| Research purposes1. 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 MethodsJanuary2009to 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.Conclusion1.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. |
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