【作者】 王莉；

【导师】 薛雁山；

【作者基本信息】 山西医科大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 研究背景近年来,肝脏外科取得了突飞猛进的发展,活体肝移植已被公认为最有希望解决全球供肝来源短缺的技术方法,移植手术主要是沿一个特定的位于肝中静脉右侧的切面进行,而该切面相关的肝静脉和门静脉变异都可能导致手术方案的改变,在实施手术前充分掌握了解肝内静脉的解剖与变异是十分重要的。多层螺旋CT使用高分辨率扫描提供全肝容积成像,通过三维重组技术为临床医生提供了立体、形象的肝静脉、门静脉解剖及变异图象,为手术方案的制定及实施提供了重要的依据和指导。目的探讨16层螺旋CT显示肝静脉的价值,优化扫描延迟时间,并分析正常国人肝内门静脉和肝静脉的解剖变异及其肝脏分段关系。方法选取120例患者,其中70例分别于注射对比剂后30s、40s、50s、60s、70s、80s、90s(欧乃派克350mg/ml,2ml/Kg,以3.5ml/s的速度静脉注射)行肝区扫描。用横断面重建图像测量肝右静脉主干、门静脉主干及肝实质的CT值,并用重复设计资料的方差分析得到肝静脉、门静脉的最佳延迟时间。其余50例行常规CT增强扫描,将120例患者的重组原始图像进行最大密度投影法(maximum intensity projection,MIP)、多平面重组(multi-planar reformation,MPR)和容积再现法(volume rendering, VR)后处理。此外,还对120例患者的肝内门静脉和肝静脉的解剖变异进行了统计分析。结果分别绘制70例研究对象肝右静脉、肝实质及其差值的时间密度曲线均获得成功。1、对比70例患者30s-90s不同延迟时间肝静脉CT值得出⑴、延迟时间为30s、40s、50s时与其他各组比较差别均有统计学意义(P=0.00<0.05),其肝静脉CT值分别达到49.68 Hu、101.93 Hu、119.11 Hu。⑵、延迟时间为60s时与其他各组比较:60s与70s组间有统计学意义(P=0.00<0.05),60s与80s、60s与90s比较差别无统计学意义(P值分别为0.10、0.59);60s时肝静脉CT值为149.21 Hu。⑶、70s与80s、70s与90s、80s与90s比较差别均有统计学意义(P值分别为0.02、0.00、0.04)且70s时肝静脉CT值达到高峰172.54Hu。80s与90s时分别为158.13 Hu、151.79 Hu。⑷、结合30s-90s不同延迟时间肝实质及肝静脉与肝实质差值的CT值可以得出70s为肝静脉的最佳扫描延迟时间。2、120例患者中门静脉各型所占比例分别为:Ⅰ型99例(82.5%)、Ⅱ型11例(9.16%)、Ⅲ型7例(5.83%)、Ⅳ型3例(2.5%)。肝静脉Nakamura分型各型所占比例分别为Ⅰ型81例(67.5%)、Ⅱ型27例(22.5%)、Ⅲ型12例(10%);Marcos分型各型所占比例分别为Ⅰ型80例(66.67%)、Ⅱ型22例(18.33%)、Ⅲ型18例(15%)此外还有103例(85.83%)存在肝中静脉和肝左静脉共干。结论多层螺旋CT可以清晰地显示肝静脉、门静脉,可评价肝静脉及门静脉的解剖学特征,为肝脏活体移植,肝段甚至亚段切除术,肝外伤修补术及临床治疗相关肝脏疾病提供了可靠的肝内血管影像资料。更多还原

【Abstract】 Background In recent years, liver surgery has made rapid development, living donor liver transplantation has been recognized as the most promising technical methods to resolve the global shortage of donor sources .surgery is performed mainly along a specific section where is located in the right of middle hepatic vein, whereas The hepatic vein and portal vein anatomy variation may lead to changes in program operation, We know intrahepatic vein anatomy and variation is very important before pre-operative. Multislice spiral CT use high-speed、high-resolution scanning to provide a full liver volume imaging . Three-dimensional image of the hepatic vein, portal vein anatomy can provid an important basis and guidance for the formulation and implementation of the operation.Objective To explore the feasibility of 16 multislice spiral CT in evaluating hepatic veins to optimize the scan delay time, Furthurmore, to analyze the anatomy and variations of the intrahepatic portal vein and hepatic veins in normal chinese.Methods live contrast enhanced CT scan were performed in 70 patients at 30s、40s、50s、60s、70s、80s、90s after the initiation of injection. The CT value of the hepatic vein trunks,portal vein and liver were measured. The rest 50 patients only get liver contrast enhanced CT scan . All data were processed using post-processing software of maximum intensity projection, volume rendering, multi-planar reformation and the results of there post-processing techniques were compared. The qualitative assessment standards include the obvervable grade of intrahepatic venous branchs,the clearness of blood vessel margin, Furthermore, the anatomy and variations of the intrahepatic portal vein and hepatic veins are statistical analysed.Results The time-density curves of hepatic vein and liver were successfully obtained in 70 patients.⑴、Delay time of the 30s, 40s, 50s when compared with the other groups were statistically significant differences (P =0.00<0.05);⑵、Delay time of the 60s when compared with other groups: there is statistical significance between 60s and 70s groups (P = 0.00 <0.05 ); there is no significant difference between 60s and 80s, 60s and 90s(P values were 0.10、0.59 respectively);⑶、They have statistically significant difference between 70s and 80s, 70s and 90s, 80s and 90s(P values were 0.02、0.00、0.04 respectively). ⑷、Combined with the CT value of hepatic parenchyma、hepatic vein and liver parenchyma when the different delay time, 70s can be drawn as the best scan delay time.2、The rates of typeⅠ,typeⅡ,typeⅢand typeⅣof intrahepatic portal vein are 99cases(82.5%)、11cases ( 9.16% )、7cases(5.83%)、3cases ( 2.5% ) respectively..The rates of Nakamura typeⅠ,typeⅡ,typeⅢof hepatic vein are 81cases ( 67.5% )、27cases ( 22.5% )、12cases(10%)respectively. The rates of Marcos typeⅠ,typeⅡ,typeⅢof hepatic vein are 80cases(66.67%)、22cases(18.33%)、18cases(15%)respectively.There is common trunk in 85.83% of all the cases.Conclusion hepatic and portal vein were clearly demonstrated with MSCTA. MSCTA could visualize the anatomical features of hepatic and portal vein.The optimal image of the intrahepatic portal veins and hepatic veins can provide details of segmentation and vascular anatomy to facilitate clinical treatment , especially for liver transplantation.更多还原