Dual-phase spiral CT angiography with volumetric 3D rendering for preoperative liver transplant evaluation: preliminary observations.
Dual-phase spiral CT angiography with volumetric 3D rendering for preoperative liver transplant evaluation: preliminary observations.
复制标题
双相螺旋 CT 血管造影与体积 3D 渲染用于术前肝移植评估：初步观察。
DOI：
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发表时间：
1998
影响因子：
1.3
通讯作者：
E. Fishman
中科院分区：
文献类型：
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作者：
P. A. Smith;A. Klein;D. Heath;K. Chavin;E. Fishman
目的
我们研究的目的是确定双期螺旋CT血管造影与三维容积再现是否可用于术前评估和原位肝移植候选人的患者选择。
方法
采用螺旋CT双期扫描结合三维容积重建技术对50例肝移植候选者进行评价。静脉内造影剂以3 ml/s的速度团注外周注射。该方案包括对比增强螺旋CT双期扫描（在造影剂注射开始后30 s进行动脉期采集，然后在60 s开始进行门静脉期采集），扫描参数为0.75 s机架旋转速度，3 mm准直，5 - 6 mm/s扫描床速度，动脉期图像以1 mm间隔重建，门静脉期研究以3 mm准直（Siemens Plus 4扫描仪; Siemens Medical Systems，Iselin，NJ，U.S.A.）。将所有扫描信息发送至独立工作站（Silicon Graphics Onyx或Infinite Reality，山景，CA，U.S.A.）用于使用定制版本的Volren体积绘制器（Silicon Graphics; Advanced Imaging Laboratory，Johns霍普金斯医疗机构，巴尔的摩，MD，美国）进行交互式实时3D体积绘制。动脉期用于创建腹腔动脉轴的血管标测图，包括肝动脉的起点和上级肠系膜动脉的起点。门静脉期用于定义门静脉通畅性以及肝静脉解剖结构。分析所有图像的血管通畅性、分流或侧支化以及基础肝脏的状态（即，肝脏大小、肝硬化、肿瘤等）。
结果
所有50项研究均成功完成，无并发症。3D CT血管造影片定义了关键动脉和静脉结构，包括肝动脉、门静脉和/或上级肠系膜静脉血栓形成、门静脉海绵样变性和/或其他侧支血管系统的起源。10例患者（20%）显示肝动脉起点解剖异常。门静脉血栓形成伴门静脉海绵样变性6例，部分性门静脉血栓形成3例。明确定义了潜在的肝脏肿瘤以及实质性肝脏疾病。5例患者发现肝脏肿块。病理证实为肝细胞癌1例，巨大海绵状血管瘤1例，肝腺瘤1例，局灶性结节增生2例。
结论
初步结果表明，双期螺旋CT与CT血管造影可以提供一个全面的术前评估肝移植，病人的选择和手术计划提供必要的信息。作为一种单一的微创检查，这应该通过最大限度地减少手术和避免潜在的并发症来显著影响患者护理。
PURPOSE
The goal of our study was to determine whether dual-phase spiral CT angiography with 3D volume rendering could be used for preoperative evaluation and patient selection for orthotopic liver transplantation candidates.
METHOD
Fifty consecutive potential candidates for liver transplantation were evaluated with dual-phase spiral CT with 3D volume rendering. Intravenous contrast medium was administered as bolus peripheral injection at 3 ml/s. The protocol consisted of a contrast-enhanced dual-phase spiral CT (arterial phase acquisition at 30 s after initiation of contrast medium injection followed by portal venous phase beginning at 60 s) with scan parameters of 0.75 s gantry rotation speed, 3 mm collimation, 5 to 6 mm/s table speed, and reconstruction at 1 mm intervals for arterial-phase images and 3 mm collimation for portal venous-phase studies (Siemens Plus 4 scanner; Siemens Medical Systems, Iselin, NJ, U.S.A.). All scan information was sent to a free-standing workstation (Silicon Graphics Onyx or Infinite Reality, Mountain View, CA, U.S.A.) for interactive real-time 3D volume rendering using a customized version of the Volren volume renderer (Silicon Graphics; Advanced Imaging Laboratory, Johns Hopkins Medical Institutions, Baltimore, MD, U.S.A.). The arterial phase was used to create vascular maps of the celiac axis including the origin(s) of the hepatic artery and origin of the superior mesenteric artery. The portal phase was used to define portal venous patency as well as the hepatic venous anatomy. All images were analyzed for vascular patency, shunting, or collateralization as well as the status of the underlying liver (i.e., liver size, cirrhosis, tumor, etc.).
RESULTS
All 50 studies were successfully completed without complication. The 3D CT angiograms defined key arterial and venous structures including origin(s) of the hepatic artery, portal vein and/or superior mesenteric vein thrombosis, cavernous transformation of the portal vein, and/or other collateral vasculature. Ten patients (20%) demonstrated anomalous anatomy at the origin(s) of the hepatic artery. Portal vein thrombosis with cavernous transformation of the portal vein was shown in six patients, and there were three cases of partial venous thrombosis. Underlying liver tumors as well as parenchymal liver disease were well defined. Hepatic masses were found in five patients. Masses were pathologically proven as hepatocellular carcinoma (n = 1), giant cavernous hemangioma (n = 1), hepatic adenoma (n = 1), and focal nodular hyperplasia (n = 2).
CONCLUSION
Preliminary results suggest that dual-phase spiral CT with CT angiography can provide a comprehensive preoperative liver transplant evaluation, supplying the necessary information for patient selection and surgical planning. As a single, minimally invasive examination, this should significantly impact patient care by minimizing procedures and avoiding potential complications.