64层螺旋CT血管成像检查在肝脏常见占位性病变扫描时间的研究及临床应用
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摘要
研究目的
1、对比研究不同剂量造影剂注射后,肝脏常见占位性性病变对腹主动脉造影剂强化峰值及HAP启动扫描时间的影响。
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供血动脉的CTA血管表现。
材料与方法
2009年10月至2011年2月因可疑肝脏占位在兰州大学第二医院放射科行上腹部CT平扫及增强扫描检查的患者84例。
选取其中44例作为病例组。病例组纳入标准：(1)已经由磁共振成像(Magnet ic Resonance Image, MRI)或者B超诊断为肝脏疾病后又行上腹部CTA检查的患者。(2)心肺和’肾功能基本正常,既往无肾功能损伤病史及严重心脏疾病病史的患者。
对组选取,10例,对照组纳入标准：肝脏无异常强化病灶患者、局灶性脂肪肝、少量的肝脏小囊肿、单个小血管瘤(≤2cm)以及对肝血流无明显影响病变或远处疾病等病例；
排除标准：(1)造影剂过敏试验阳性者；(2)患严重糖尿病、重症高血压等严重内科疾病以及其他原因不能耐受高增强扫描过程的患者；(3)不能耐受实验要求的注射速率的患者；(4)胃肠道未准备或胃肠道准备较差病人。
所有84例患者均行上腹部CTA检查。其中男53例,女31例,年龄13-88岁,平均每羚56.5岁。体重43-90kg,平均54.78kg。病例组44例中：肝血管瘤(HCH≥3cm)8例,肝转移瘤(MHT)12例,原发性肝细胞肝癌(PHC)23例,局灶性结节样增生(FNH)1例。所有PHC病例中有12例为穿刺活检或手术证实,4例为肝癌治疗后,7例为临床综合诊断；MHT均明确了原发病灶或者有原发病史；HCH中4例为手术或穿刺活检证实,2例为诊断血管瘤术后1-2年的随访病例,其余为临床综合诊断,FNH为术后病理证实。所有病例组患者中有7例进行过减影血管造影术(digital subtraction angiography,DSA)检查,1例行肝移植术；
患者检查前30-45min口服清水500-1000ml,以充盈胃肠道。全部病例均先行腹部平扫,然后从肘正中静脉注入造影剂先进行吸气并屏气状态下的小剂量同层动态测试法(Test Bolus)扫描试验监测腹主动脉,得到同层面腹主动脉的时间密度曲线,研究病例组与正常对照组腹主动脉峰值时间的差异性；然后在智能追踪技术(Smart Prep)对腹主动脉追踪下行肝动脉期(hepatic arterial phase, HAP)扫描,数据统计指标包括时间、CT值(或称密度),所有图像均以最小层厚1mm、间隔0.7mrn重建,重建图像传至西门子工作站。所有病例的图像均采用最大密度投影(MIP)和容积再现(VR)及多平面重建(MPR)三种方法进行后处理重建。所有重建图像由2名高资历的影像医师阅片并诊断。肝动脉CTA图像质量独立进行3级评分,仅显示肝动脉第一级分支记1分。可清晰显示肝动脉的第二级分支记2分,可清晰显示肝动脉的第三级或更进一步分支记3分。
结果：
1.根据各组腹主动脉平均CT值和括弧中所标记时间点或时间段绘制腹主动脉时间密度曲线,从各时间点或时间段腹主动脉平均CT值高低可知,可见小剂量造影剂注射时候正常组腹主动脉强化高峰范围主要分布在21.4±2.3秒时间段。疾病组腹主动脉强化高峰范围主要分布在21.9±2.8秒时间段,二者无显著差异(P>0.05),以在大剂量造影剂注射时候肝脏动脉期启动扫描时间分别为注射造影剂后28.6±3.6秒、30.1±4.8秒,经配对检验,P>0.05,无显著性差异。这说明不管是在小剂量造影剂注射还是大剂量造影剂注射病例组及对照组在腹主动脉的强化峰值时间及HAP扫描的启动时间无明显差异。
2.PHC(23例)MHT(12例)、HCH(8例)三种病变的肝固有动脉平均内径测量分别为：PHC:4.96±0.58mm、MHT:3.45±0.27mm、HCH:3.31±0.28mm。显示PHC导致的肝固有动脉内径改变明显,与MHT及HCH相比存在着显著性差异(P=0.000),而MHT与HCH二者间的肝固有动脉内径变化无显著差异(P=0.74)。
3.MIP法与VR法对肝动脉分级的图像评价得分为：2.73±0.25和2.10±0.32,经统计学分析,图像后处理MIP法和VR法二者方法在评价肝动脉分级显示中存在显著性差异(P=0.000),MIP法优于VR法。
4.84例肝脏CTA检查所见：肝动脉表现为正常解剖共54例,占64%,存在各种正常变异的30例,占36%,其本组病例可以见到的Michels分型的有3种。所有变异病例中较多的是Michels Ⅸ型,共15例即：肝总动脉(CHA)起自于肠系膜上动脉(SMA),占17.9%,其次为MichelsⅢ型共9例即：替代肝右动脉(rRHA)来自肠系膜上动脉(SMA),占10.7%;最后MichelsⅦ型6例即：替代肝右动脉(rRHA)来自肠系膜上动脉(SMA)+副肝左动脉aLHA来自胃左动脉(LGA),占7.4%(图7-9)。
5.23例PHC中有20例动脉血管增粗、扩张,肝固有动脉管径达4.96±0.58mm,最粗内径达到5.96mm,有19例可见明显的动脉血管分支增多、紊乱,8例可见动脉~门静脉瘘。1例FNH肝内供血动脉明显增粗。8例HCH中有7例肝动脉及其分支无明显增粗,1例肝右动脉轻度增粗,管径达3.9mm。12例MHT中有10例血管无明显增粗,2例位于肝脏右叶的结肠癌患者血管有增粗,肝右动脉管径达3.9～4.7mm。同时原发性肝癌异位肿瘤血供来源中见胃左动脉供血3例,肝左侧动脉并膈下动脉供血1例。
结论：
1.在决定肝脏CTA各期扫描的启动时间方面,以腹主动脉作为参照靶血管标准的方法是完全可行的。剂量大小对腹主动脉峰值时间的影响具有明显的差异。肝脏区疾病对腹主动脉的峰值时间无显著的影响。
2.PHC导致的肝固有动脉内径改变明显,PHC与MHT及HCH相比存在着显著性差异。而MHT与HCH二者间的肝固有动脉内径变化无显著差异。
