64层螺旋CT对胆囊动脉的显示效果

Application of 64-slice spiral CT in the assessment of cystic artery

目的探讨64层螺旋CT显示胆囊动脉及其与胆囊三角关系的能力。方法 76例无上腹部手术史的患者均接受64层螺旋CT检查,增强扫描后于动脉期在薄层（层距、层厚1 mm）轴位图像和冠状位图像上连续观察胆囊动脉的走行及其与胆囊三角的关系,同时观察胆囊动脉的起源,进行胆囊动脉及胆管显影评分。76例中有54例同时接受了超声检查,比较64层螺旋CT与超声检查胆囊动脉的显示率。结果 64层螺旋CT检查结果如下,76例中75例（98.7%）显示了胆囊动脉;75例中共显示胆囊动脉89支,其中显示1支者61例（81.3%）,2支者14例（18.7%）,3支及以上者未见显示。胆囊动脉分别来源于肝右动脉78支（87.6%）、胃十二指肠动脉4支（4.5%）、肝左动脉3支（3.4%）、肝中动脉2支（2.2%）、变异肝右动脉1支（1.1%）、肝固有动脉1支（1.1%）。胆囊动脉与胆囊三角的位置显示清晰,其中位于胆囊三角内65支（73.0%）,胆囊三角外24支（27.0%）。89支显影动脉中,胆囊动脉显影评分1分18支、2分71支。76例中75例可见胆囊管,1例未显示,75例中胆囊管显影评分1分6例、2分69例。64层螺旋CT胆囊动脉的显示率高于超声检查（100%vs.85.2%,χ~2=44.022,P〈0.001）。结论 64层螺旋CT能清晰显示胆囊动脉及其与胆囊三角的解剖关系。

Objective To assess the efficacy of 64-slice spiral computed tomography（ CT） in displaying cystic duct and its anatomical association with the calot triangle. Methods Seventy six patients who had not undergone upper abdominal surgery were examined with 64-slice spiral CT. After enhanced CT scan,the location of cystic arteries and anatomical relationship with the calot triangle on the axial and coronal multiplanar images during arterial phase was evaluated. The origin of cystic arteries was assessed. The imaging scores of the cystic arteries and duct were obtained. Fifty four among 76 patients also received ultrasound examination.The accuracy rate between 64-slice spiral CT and ultrasound examination in displaying cystic arteries was statistically compared. Results A total of 89 cystic arteries were delineated on 64-slice spiral CT images in 75 of76 patients（ 98. 7%）. One cystic artery was found in 61 patients（ 81. 3%）,and two in 14（ 18. 7%）. The cystic arteries originated from the right hepatic arteries（ 78 /89,87. 6%）,gastroduodenal arteries（ 4 /89,4. 5%）,left hepatic arteries（ 3 /89,3. 4%）,middle hepatic arteries（ 2 /89,2. 2%）,variant right hepatic artery（ 1 /89,1. 1%） and proper hepatic artery（ 1 /89,1. 1%）. The anatomical position of the cystic arteries and the calot triangle were explicitly delineated including 65 cystic arteries（ 73. 0%） inside and 24（ 27. 0%）outside the calot triangle. The imaging score was one point in 18 cystic arteries and two points in 71,and one point in six cystic ducts and two points in 69. The accuracy rate of 64-slice spiral CT was significantly higher compared with that of ultrasound examination in displaying the anatomy of cystic arteries（ 100% vs. 85. 2%,χ~2= 44. 022,P 0. 001）. Conclusion Application of 64-slice spiral CT can be used to provide anatomical structures of the cystic arteries and the anatomical relationship with the calot triangle.