64层螺旋CT血管造影及融合技术对胃周动脉的评价

Assessment of 64-slice spiral computed tomography angiography with image fusion for perigastric arteries anatomy

目的探讨64层螺旋CT血管成像（64-MSCTA）及融合技术对胃周动脉的显示能力和临床应用价值。方法对2011年4—8月间收治的53例患者行腹部64层螺旋CT扫描．其中26例胃癌患者行手术治疗。采用容积再现（VR）技术分别重建胃周动脉和胃，并使之相融合，观察腹腔干分型和10条胃周动脉的起源和走行及其与胃的空间关系：将手术患者的术前MSCTA资料与术中所见对比，评价64-MSCTA的准确性、敏感性和特异性。结果53例MSCTA均清晰显示腹腔干，其中MichelsI型（肝脾胃干型）46例（86．8％）。通过融合技术可任意角度清晰显示胃周动脉和胃的空间解剖关系，胃左动脉和胃网膜右动脉显示率均为100％（53／53），胃网膜左动脉94_3％（50／53）．胃右动脉83．0％（44／53），胃短动脉58．5％（31／53），胃后动脉49．1％（26／53），替代肝左动脉15．1％（8／53）。副肝左动脉、副胃左动脉及替代肝右动脉显示率均为7．5％（4／53）。CTA术前预测各动脉的准确性为84．6％。100％．敏感性为82．6％～100％．特异性均为100％。结论64．MSCTA可清晰显示胃周动脉．采用融合技术使胃周动脉和胃相融合．可真实显示活体胃及胃周血管解剖，指导手术安全进行。

Objective To evaluate the efficacy and clinical significance of 64-multislice spiral computed tomography angiography （MSCTA） with image fusion for the anatomy of perigastric arteries. Methods A total of 53 patients underwent abdominal 64-MSCTA, among whom 26 patients with gastric cancer underwent gastrectomy. Using volume rendering techniques, computed tomography angiography （CTA） of perigastric arteries and the stomach were reconstructed respectively, and then the images were fused together. The branching pattern of the celiac trunk and the origins and courses along the stomach of the 10 perigastric arteries were assessed. The accuracy, sensitivity, and specificity of 64-MSCTA were determined based on intraoperative findings. Results CTA clearly showed the celiac trunk. The most common branching pattern of the celiac trunk was Michels type I in 46 patients （86.8%）. The anatomy of perigastric arteries and stomach could be clearly demonstrated from any angle according to image fusion. The left gastric artery and the right gastroepiploic artery were shown in 100%, the left gastroepiploic artery 94.3% （50/53）, the right gastric artery 83.0% （44/53）, short gastric artery 58.5% （31/53 ）, posterior gastric artery 49.1% （26/53）, the replaced left hepatic artery 15.1% （8/53）. The accessory left hepatic artery, accessory left gastric artery and replaced right hepatic artery were all identified in 7.5%（4/53） patients. The accuracy of preoperative CTA in term of correctlyidentifying perigastric arteries ranged from 84.6% to 100%, the sensitivity 82.6% to 100%, and the specificity was 100% for all the perigastrie arteries. Conclusions 64-MSCTA can clearly reveal individual perigastric arteries. The anatomy of the stomach and perigastric arteries can be shown in vivo by fused image, and can provide guidance for gastrectomy.