3.通过对2组共84例肝动脉正常解剖及变异的CTA的研究,表明64排螺旋CT肝动脉CTA能够如实的反应肝动脉解剖与变异,显示肝癌的供瘤血管及异位侧支来源,为临床手术、介入治疗及肝移植等提供更多重要信息。
Research purposes
1. To explore the64-slice spiral CT hepatic arterial imaging technology to study liver disease liver of64-slice CT angiography (computed tomography angiography, the CTA) depiction of time.
2. Study CTA hepatic artery of normal anatomy and variations display and guidance on the clinical value.
3. To investigate the intrahepatic common space-occupying lesions and liver cancer feeding artery CTA vascular performance.
Materials and Methods
January2009to February2011because of suspected liver occupying Lanzhou University Hospital Radiology line abdominal CT scan and enhanced scan in84patients.
Select one of44cases as the case group. The case group inclusion criteria:(1) has been diagnosed by magnetic resonance imaging (Magnetic Resonance Image, MRI) or B-CTA examination of patients with liver disease and then line the upper abdomen.(2) basic cardiopulmonary and renal function is normal, and no previous history of renal injury and in patients with a history of serious heart disease.
group selected40patients in the control group. Inclusion criteria:liver abnormalities strengthen lesions in patients with focal fatty liver, small liver cyst, a single small hemangioma (<2cm) and no significant effect on hepatic vascular lesions or distant disease and other cases;
Exclusion criteria:(1) contrast agent allergy test positive;(2) suffering from severe diabetes, severe hypertension and other serious medical illness and other reasons, patients can not tolerate high-enhanced scanning process;(3) can not tolerate the experimental requirements injection the rate of patients;(4) of the gastrointestinal tract is not ready or gastrointestinal ready to poor patient.
All84patients underwent upper abdominal CTA examination. There were53males and31females, aged13to88years, average antelope56.5years old.43～90kg, the average weight of54.78kg.:The case group and44cases of hepatic hemangioma (HCH≥3cm)8Li, liver metastases (MHT)12cases of hepatocellular carcinoma (PHC)23cases, focal nodular hyperplasia of FNH,. All PHC cases,12cases of biopsy or surgery confirmed four cases of liver cancer treatment, seven cases of general clinical diagnosis; MHT clear primary lesion or history of the primary disease; HCH four cases surgery or biopsy confirmed two cases for diagnostic the hemangioma after1to2years of follow-up cases, and the rest is a comprehensive clinical diagnosis, FNH postoperative pathology confirmed.Seven cases digital subtraction angiography (digital subtraction angiography, DSA) check, a routine liver transplantation in all patients in the case group.
