries with contrast-enhanced sonography-assessment of the preand post-transplant patient

目的探讨肝动脉三维灰阶超声造影（3D-CEUS）在肝移植中的临床应用价值。方法26例肝移植供体或怀疑肝动脉并发症的肝移植受体行二维灰阶超声造影（2D-CEUS）和3D-CEUS检查，评价3D-CEUS图像重建成功率、图像质量和对肝动脉并发症的诊断准确性，并与2D-CEUS相比较。结果26例患者3D-CEUS可显示21条肝动脉，图像重建成功率80．8％，重建图像血管连续性好，可显示冠状面上的分支或属支，能帮助判定段动脉起源，能明确显示血管空间关系。5例确诊肝动脉并发症者，2D-CEUS和3D-CEUS能明确诊断并与结果相符者均为4例，2D-CEUS将1例肝动脉迂曲误诊为动脉狭窄，3D-CEUS予以纠正。结论肝动脉3D-CEUS可获得直观、立体、清晰的肝动脉重建图。在评价肝移植术后肝动脉并发症方面，当血管走行迂曲、有复杂的解剖空间关系时，3D-CEUS能提供更丰富的诊断信息，可对2D-CEUS发现的一些病变作进一步的证实或纠正。

Objective To evaluate the clinical value of three-dimensional contrast-enhanced ultrasonography（3D-CEUS） of hepatic arteries in liver transplant candidates. Methods Twenty-six liver transplantation donors and recipients were examined using two-dimensional contrast-enhanced ultrasound （2D-CEUS） and 3D-CEUS. The 3D image＇s qualities, reconstruction successful rates, and the diagnostic level of hepatic artery complications were estimated. Results Twenty-one hepatic arteries were reconstructed successfully （80.8%）. The 3D images showed artery trees continuous, spatial relationship definite, fine and circuitous branches distinct,and the segmental hepatic arteries＇ origin could be recognized. In 4 of 5 hepatic artery complications,both 2D-CEUS and 3D-CEUS made the correct diagnoses. However, 2D-CEUS made a false positive diagnosis and 3D-CEUS retrieved it. Conclusions The 3D-CEUS images of the hepatic arteries are direct and distinct, In evaluating hepatic artery complications, when artery spatial relationship is complicated, the 3D-CEUS could provide more information, and confirm or correct some diagnosis of 2D-CEUS,