64排螺旋CT肝动脉血管成像的技术及临床应用研究
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摘要
研究目的
1、探讨64层螺旋CT肝动脉血管成像技术，比较不同扫描启动时间与不同浓度对比剂两因素对CTA成像质量的影响。
2、研究CTA对肝动脉正常解剖和变异的显示及对临床指导价值。
3、探讨肝内常见占位性病变及肝癌异位侧支供血的CTA血管表现。
材料与方法
1、病例组成：选择临床可疑肝脏占位病变的60例患者行64排螺旋CT多期扫描，其中动脉早期扫描时间为CTA扫描启动时间。男35例，女25例，平均56.4岁。病例组成为四种：原发性肝癌(PHC)组25例，肝转移瘤(MHT)组21例，肝血管瘤(HCH)组13例，局灶性结节样增生(FNH)1例。
2、研究分组：根据不同扫描启动时间和不同浓度对比剂共分为四组，每组15例，共60例。A组：小剂量预注射试验300mgI／ml组；B组：小剂量预注射试验370mgI／ml组：C组：经验时间注射组300mgI／ml组；D组：经验时间注射组370mgI／ml组。根据所得腹主动脉CT值的测量结果是否存在统计学差异探讨不同时间和不同浓度对比剂两个因素对CTA成像质量的影响。
3、检查方法：(1)平扫：所有患者检查前口服清水500～1000ml，平扫取仰卧位，取头足方向扫描，范围自肝顶至肾下极。扫描参数：电压120kV，电流250mAs，
Objective
1. To study the technique control of computed tomography angiography(CTA) of hepatic artery in 64- detector row helical CT, comparing the imaging quality of CTA by adopting different starting time of scan and concentrations of contrast agent.
2. To study the normal anatomy and anatomical variation of hepatic artery and the clinic applications of the variations by CTA.
3. To discuss the manifestation of the feeding-artery of common focal hepatic lesions and the abnormality branch blood-supply for primary hepatic carcinoma by the use of CTA.
Materials and methods
1. Patient data: 60 patients who had clinically been suspected hepatic neoplasms underwent CTA examination by 64- detector row helical CT. They included 35 men and 25 women, and the average age was 56.4 years. The final diagnoses of the patients were primary hepatic carcinoma(n=25), metastatic hepatic tumor(n=21), hepatic cavernous hemangioma(n=13), focal nodular hyperplasia(n=1).
2. Study groups: All patients were separated into 4 groups with the same cases in each group according to the starting time of scan and the concentrations of contrast agent ,15 cases in each group. Group A: small dose experimental injection of 300 mgI/ml; Group B: small dose experimental injection of 370 mgI/ml; Group C:
1、探讨64层螺旋CT肝动脉血管成像技术，比较不同扫描启动时间与不同浓度对比剂两因素对CTA成像质量的影响。
2、研究CTA对肝动脉正常解剖和变异的显示及对临床指导价值。
3、探讨肝内常见占位性病变及肝癌异位侧支供血的CTA血管表现。
材料与方法
1、病例组成：选择临床可疑肝脏占位病变的60例患者行64排螺旋CT多期扫描，其中动脉早期扫描时间为CTA扫描启动时间。男35例，女25例，平均56.4岁。病例组成为四种：原发性肝癌(PHC)组25例，肝转移瘤(MHT)组21例，肝血管瘤(HCH)组13例，局灶性结节样增生(FNH)1例。
2、研究分组：根据不同扫描启动时间和不同浓度对比剂共分为四组，每组15例，共60例。A组：小剂量预注射试验300mgI／ml组；B组：小剂量预注射试验370mgI／ml组：C组：经验时间注射组300mgI／ml组；D组：经验时间注射组370mgI／ml组。根据所得腹主动脉CT值的测量结果是否存在统计学差异探讨不同时间和不同浓度对比剂两个因素对CTA成像质量的影响。
3、检查方法：(1)平扫：所有患者检查前口服清水500～1000ml，平扫取仰卧位，取头足方向扫描，范围自肝顶至肾下极。扫描参数：电压120kV，电流250mAs，
Objective
1. To study the technique control of computed tomography angiography(CTA) of hepatic artery in 64- detector row helical CT, comparing the imaging quality of CTA by adopting different starting time of scan and concentrations of contrast agent.