Patients before the examination30～45min oral Shimizu500～1000ml, to filling the gastrointestinal tract. All cases were first abdominal plain Inhale and breath-hold state small dose of the same-layer dynamic test method (Test Bolus) scan test monitoring abdominal aortic injection of contrast agent, and then from the cubital vein, to get the same level of the abdominal aorta time density curve of the case group and the normal control group of abdominal aortic peak time differences; intelligent tracking technology (Smart Prep) and then tracking downstream hepatic arterial phase of the abdominal aorta (hepatic arterial phase, HAP) scanning, data statistical indicators including time, CT value (or density), all images are the smallest thickness lmm, interval0.7mrn reconstruction, the reconstructed image is transmitted to the Siemens workstation. All cases the images are maximum intensity projection (MIP) and volume rendering (VR) and multiplanar reconstruction (MPR) three methods of post-processing reconstruction. All the reconstructed image by the image of three highly qualified physicians and reading diagnosis. The hepatic artery CTA image quality independent3ratings only display the first level of the hepatic artery branch remember. Can clearly show the second level of the hepatic artery branch2points, can clearly show the third level of the hepatic artery or further branch in mind.
Results:
1. Mark the point in time or time period draws abdominal aortic time-density curve, from the level of the average CT value for each point in time or time period abdominal aortic shows, we can see a small dose of contrast agent injection when the groups abdominal aorta mean CT value and in parentheses normal group abdominal aortic strengthen peak range is mainly distributed in the time period of21.4±2.3seconds. Disease group abdominal aortic enhancement peak mainly distributed in21.9±2.8seconds time period, no significant difference (P>0.05), a large dose of contrast agent injection when start the scan time of the hepatic arterial phase after injection of contrast medium28.6±3.6seconds,30.1±4.8seconds, paired test, P>0.05, no significant difference. This disease group, whether it is in the small dose of contrast agent injection or large doses of contrast agent injection in abdominal aortic peak enhancement time has no effect.
2. PHC (23cases) MHT (12cases), HCH (8cases), three groups of hepatic artery average inner diameter measurements show that the average diameter measurement of the hepatic artery three lesions were:PHC:4.96±0.58mm, MHT:3.45±0.27mm, HCH:3.31±0.28mm. Three groups between the PHC cause hepatic artery diameter change significantly compared with MHT and HCH there is a significant difference (P=0.000), hepatic arterial diameter in both MHT and HCH were no significant differences hepatic artery diameter change was no significant difference (P=0.74).
3. The MIP law and VR hepatic artery grading image evaluation score of:2.73±0.25and2.10±0.32, statistical analysis the MIP law and VR image post-processing method of both methods in evaluation hepatic artery grading in the presence of a significant difference (P=0.000), the MIP method is better than the VR method.
4. The84cases of liver CTA examination findings:hepatic artery showed normal anatomy of54cases (64%), there are30cases of normal variation accounted for36%. More variation cases Michels IX, a total of15cases:from the common hepatic artery (CHA) from the superior mesenteric artery (SMA), accounting for17.9%, followed by Michels Ⅲ type of9cases:instead of the right hepatic artery(rRHA) from the superior mesenteric artery (SMA), accounting for10.7%; final Michels Ⅷ6cases: the alternative right hepatic artery (rRHA) from the superior mesenteric artery (SMA) and Vice left hepatic artery aLHA the from the left gastric artery (LGA), accounting for7.4%.
5. The23cases PHC in20patients with arterial thickening, dilatation, hepatic artery diameter of4.96±0.58mm, most coarse inner diameter of5.96mm,19cases showed obvious arteries branch increased disorder, eight cases the visible artery to the portal vein fistula. One cases of FNH the intrahepatic feeding artery significantly enlarged. HCH in8cases,7cases of hepatic artery and its branches is no obvious thickening, cases of right hepatic artery mild thickening diameters up to3.9mm. MHT in12cases,10cases of blood vessels no obvious thickening, two cases of patients with colon cancer in the right lobe of liver vascular thickening of the right hepatic artery diameter of3.9to4.7mm. the same time see the left gastric artery, liver left artery and inferior phrenic artery cases primary liver ectopic tumor blood supply.
