| ObjectiveThis study sought to explore the application and clinical significance of 64-MSCT by using 64-MSCT to do the three-dimensional reconstruction of the hepatic artery, portal vein and hepatic vein. In order to offer clinical applicable information on morphology, we measured the data of simulation channels puncture with right portal branch 1cm,2cm spot connect intermediate hepatic veins and right hepatic veins 1cm,2cm,3cm in patients who have no liver diseases and those who have cirrhosis Child-Pugh A, B grade.Methods1. 153 cases (80males, 73females) underwent the upper abdomen 64 - MSCT scan. Firstly the routine scan was performed, and then the hepatic artery scan was started after contrast medium was injected at median cubital vein, and the test of the celiac levels of abdominal aorta was performing by the smart tracking technology (Smart Prep). The data was processed for imaging on the GE ADW4.2 workstations. 2. 40 cases (10males, 30females) who have no liver diseases and 14 cases (7males, 7females) who have cirrhosis underwent the upper abdomen 64 - MSCT scan. Firstly the routine scan was performed, and then the hepatic artery scan, twice scans were performed after contrast medium was injected at median cubital vein, and the test of the celiac levels of abdominal aorta was performing by the smart tracking technology (Smart Prep). The data was processed for imaging on the GE ADW4.2 workstations.Results1. The classification of hepatic artery on 153 cases by Michels are as follows:①type I: 123 cases, 80.39% (123/153 cases);②type II: 3 cases, 1.96% (3/153 cases);③type III: 4 cases, 2.61% (4/153 cases);④typeⅣ: 3 cases, 1.96% (3/153 cases);⑤type V: 6 cases, 3.92% (6/153 cases);⑥type VI: 2 cases, 1.30% (2/153 cases);⑦typeⅦ:2 cases, 1.30% (2/153 cases);⑧typeⅧ: None;⑨type IX: 4 cases, 2.61% (4/153 cases );⑩type X: None.In addition, 6 cases, 3.92% (6/153 cases) can not belong to the Michels classification. Among them 2 cases are the left hepatic artery arises from the celiac trunk, 1.30% (2/153 cases); another 2 cases are the right hepatic artery arises from superior mesenteric artery and the left hepatic artery arises from the gastroduodenal artery, 1.30% (2/153 cases); one case is the common hepatic artery arises from the superior mesenteric artery, 0.65% (1/153 cases); the last one case is the artery of left lateral lobe and the artery of left medial lobe arises from the hepatic artery.2. The classification of hepatic portal vein on 153 cases are as follows:①type a: 128 cases, 83.66% (128/153 cases);②type b: 12 cases, 7.84% (12/153 cases);③type c: of 12 cases,7.84% (12/153 cases);④type d: none;⑤type e: 1 case, 0.65% (1/153 cases).3. The classification of hepatic vein on 153 cases are as follows:①Trifurcate: Left hepatic vein, middle hepatic vein and right hepatic vein opened into the inferior vena cava separately, 35.29% (54/153 cases);②Right hepatic vein was openings in the inferior vena cava. Left hepatic vein and middle hepatic vein confluence,before they join in the inferior vena cava, 41.83% (64/153 cases);③Right hepatic vein were openings in the inferior vena cava. Left hepatic vein and middle hepatic vein join and openings in the inferior vena cava, 20.91% (32/153 cases);④Middle hepatic vein was openings right hepatic vein. Left hepatic vein and middle hepatic vein openings in the inferior vena cava, 1.96% (3/ 53 cases).4. Intrahepatic portosystemic shunt hepatic veins angle the point of retrograde entrance (the internal jugular vein puncture channels) was significantly greater than angle of antegrade(via the femoral vein puncture channels).5. Normal group and cirrhosis Child-Pugh A, B grade group,ФMHV1,ФRHV1 have significant differences (P<0.05),ФRPV1, ФRPV2,ФMHV2,ФMHV3,ФRHV2,ФRHV3 have no significant differences. Normal right hepatic vein 1cm~2cm and middle hepatic vein 1cm~2cm diameter decreased rapidly compared with cirrhosis Child-Pugh A, B grade group.6. There were difference between normal and cirrhosis Child-Pugh A, B grade group in the simulation channels puncture of DMHV2-RPV1,DMHV3-RPV1,DMHV3-RPV2,DRHV1-RPV1. It shows that the right liver vein 1cm, 2cm, 3cm and portal vein 1cm, 2cm between the puncture point have DMHV1-RPV1>DMHV2-RPV1> DMHV3-RPV1, DMHV1 -RPV2>DMHV2-RPV2> DMHV3-RPV2, DRHV1-RPV1>DRHV2- RPV1 >DRHV3-RPV1, DRHV1-RPV2> DRHV2-RPV2>DRHV3-RPV2 in normal or cirrhosis Child-Pugh A, B grade.7.There have no significant difference in the angle of the vertical line of the normal group and the hepatic cirrhosis of group (α=0.05). The normal group vertical angle of the average water level was less than cirrhosis Child-Pugh A, B grade group.8. There have no significant difference in simulation channels hepatic vein puncture the export, import point of angle of the normal group and liver cirrhosis Child-Pugh A, B grade group (α=0.05).Conclusions1. 64-MSCT and the reconstruction methods offer a new research tool for anatomical structural study in vivo. 2. 64-MSCT and the three-dimensional reconstruction is an effective way to accurately measure the intrinsic liver vessels in vivo. It provides the anatomical information of hepatic artery, hepatic vein and portal vein in vivo.3. The inferior vena cava - right hepatic vein puncture retrograde channel is better than that right hepatic vein puncture channel, retrograde and antegrade puncture channel of middle hepatic vein.4. The study of the intrahepatic portosystemic shunt simulation can help to choose the appropriate length and type of the stents.5. There have no difference in simulation channels for puncture with middle hepatic vein and right hepatic vein from the entrance of IVC 1cm, 2cm, 3cm between the right of portal vein bifurcation 1cm, 2cm of normal group and cirrhosis Child-Pugh A, B grade group exception ofФMHV1,ФRHV1, DMHV2-RPV1, DMHV3-RPV1, DMHV3-RPV2, DRHV1- RPV1.6. There have opposite direction between the simulation puncture angle of the entrance and export in intrahepatic portosystemic shunt. The choice should be based on need.
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