2. To study the normal anatomy and anatomical variation of hepatic artery and the clinic applications of the variations by CTA.
3. To discuss the manifestation of the feeding-artery of common focal hepatic lesions and the abnormality branch blood-supply for primary hepatic carcinoma by the use of CTA.
Materials and methods
1. Patient data: 60 patients who had clinically been suspected hepatic neoplasms underwent CTA examination by 64- detector row helical CT. They included 35 men and 25 women, and the average age was 56.4 years. The final diagnoses of the patients were primary hepatic carcinoma(n=25), metastatic hepatic tumor(n=21), hepatic cavernous hemangioma(n=13), focal nodular hyperplasia(n=1).
2. Study groups: All patients were separated into 4 groups with the same cases in each group according to the starting time of scan and the concentrations of contrast agent ,15 cases in each group. Group A: small dose experimental injection of 300 mgI/ml; Group B: small dose experimental injection of 370 mgI/ml; Group C:
引文
[1] Hiart JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases[J]. Ann Surg, 1994, 220(1): 50-52.
[2] Green D, Parker D. CTA and MRA: visualization without catheterization[J]. Semin Ultrasound CT MR, 2003, 24(4): 185-191.
[3] Takayasu K, Muramatsu Y, Furakawa N, et al. Early hepatocellular carcinoma: appearance at CT during arterial portography and CT anteriography with pathologic correlation. Radiology. 1995, 194: 101.
[4] Hu H, He HD, Fox SH. For multidetector-row helical CT: image quality and volume corverage speed. Radiology, 2000, 215: 55.
[5] Hu H. Multi-slice CT: Scan and reconstruction. Med Phys, 1999, 26: 5.
[6] Winter TC, Nghiem HV, Freeny PC, et al. Hepatic arterial anatomy: demonstration of normal supply and vascular variants with three-dimensional CT angiography[J].Radiographics, 1995, 15(3): 771-780.
[7] Weszelits V, Doros A, Puhl M, et al. 3D CT angiography in patients before and after liver transplantation[J].Transplant Proc, 2001, 33(1-2): 1372-1376.
[8] Nghiem HV, Dimas CT, Mc Vivar JP, et al. Impact of double helical CT and three-dimensional CT arteriography on surgical planning for hepatic transplantation[J]. Abdom Imaging, 1999, 24(3): 278-284.
[9] Kamel IR, Kruskal JB, Pomfret ES, et al. Impact of multidetectorction donor selection and surgical planning before living adult right lobe liver transplantation[J]. AJR, 2001, 176(1): 193-200.
[10] Sahani D, Saini S, Pena C, et al. Using multidetector CT for preoperative vascular evaluation of liver neoplasms: technique and results[J]. AJR, 2002, 179(1): 53-59.
[11] Takahashi S, Murakamu T, Takamura M, et al. Multi-detector row helical CT angiography of hepatic vessels: depiction with dual-arterial phase acquisition during single breath hold[J].Radiology, 2002, 222: 81-88.
[12] 葛英辉，谢晓东，宋彬，等．肝脏螺旋CT血管造影——动脉系统三维成像初探[J]．胃肠病学和肝病学杂志，1999，8(1)：40 43．
[13] 罗建光，杨东益，刘固岗，等．肝动脉螺旋CT血管造影和三维重建的临床应用[J]．实用放射学杂志，1999，15(3)：201 204．
[14] 张龙江，杨亚英，杨桂芬等．国人肝动脉解剖及变异：160例多层螺旋CT血管造影分析．放射学实践，2004，19(6)：401-404．
[15] Rubin GD, Shiou MC, Leung AN, et al. Aorta and iliac arteries: single versus multiple detector-row helical CT angiography[J]. Radiology, 2000, 215: 670-676.