Conclusion
1.In the decision liver CTA scan start time, the abdominal aorta as a reference to the target vessel standard method is entirely feasible. The size of the dose peak time of the abdominal aorta with a significant difference. Area of the liver disease no significant effect on the peak time of the abdominal aorta.
2.The induced liver artery diameter in PHC to change significantly, PHC there is a significant difference compared with MHT and HCH. MHT HCH between the two changes in the inner diameter of the hepatic artery was no significant difference.
3.Normal anatomy and variations of two groups of84patients with hepatic artery CTA, indicating that the64-slice spiral CT hepatic artery CTA can truthfully reaction anatomical variation of the hepatic artery for liver cancer tumor blood vessels and ectopic collateral source for clinical surgery, interventional treatment of liver transplantation for more important information.
1、对比研究不同剂量造影剂注射后,肝脏常见占位性性病变对腹主动脉造影剂强化峰值及HAP启动扫描时间的影响。
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供血动脉的CTA血管表现。
材料与方法
2009年10月至2011年2月因可疑肝脏占位在兰州大学第二医院放射科行上腹部CT平扫及增强扫描检查的患者84例。
选取其中44例作为病例组。病例组纳入标准：(1)已经由磁共振成像(Magnet ic Resonance Image, MRI)或者B超诊断为肝脏疾病后又行上腹部CTA检查的患者。(2)心肺和’肾功能基本正常,既往无肾功能损伤病史及严重心脏疾病病史的患者。
对组选取,10例,对照组纳入标准：肝脏无异常强化病灶患者、局灶性脂肪肝、少量的肝脏小囊肿、单个小血管瘤(≤2cm)以及对肝血流无明显影响病变或远处疾病等病例；
排除标准：(1)造影剂过敏试验阳性者；(2)患严重糖尿病、重症高血压等严重内科疾病以及其他原因不能耐受高增强扫描过程的患者；(3)不能耐受实验要求的注射速率的患者；(4)胃肠道未准备或胃肠道准备较差病人。
所有84例患者均行上腹部CTA检查。其中男53例,女31例,年龄13-88岁,平均每羚56.5岁。体重43-90kg,平均54.78kg。病例组44例中：肝血管瘤(HCH≥3cm)8例,肝转移瘤(MHT)12例,原发性肝细胞肝癌(PHC)23例,局灶性结节样增生(FNH)1例。所有PHC病例中有12例为穿刺活检或手术证实,4例为肝癌治疗后,7例为临床综合诊断；MHT均明确了原发病灶或者有原发病史；HCH中4例为手术或穿刺活检证实,2例为诊断血管瘤术后1-2年的随访病例,其余为临床综合诊断,FNH为术后病理证实。所有病例组患者中有7例进行过减影血管造影术(digital subtraction angiography,DSA)检查,1例行肝移植术；
患者检查前30-45min口服清水500-1000ml,以充盈胃肠道。全部病例均先行腹部平扫,然后从肘正中静脉注入造影剂先进行吸气并屏气状态下的小剂量同层动态测试法(Test Bolus)扫描试验监测腹主动脉,得到同层面腹主动脉的时间密度曲线,研究病例组与正常对照组腹主动脉峰值时间的差异性；然后在智能追踪技术(Smart Prep)对腹主动脉追踪下行肝动脉期(hepatic arterial phase, HAP)扫描,数据统计指标包括时间、CT值(或称密度),所有图像均以最小层厚1mm、间隔0.7mrn重建,重建图像传至西门子工作站。所有病例的图像均采用最大密度投影(MIP)和容积再现(VR)及多平面重建(MPR)三种方法进行后处理重建。所有重建图像由2名高资历的影像医师阅片并诊断。肝动脉CTA图像质量独立进行3级评分,仅显示肝动脉第一级分支记1分。可清晰显示肝动脉的第二级分支记2分,可清晰显示肝动脉的第三级或更进一步分支记3分。
结果：
1.根据各组腹主动脉平均CT值和括弧中所标记时间点或时间段绘制腹主动脉时间密度曲线,从各时间点或时间段腹主动脉平均CT值高低可知,可见小剂量造影剂注射时候正常组腹主动脉强化高峰范围主要分布在21.4±2.3秒时间段。疾病组腹主动脉强化高峰范围主要分布在21.9±2.8秒时间段,二者无显著差异(P>0.05),以在大剂量造影剂注射时候肝脏动脉期启动扫描时间分别为注射造影剂后28.6±3.6秒、30.1±4.8秒,经配对检验,P>0.05,无显著性差异。这说明不管是在小剂量造影剂注射还是大剂量造影剂注射病例组及对照组在腹主动脉的强化峰值时间及HAP扫描的启动时间无明显差异。
2.PHC(23例)MHT(12例)、HCH(8例)三种病变的肝固有动脉平均内径测量分别为：PHC:4.96±0.58mm、MHT:3.45±0.27mm、HCH:3.31±0.28mm。显示PHC导致的肝固有动脉内径改变明显,与MHT及HCH相比存在着显著性差异(P=0.000),而MHT与HCH二者间的肝固有动脉内径变化无显著差异(P=0.74)。
