320排CT检查技术对肝移植术后肝动脉并发症的诊断价值

The clinical application of 320-slice computed tomography （CT） hepatic artery images in patients with liver transplantation

目的探讨320排CT中采用高浓度低剂量对比剂对移植肝动脉并发症的临床诊断价值。方法58例肝移植术后患者，分A、B两组，对比剂分别为碘350g／L（27例）和370g／L（31例）；均采用320排CT扫描机，对比剂流速均为6ml／s，总剂量50ml，采用动态容积扫描模式，扫描参数：X线管转速0．5s／r，层厚0．5mm，管电流100～250mA，管电压100kV。利用4D DSA成像软件，测量纯肝动脉的达峰时间、达峰CT值；记录肝移植组患者的身高和体质量。选取最佳纯肝动脉期的图像，进行容积（VR），最大密度投影（MIP），多层面图像重建（MPR）。应用SPSS10．0统计分析软件，根据不同数据资料进行非参数检验、Х^2检验或t检验。结果（1）肝移植A组、B组间的年龄、性别、身高、体质量和人体质量指数间比较，差异均无统计学意义，A组、B组间肝动脉达峰时间分别为（19．71±3．11）s、（20．06±3．67）S，两者间差异无统计学意义（P〉0．05）；B组肝动脉达峰CT值、达峰绝对CT值分别为451．39±113．16、412．06±112．30，与A组的396．26±89．46、357．59±87．54相比，差异具有统计学意义（t值分别为2．036、2．038，P值均〈0．05）；（2）移植肝动脉成像：肝动脉吻合口假性动脉瘤2例，肝动脉吻合口轻度、中度、重度狭窄、闭塞分别为13例、5例、9例、1例；肝动脉吻合口处多发中重度狭窄4例，肝动脉吻合口病变发生率为58．6％（34／58），肝动脉闭塞及重度狭窄者伴有肝门部侧支动脉形成6例，肝动脉门静脉瘘及肝动脉迂曲各12例，肝内动脉小分支开放8例，其他包括15例伴有肝内动脉小分支稀疏，3例供受体肝动脉管径粗细不一致。结论320排CT低剂量对比剂的4DDSA成像可获得准确的移植肝动脉纯动脉期图像，对肝移植术后肝动脉病变的诊断具有安全、无创、准确的优点，可作为肝移植术后对肝动脉并发症进行随访的有效手段。

Objective To evaluate the clinical significance of 320-slice CT hepatic artery images in patients with liver transplantation. Methods A total of 58 patients underwent CT scanning by 320-slice scanner after liver transplantation. They were divided into 2 groups according to the concentration of contrast media as follows： Group A （27 cases, 350 mgI/ml iopromide）, Group B （31 cases, 370 mgI/ml iopromide）. Contrast medium was infused at 6 ml/s, with a total dose of 50 ml. Images were generated by dynamic volume scanning and were processed by 4D digital subtraction angiography （DSA） imaging software. The time-density curve （TDC） of the hepatic artery was delineated. The time to peak, peak contrast enhancement were recorded. The physiological parameters such as body weight and height were annlyzed. Results （1）There were no differences in clinical parameters such as age, sex, height, weight, or BMI between groups. The time to peak of hepatic artery of group A and B was （19.71± 3.11） s and （20.06 ± 3.67） s, and had no significant difference. The maximum peak enhancement of hepatic artery in groups B was higher than that group A （P 〈 0.05）. （2） 4D DSA revealed hepatic artery pseudo-aneurysm （n = 2）, and hepatic artery mild stenosis （n = 13）, moderate stenosis （n = 5）, severe stenosis （n = 9） and occlusion （n = 1）, segmental moderate and severe stenosis （n = 4）, and compensatory circulation with hepatic artery severe stenosis and occlusion （n = 6）. hepatoportal arteriovenous fistulas （HPAVF, n = 12）, donor-recipient hepatic artery mismatch （n = 3）. Hepatic arterial branch are decreased and opened in 15 cases and 8 cases. Conclusion 320-slice CT hepatic artery images is safe, noninvasive, and accurate technique to evaluate hepatic arterial complications after liver transplantation.