[16] Taguchi K, Aradate H. Algorithm for in multi-slice helical CT[J].Med Phys, 1998, 25: 550.
[17] Armerding MA, Rubin GD, Beaulieu CF, et al. Aortic aneurismal disease: assessment of stent-graft treatment-CT versus Coinventional angiography[J].Radiology, 2000, 215: 138-146.
[18] Foley WD, Karcaaltincaba M. Computed tomography angiography: principles and clinical application[J].J Comput Assist Tomogr, 2003, 27(Suppl. 1): S23-S30.
[19] Kopp AF, Heuschmid M, Claussen CD. Multi detector helical CT of the liver for tumor detection and characterization[J].Eur Radiol, 2002, 12(4): 745-752.
[20] Sandstede JJ W, Tschammler A, Beer M, et al. Optimization of automatic volus tracking for timing of the arterial phase of helical liver CT[J]. Eur Radiol, 2001, 11(8): 1396-1400.
[21] Kopka L, Rodenwaldt J, Fischer U, et al. Dual-phase helical CT of the liver: effects of bolus tracking and different volmes of contrast material [J]. Radiology, 1996, 201(2): 321-326.
[22] Tanikake M, Shimizu T, Narabayashi I. et al. Three-dimensional CT angiography of the hepatic artery: use of multi-detector row helical CT and a comtrast agent[J]. Radiology, 2003, 227(3): 883-889.
[23] Kim T, Murakami T, Hori M, et al. Small hypervascular hepatocellular carcinoma revealed by double arterial phase CT performed with single breath-hold scanning and automatic bolus tracking[J]. Am JRoentgenol, 2002, 178(4: 899-904.)
[24] Byun JH, Kim TK, Lee SS, et al. Evaluation of the hepatic artery in potential donors for living donor liver transplantation by computed tomography angiography using multidetector row computed tomography: comparison of volume rendering and maximum intensity projection techniques[J]. J Comput Asist Tomogr, 2003, 27(2): 125-131.
[25] Shimizu T, Misaki T, Yamamoto K, et al. Helical CT of the liver with compute-assisted bolus-tracking technology: scan delay of arterial phase scanning and effect of flow rates[J].J Comput Assist Tomogr, 2000, 24(2): 219-223.
[26] Horton KM, Fishman EK. 3D CT angiography of the celiac and superior mesenteric arteries with multi-detector CT data sets: preliminary observations[J].Abdom Imaging, 2000, 25(5): 523-525.
[27] Laghi A, Lannaccone R, Catalano C, et al. Multi-slice spiral computed tomography angiography of mesenteric arteries[J]. Lancet, 2001, 358: 638-639.
[28] Macari M, Istael GM, Berman P, et al. Infrarenal abdominal aortic aneurysms at multi-detector row CT angiography: intravascular enhancement without a timing acquisition[J].Radiology, 2001, 220: 519-523.
[29] 王爽，赵心明，罗德红，等．多层螺旋CT肝脏血管成像最佳扫描时间的研究[J]．中国医学影像技术，2005，21(7)：1108-1111．
[30] 陈青华，柳澄．腹部螺旋CT血管成像技术[J]．中国医学影像技术，2004，22(4)：641-643．
[31] 王锡明，武乐斌，邵广瑞，等．多层螺旋CT成像技术在全身血管造影中的应用[J]．中国医学影像技术，2002，18(4)：333-334．
[32] 韩志茹，陈育霞．螺旋CT三维重建参数选择及临床应用[J]．实用放射学杂志，2003，19(9)：837-839．
[33] Smith PA, Klein AS, Heath DG, et al. Dual-phase spiral CT angiography with volumetric 3D rendering for preoperation liver transplant evaluation: preliminary observation[J]. J Comput Assist Tomogr, 1998, 22(6): 868-874.