3.MIP法与VR法对肝动脉分级的图像评价得分为：2.73±0.25和2.10±0.32,经统计学分析,图像后处理MIP法和VR法二者方法在评价肝动脉分级显示中存在显著性差异(P=0.000),MIP法优于VR法。
4.84例肝脏CTA检查所见：肝动脉表现为正常解剖共54例,占64%,存在各种正常变异的30例,占36%,其本组病例可以见到的Michels分型的有3种。所有变异病例中较多的是Michels Ⅸ型,共15例即：肝总动脉(CHA)起自于肠系膜上动脉(SMA),占17.9%,其次为MichelsⅢ型共9例即：替代肝右动脉(rRHA)来自肠系膜上动脉(SMA),占10.7%;最后MichelsⅦ型6例即：替代肝右动脉(rRHA)来自肠系膜上动脉(SMA)+副肝左动脉aLHA来自胃左动脉(LGA),占7.4%(图7-9)。
5.23例PHC中有20例动脉血管增粗、扩张,肝固有动脉管径达4.96±0.58mm,最粗内径达到5.96mm,有19例可见明显的动脉血管分支增多、紊乱,8例可见动脉~门静脉瘘。1例FNH肝内供血动脉明显增粗。8例HCH中有7例肝动脉及其分支无明显增粗,1例肝右动脉轻度增粗,管径达3.9mm。12例MHT中有10例血管无明显增粗,2例位于肝脏右叶的结肠癌患者血管有增粗,肝右动脉管径达3.9～4.7mm。同时原发性肝癌异位肿瘤血供来源中见胃左动脉供血3例,肝左侧动脉并膈下动脉供血1例。
结论：
1.在决定肝脏CTA各期扫描的启动时间方面,以腹主动脉作为参照靶血管标准的方法是完全可行的。剂量大小对腹主动脉峰值时间的影响具有明显的差异。肝脏区疾病对腹主动脉的峰值时间无显著的影响。
2.PHC导致的肝固有动脉内径改变明显,PHC与MHT及HCH相比存在着显著性差异。而MHT与HCH二者间的肝固有动脉内径变化无显著差异。
3.通过对2组共84例肝动脉正常解剖及变异的CTA的研究,表明64排螺旋CT肝动脉CTA能够如实的反应肝动脉解剖与变异,显示肝癌的供瘤血管及异位侧支来源,为临床手术、介入治疗及肝移植等提供更多重要信息。
Research purposes
1. To explore the64-slice spiral CT hepatic arterial imaging technology to study liver disease liver of64-slice CT angiography (computed tomography angiography, the CTA) depiction of time.
2. Study CTA hepatic artery of normal anatomy and variations display and guidance on the clinical value.
3. To investigate the intrahepatic common space-occupying lesions and liver cancer feeding artery CTA vascular performance.
Materials and Methods
January2009to February2011because of suspected liver occupying Lanzhou University Hospital Radiology line abdominal CT scan and enhanced scan in84patients.
Select one of44cases as the case group. The case group inclusion criteria:(1) has been diagnosed by magnetic resonance imaging (Magnetic Resonance Image, MRI) or B-CTA examination of patients with liver disease and then line the upper abdomen.(2) basic cardiopulmonary and renal function is normal, and no previous history of renal injury and in patients with a history of serious heart disease.
group selected40patients in the control group. Inclusion criteria:liver abnormalities strengthen lesions in patients with focal fatty liver, small liver cyst, a single small hemangioma (<2cm) and no significant effect on hepatic vascular lesions or distant disease and other cases;
Exclusion criteria:(1) contrast agent allergy test positive;(2) suffering from severe diabetes, severe hypertension and other serious medical illness and other reasons, patients can not tolerate high-enhanced scanning process;(3) can not tolerate the experimental requirements injection the rate of patients;(4) of the gastrointestinal tract is not ready or gastrointestinal ready to poor patient.
All84patients underwent upper abdominal CTA examination. There were53males and31females, aged13to88years, average antelope56.5years old.43～90kg, the average weight of54.78kg.:The case group and44cases of hepatic hemangioma (HCH≥3cm)8Li, liver metastases (MHT)12cases of hepatocellular carcinoma (PHC)23cases, focal nodular hyperplasia of FNH,. All PHC cases,12cases of biopsy or surgery confirmed four cases of liver cancer treatment, seven cases of general clinical diagnosis; MHT clear primary lesion or history of the primary disease; HCH four cases surgery or biopsy confirmed two cases for diagnostic the hemangioma after1to2years of follow-up cases, and the rest is a comprehensive clinical diagnosis, FNH postoperative pathology confirmed.Seven cases digital subtraction angiography (digital subtraction angiography, DSA) check, a routine liver transplantation in all patients in the case group.
Patients before the examination30～45min oral Shimizu500～1000ml, to filling the gastrointestinal tract. All cases were first abdominal plain Inhale and breath-hold state small dose of the same-layer dynamic test method (Test Bolus) scan test monitoring abdominal aortic injection of contrast agent, and then from the cubital vein, to get the same level of the abdominal aorta time density curve of the case group and the normal control group of abdominal aortic peak time differences; intelligent tracking technology (Smart Prep) and then tracking downstream hepatic arterial phase of the abdominal aorta (hepatic arterial phase, HAP) scanning, data statistical indicators including time, CT value (or density), all images are the smallest thickness lmm, interval0.7mrn reconstruction, the reconstructed image is transmitted to the Siemens workstation. All cases the images are maximum intensity projection (MIP) and volume rendering (VR) and multiplanar reconstruction (MPR) three methods of post-processing reconstruction. All the reconstructed image by the image of three highly qualified physicians and reading diagnosis. The hepatic artery CTA image quality independent3ratings only display the first level of the hepatic artery branch remember. Can clearly show the second level of the hepatic artery branch2points, can clearly show the third level of the hepatic artery or further branch in mind.
Results:
1. Mark the point in time or time period draws abdominal aortic time-density curve, from the level of the average CT value for each point in time or time period abdominal aortic shows, we can see a small dose of contrast agent injection when the groups abdominal aorta mean CT value and in parentheses normal group abdominal aortic strengthen peak range is mainly distributed in the time period of21.4±2.3seconds. Disease group abdominal aortic enhancement peak mainly distributed in21.9±2.8seconds time period, no significant difference (P>0.05), a large dose of contrast agent injection when start the scan time of the hepatic arterial phase after injection of contrast medium28.6±3.6seconds,30.1±4.8seconds, paired test, P>0.05, no significant difference. This disease group, whether it is in the small dose of contrast agent injection or large doses of contrast agent injection in abdominal aortic peak enhancement time has no effect.
2. PHC (23cases) MHT (12cases), HCH (8cases), three groups of hepatic artery average inner diameter measurements show that the average diameter measurement of the hepatic artery three lesions were:PHC:4.96±0.58mm, MHT:3.45±0.27mm, HCH:3.31±0.28mm. Three groups between the PHC cause hepatic artery diameter change significantly compared with MHT and HCH there is a significant difference (P=0.000), hepatic arterial diameter in both MHT and HCH were no significant differences hepatic artery diameter change was no significant difference (P=0.74).
3. The MIP law and VR hepatic artery grading image evaluation score of:2.73±0.25and2.10±0.32, statistical analysis the MIP law and VR image post-processing method of both methods in evaluation hepatic artery grading in the presence of a significant difference (P=0.000), the MIP method is better than the VR method.
4. The84cases of liver CTA examination findings:hepatic artery showed normal anatomy of54cases (64%), there are30cases of normal variation accounted for36%. More variation cases Michels IX, a total of15cases:from the common hepatic artery (CHA) from the superior mesenteric artery (SMA), accounting for17.9%, followed by Michels Ⅲ type of9cases:instead of the right hepatic artery(rRHA) from the superior mesenteric artery (SMA), accounting for10.7%; final Michels Ⅷ6cases: the alternative right hepatic artery (rRHA) from the superior mesenteric artery (SMA) and Vice left hepatic artery aLHA the from the left gastric artery (LGA), accounting for7.4%.