[34] 刘玉林，陈宪，安连峰，等．多层面螺旋CT血管成像应用参数优化[J]．临床放射学杂志，2003，22，877-881．
[35] 32．陈文华，黄庆娟，徐青．多层螺旋CT腹腔动脉成像在不同重叠率与成像方法的相关研究[J]．南京医科大学学报(自然科学版)，2004，24(4)：364-367．
[36] 周建军，周康荣，陈祖望，等．螺旋CT门静脉造影层厚和成像方法的合理选择[J]．临床放射学杂志，2003，22(1)：14-17．
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[1]．吴孟超，原发性肝癌治疗经验谈[J]．华夏医药，2003，2：1-4．
[2]. Hiart JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases[J]. Ann Surg, 1994, 220(1): 50-52.
[3]. Green D, Parker D. CTA and MRA: visualization without catheterization[J]. Semin Ultrasound CT MR, 2003, 24(4): 185-191.
[4]. Takayasu K, Muramatsu Y, Furakawa N, et al. Early hepatocellular carcinoma: appearance at CT during arterial portography and CT anteriography with pathologic correlation. Radiology. 1995, 194: 101.
[5]. Foley WD, Karcaaltincaba M. Computed tomography angiography: principles and clinical application[J]. J Comput Assist Tomogr, 2003, 27(Suppl.1): S23-S30.
[6]. Kopp AF, Heuschmid M, Claussen CD. Multi detector helical CT of the liver for tumor detection and characterization[J]. Eur Radiol, 2002, 12(4): 745-752.
[7]. Sandstede JJ W, Tschammler A, Beer M, et al. Optimization of automatic volus tracking for timing of the arterial phase of helical liver CT[J]. Eur Radiol, 2001, 11(8): 1396-1400.
[8]. Kopka L, Rodenwaldt J, Fischer U, et al. Dual-phase helical CT of the liver: effects of bolus tracking and different volmes of contrast material [J]. Radiology, 1996, 201(2): 321-326.
[9]．王爽，赵心明，罗德红，等．多层螺旋CT肝脏血管成像最佳扫描时间的研究[J]．中国医学影像技术，2005，21(7)：1108-1111．
[10]．陈青华，柳澄．腹部螺旋CT血管成像技术[J]．中国医学影像技术，2004，22(4)：641-643．
[11]．王锡明，武乐斌，邵广瑞，等．多层螺旋CT成像技术在全身血管造影中的应用[J]．中国医学影像技术，2002，18(4)：333-334．
[12]．韩志茹，陈育霞．螺旋CT三维重建参数选择及临床应用[J]．实用放射学杂志，2003，19(9)：837-839．
[13]．刘玉林，陈宪，安连峰，等．多层面螺旋CT血管成像应用参数优化[J]．临床放射学杂志，2003，22，877-881．
[14]. Smith PA, Klein AS, Heath DG, et al. Dual-phase spiral CT angiography with volumetric 3D rendering for preoperation liver transplant evaluation: preliminary observation[J]. J Comput Assist Tomogr, 1998, 22(6): 868-874.
[15]．陈文华，黄庆娟，徐青．多层螺旋CT腹腔动脉成像在不同重叠率与成像方法的相关研究[J]．南京医科大学学报(自然科学版)，2004，24(4)：364-367．
[16]. Shimizu T, Misaki T, Yamamoto K, et al. Helical CT of the liver with compute-assisted bolus-tracking technology: scan delay of arterial phase scanning and effect of flow rates[J]. J Comput Assist Tomogr, 2000, 24(2): 219-223.
[17]. Brink JA, Heiken JP, Forman HP, et al. Hepatical CT: reduction of dose of intravenous contrast material on hepatic vontrast enhancement[J].Radiology, 1995, 197(1): 83-88.
[18]. Horton KM, Fishman EK. 3D CT angiography of the celiac and superior mesenteric arteries with multi-detector CT data sets: preliminary observations[J]. Abdom Imaging, 2000, 25(5): 523-525.