5. The23cases PHC in20patients with arterial thickening, dilatation, hepatic artery diameter of4.96±0.58mm, most coarse inner diameter of5.96mm,19cases showed obvious arteries branch increased disorder, eight cases the visible artery to the portal vein fistula. One cases of FNH the intrahepatic feeding artery significantly enlarged. HCH in8cases,7cases of hepatic artery and its branches is no obvious thickening, cases of right hepatic artery mild thickening diameters up to3.9mm. MHT in12cases,10cases of blood vessels no obvious thickening, two cases of patients with colon cancer in the right lobe of liver vascular thickening of the right hepatic artery diameter of3.9to4.7mm. the same time see the left gastric artery, liver left artery and inferior phrenic artery cases primary liver ectopic tumor blood supply.
Conclusion
1.In the decision liver CTA scan start time, the abdominal aorta as a reference to the target vessel standard method is entirely feasible. The size of the dose peak time of the abdominal aorta with a significant difference. Area of the liver disease no significant effect on the peak time of the abdominal aorta.
2.The induced liver artery diameter in PHC to change significantly, PHC there is a significant difference compared with MHT and HCH. MHT HCH between the two changes in the inner diameter of the hepatic artery was no significant difference.
3.Normal anatomy and variations of two groups of84patients with hepatic artery CTA, indicating that the64-slice spiral CT hepatic artery CTA can truthfully reaction anatomical variation of the hepatic artery for liver cancer tumor blood vessels and ectopic collateral source for clinical surgery, interventional treatment of liver transplantation for more important information.
引文
[1]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]Hiart JR,Gabbay J,Busuttil RW.Surgical anatomy ofthe hepatic arteries in 1000 cases[J].Ann Surg,1994,220(1):50-52.
[3]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)：641643.[4]Foley WD,Karcaaltincaba M.Computed tomography angiograpby:principles and clinical application[J].J Comput Assist Tomogr,2003,27(1):23-30.
[5]唐秉航,李良才,何亚奇,等.中晚期肝癌动脉早期MSCT血管造影[J].放射学实践,2004,19(3)：194-198.
[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]Green D,Parker D.CTA and MRA:visualization without catheterization[J].Semin Ultrasound CT MR,2003,24(4):185-191.
[9]Ishigami K,Yoshimitsu K Irie H, et al. Accessory left gastric artery from left hepatic artery shown on MDCT and conventional angiography:correlation with CT hepatic arteriography[J]. AJRAm J Roentgenol,2006 Oct,187(4):1002-1009.
[10]Takayasu K,Mummatsu Y,'Furakawa N,et al.Early hepatocellular carcinoma:appearance at CT during arterial portography and CT anteriography with pathologic correlation[J].Radiology, 1995,194(7):101-104.
[11]Michels Nicholas A New anatomy of the liver and its variant blood supply and collateral circulation[J]. American Journal of Surgery,1966,112(2):337-347.
[27]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.
[12]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.
[13]王爽,赵心明,罗德红,等.多层螺旋C T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.
[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]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.
[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 offlow rates[J].J ComputAssist 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]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),2004,2/4(4)：364-367.
[19]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.
[20]Tanikake M,Shimizu T,Narabayashi I,et al.Three-dimensional CT angiography of the hepatic artery:rise of multi-detector row helical CT and a comtrast agent[J].Radiology,2003,227(3): 883-889.
[21]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.
[22]. 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.
[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]Kuszyk BS, Beauchamp NJ, Fishman EK. Neurovascular application of CTangiography[J]. Seminars in US, CT and MRI,1998,19(5):394-404.
[25]Covey AM, Brody LA, Maluccio MA, et al Variant hepatic artefial anatomyrevisited:digital subtraction angiography performed in 600 patients[J]. Radiology,2002,224(5):542-547.
[26]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.
[28]Macari M, Israel 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(7):519-523.
[29]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.
[30]Shimizu T, Misaki T'Yamamom 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.
[31]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,(3)：877-881.
[32]Atasoy C, Ozyurek E. Prevalence and types of main and right portal vein branching variations on MDCT[J]. AJR Am J Roentgeno,2006 Sep,187(3):676-681.
[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 ofthe hepatic arteries in 1000 cases[J].Ann Surg,1994,220(1):50-52.
[3]唐秉航,李良才,何亚奇,等.中晚期肝癌动脉早期MSCT血管造影[J].放射学实践,2004,19(3)：194-198.
[4]Foley WD,Karcaaltincaba M.Computed tomography angiograpby:principles and clinical application[J].J Comput Assist Tomogr,2003,27(Suppl 1):23-30.
[5]Takayasu K,Mummatsu Y,'Furakawa N,et al.Early hepatocellular carcinoma:appearance at CT during arterial portography and CT anteriography with pathologic correlation[J].Radiology,
1995,194(6):101. [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]Green D,Parker D.CTA and MRA:visualization without catheterization[J].Semin Ultrasound CT MR,2003,24(4):185-191.
[9]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,(3)：877-881.
[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)：641643.
[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]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.
[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]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.
[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 offlow rates[J].J
ComputAssist 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(l):83-88.
[18]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.
[19]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.
[20]Tanikake M,Shimizu T,Narabayashi I,et al.Three-dimensional CT angiography of the hepatic artery:rise of multi-detector row helical CT and a comtrast agent[J].Radiology,2003,227(3): 883-889.
[21]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.
[2]Hiart JR,Gabbay J,Busuttil RW.Surgical anatomy ofthe hepatic arteries in 1000 cases[J].Ann Surg,1994,220(1):50-52.
[3]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)：641643.[4]Foley WD,Karcaaltincaba M.Computed tomography angiograpby:principles and clinical application[J].J Comput Assist Tomogr,2003,27(1):23-30.
[5]唐秉航,李良才,何亚奇,等.中晚期肝癌动脉早期MSCT血管造影[J].放射学实践,2004,19(3)：194-198.
[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]Green D,Parker D.CTA and MRA:visualization without catheterization[J].Semin Ultrasound CT MR,2003,24(4):185-191.
[9]Ishigami K,Yoshimitsu K Irie H, et al. Accessory left gastric artery from left hepatic artery shown on MDCT and conventional angiography:correlation with CT hepatic arteriography[J]. AJRAm J Roentgenol,2006 Oct,187(4):1002-1009.
[10]Takayasu K,Mummatsu Y,'Furakawa N,et al.Early hepatocellular carcinoma:appearance at CT during arterial portography and CT anteriography with pathologic correlation[J].Radiology, 1995,194(7):101-104.
[11]Michels Nicholas A New anatomy of the liver and its variant blood supply and collateral circulation[J]. American Journal of Surgery,1966,112(2):337-347.
[27]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.
[12]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.
[13]王爽,赵心明,罗德红,等.多层螺旋C T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.
[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]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.
[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 offlow rates[J].J ComputAssist 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]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),2004,2/4(4)：364-367.
[19]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.
[20]Tanikake M,Shimizu T,Narabayashi I,et al.Three-dimensional CT angiography of the hepatic artery:rise of multi-detector row helical CT and a comtrast agent[J].Radiology,2003,227(3): 883-889.
[21]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.
[22]. 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.
[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]Kuszyk BS, Beauchamp NJ, Fishman EK. Neurovascular application of CTangiography[J]. Seminars in US, CT and MRI,1998,19(5):394-404.
[25]Covey AM, Brody LA, Maluccio MA, et al Variant hepatic artefial anatomyrevisited:digital subtraction angiography performed in 600 patients[J]. Radiology,2002,224(5):542-547.
[26]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.
[28]Macari M, Israel 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(7):519-523.
[29]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.
[30]Shimizu T, Misaki T'Yamamom 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.
[31]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,(3)：877-881.
[32]Atasoy C, Ozyurek E. Prevalence and types of main and right portal vein branching variations on MDCT[J]. AJR Am J Roentgeno,2006 Sep,187(3):676-681.
[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 ofthe hepatic arteries in 1000 cases[J].Ann Surg,1994,220(1):50-52.
[3]唐秉航,李良才,何亚奇,等.中晚期肝癌动脉早期MSCT血管造影[J].放射学实践,2004,19(3)：194-198.
[4]Foley WD,Karcaaltincaba M.Computed tomography angiograpby:principles and clinical application[J].J Comput Assist Tomogr,2003,27(Suppl 1):23-30.
[5]Takayasu K,Mummatsu Y,'Furakawa N,et al.Early hepatocellular carcinoma:appearance at CT during arterial portography and CT anteriography with pathologic correlation[J].Radiology,
1995,194(6):101. [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]Green D,Parker D.CTA and MRA:visualization without catheterization[J].Semin Ultrasound CT MR,2003,24(4):185-191.
[9]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,(3)：877-881.
[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)：641643.
[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.
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