[19]．周康荣．螺旋CT[M]．上海：上海医科大学出版社，1999，256-258．
[20]. Tanikake M, Shimizu T, Narabayashi I. et al. Three-dimensional CT angiography of the hepatic artery: use of multi-detector row helical CT and a comtrast agent[J].Radiology, 2003, 227(3): 883-889.
[21]．唐秉航，李良才，何亚奇，等．中晚期肝癌动脉早期M S C T血管造影[J]．放射学实践，2004，19(3)：194-198．
[22]. Kamel IR, Rapotopoulos V, Pomfret EA, , et al. Impact of multi-detector CT on donor selection and surgical planning before living adult right lobe live transplantation [J].AJR, 2001, 176(1): 193-200.
[23]. Karyal S, Oliver JH, Buck DG; et al. Detection of vascular complications after liver transplantation: early experiencr in multislice CT angiography with volume rendering [J]. AJR, 2000, 175(6): 1735-1739.
[24]. Uchida M, Ishibashi M, Abe T, et al. Three-dimensional imaging of liver tumors using helical CT during intravenous injection of contrast medium[J]. J Comput Assist Tomogr, 1999, 23(3): 435-440.
[25]. Winter TC, Nghiem HV, Freeny PC, et al. Hepatic arterial anatomy: demonstration of normal supply and vascular variants with three-dimensional CT angiography [J]. Radiographics, 1995, 15(3): 771-780.
[2] Green D, Parker D. CTA and MRA: visualization without catheterization[J]. Semin Ultrasound CT MR, 2003, 24(4): 185-191.
[3] Takayasu K, Muramatsu Y, Furakawa N, et al. Early hepatocellular carcinoma: appearance at CT during arterial portography and CT anteriography with pathologic correlation. Radiology. 1995, 194: 101.
[4] Hu H, He HD, Fox SH. For multidetector-row helical CT: image quality and volume corverage speed. Radiology, 2000, 215: 55.
[5] Hu H. Multi-slice CT: Scan and reconstruction. Med Phys, 1999, 26: 5.
[6] Winter TC, Nghiem HV, Freeny PC, et al. Hepatic arterial anatomy: demonstration of normal supply and vascular variants with three-dimensional CT angiography[J].Radiographics, 1995, 15(3): 771-780.
[7] Weszelits V, Doros A, Puhl M, et al. 3D CT angiography in patients before and after liver transplantation[J].Transplant Proc, 2001, 33(1-2): 1372-1376.
[8] Nghiem HV, Dimas CT, Mc Vivar JP, et al. Impact of double helical CT and three-dimensional CT arteriography on surgical planning for hepatic transplantation[J]. Abdom Imaging, 1999, 24(3): 278-284.
[9] Kamel IR, Kruskal JB, Pomfret ES, et al. Impact of multidetectorction donor selection and surgical planning before living adult right lobe liver transplantation[J]. AJR, 2001, 176(1): 193-200.
[10] Sahani D, Saini S, Pena C, et al. Using multidetector CT for preoperative vascular evaluation of liver neoplasms: technique and results[J]. AJR, 2002, 179(1): 53-59.
[11] Takahashi S, Murakamu T, Takamura M, et al. Multi-detector row helical CT angiography of hepatic vessels: depiction with dual-arterial phase acquisition during single breath hold[J].Radiology, 2002, 222: 81-88.
[12] 葛英辉，谢晓东，宋彬，等．肝脏螺旋CT血管造影——动脉系统三维成像初探[J]．胃肠病学和肝病学杂志，1999，8(1)：40 43．
[13] 罗建光，杨东益，刘固岗，等．肝动脉螺旋CT血管造影和三维重建的临床应用[J]．实用放射学杂志，1999，15(3)：201 204．
[14] 张龙江，杨亚英，杨桂芬等．国人肝动脉解剖及变异：160例多层螺旋CT血管造影分析．放射学实践，2004，19(6)：401-404．
[15] Rubin GD, Shiou MC, Leung AN, et al. Aorta and iliac arteries: single versus multiple detector-row helical CT angiography[J]. Radiology, 2000, 215: 670-676.
[16] Taguchi K, Aradate H. Algorithm for in multi-slice helical CT[J].Med Phys, 1998, 25: 550.
[17] Armerding MA, Rubin GD, Beaulieu CF, et al. Aortic aneurismal disease: assessment of stent-graft treatment-CT versus Coinventional angiography[J].Radiology, 2000, 215: 138-146.
[18] Foley WD, Karcaaltincaba M. Computed tomography angiography: principles and clinical application[J].J Comput Assist Tomogr, 2003, 27(Suppl. 1): S23-S30.
[19] Kopp AF, Heuschmid M, Claussen CD. Multi detector helical CT of the liver for tumor detection and characterization[J].Eur Radiol, 2002, 12(4): 745-752.
[20] Sandstede JJ W, Tschammler A, Beer M, et al. Optimization of automatic volus tracking for timing of the arterial phase of helical liver CT[J]. Eur Radiol, 2001, 11(8): 1396-1400.
[21] Kopka L, Rodenwaldt J, Fischer U, et al. Dual-phase helical CT of the liver: effects of bolus tracking and different volmes of contrast material [J]. Radiology, 1996, 201(2): 321-326.
[22] Tanikake M, Shimizu T, Narabayashi I. et al. Three-dimensional CT angiography of the hepatic artery: use of multi-detector row helical CT and a comtrast agent[J]. Radiology, 2003, 227(3): 883-889.
[23] Kim T, Murakami T, Hori M, et al. Small hypervascular hepatocellular carcinoma revealed by double arterial phase CT performed with single breath-hold scanning and automatic bolus tracking[J]. Am JRoentgenol, 2002, 178(4: 899-904.)
[24] Byun JH, Kim TK, Lee SS, et al. Evaluation of the hepatic artery in potential donors for living donor liver transplantation by computed tomography angiography using multidetector row computed tomography: comparison of volume rendering and maximum intensity projection techniques[J]. J Comput Asist Tomogr, 2003, 27(2): 125-131.
[25] Shimizu T, Misaki T, Yamamoto K, et al. Helical CT of the liver with compute-assisted bolus-tracking technology: scan delay of arterial phase scanning and effect of flow rates[J].J Comput Assist Tomogr, 2000, 24(2): 219-223.
[26] Horton KM, Fishman EK. 3D CT angiography of the celiac and superior mesenteric arteries with multi-detector CT data sets: preliminary observations[J].Abdom Imaging, 2000, 25(5): 523-525.
[27] Laghi A, Lannaccone R, Catalano C, et al. Multi-slice spiral computed tomography angiography of mesenteric arteries[J]. Lancet, 2001, 358: 638-639.
[28] Macari M, Istael GM, Berman P, et al. Infrarenal abdominal aortic aneurysms at multi-detector row CT angiography: intravascular enhancement without a timing acquisition[J].Radiology, 2001, 220: 519-523.
[29] 王爽，赵心明，罗德红，等．多层螺旋CT肝脏血管成像最佳扫描时间的研究[J]．中国医学影像技术，2005，21(7)：1108-1111．
[30] 陈青华，柳澄．腹部螺旋CT血管成像技术[J]．中国医学影像技术，2004，22(4)：641-643．
[31] 王锡明，武乐斌，邵广瑞，等．多层螺旋CT成像技术在全身血管造影中的应用[J]．中国医学影像技术，2002，18(4)：333-334．
[32] 韩志茹，陈育霞．螺旋CT三维重建参数选择及临床应用[J]．实用放射学杂志，2003，19(9)：837-839．
[33] Smith PA, Klein AS, Heath DG, et al. Dual-phase spiral CT angiography with volumetric 3D rendering for preoperation liver transplant evaluation: preliminary observation[J]. J Comput Assist Tomogr, 1998, 22(6): 868-874.
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