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目的显示正常人和肝细胞癌患者的右膈下动脉(R IPA),为经导管肝动脉化疗栓塞(TACE)提供有价值的解剖信息。方法对行腹部双期增强扫描的440例患者,包括133例肝细胞癌进行评价。采用16层螺旋CT(MSCT)对动脉期原始数据进行后处理重组,获得多平面重组(MPR)、曲面重组(CPR)和最大密度投影(M IP)图像。薄层和MPR、M IP图像由2名CT室诊断医生评阅并对R IPA进行确认。结果所有440例患者的R IPA均能显示,显示率为100%。在218例(49.5%)起源于主动脉的R IPA中,140例发自主动脉右侧,56例发自主动脉前壁,22例发自主动脉左侧,36例R IPA于左侧膈下动脉共同起源。R IPA起源均在腹腔干动脉上下1 cm水平。在138例起源于腹腔干动脉的R IPA中,95例为单独起源,10例与胃左动脉共同起源,33例与左膈下动脉共同起源。78例发自右肾动脉的R IPA均为独立发出,与左膈下动脉无关。133例肝细胞癌中,16例(12.0%)可见R IPA肝外供血,CT显示R IPA较左侧增粗,并供血至肿瘤内部。结论MSCT能很好地显示正常人和肝细胞癌患者的R IPA,可作为TACE术前、术后了解肝细胞癌肝外供血首选的非创性影像手段。
Objective To show the right subphrenic artery (R IPA) in normal and hepatocellular carcinoma patients and to provide valuable anatomic information for transcatheter arterial chemoembolization (TACE). Methods Forty-four patients undergoing double-phase enhanced abdominal biopsies, including 133 hepatocellular carcinomas, were evaluated. The 16-slice spiral CT (MSCT) was used to perform post-processing and reconstruction of the arterial phase raw data to obtain multiplanar reconstruction (MPR), surface reconstruction (CPR) and maximum density projection (MIP) images. Thin layer and MPR, M IP images were reviewed by two CT room diagnostics physicians and confirmed R IPA. Results All 440 patients showed R IPA, showing a rate of 100%. In 218 cases (49.5%) of R IPA originating in the aorta, 140 cases developed from the right side of the aorta, 56 from the anterior wall of the aorta, 22 from the left side of the aorta, and 36 cases of R IPA from the left subphrenic artery Common origin The origin of R IPA is 1 cm above and below the celiac artery. Of the 138 R IPA originated from the celiac artery, 95 had a single origin, 10 had a common origin with the left gastric artery, and 33 had a common origin with the left subphrenic artery. 78 cases of R IPA from the right renal artery were issued independently, and the left subphrenic artery has nothing to do. Of 133 HCCs, R IPA extrahepatic blood supply was seen in 16 (12.0%) patients. CT showed R IPA thickened to the left and blood was supplied to the tumor interior. Conclusion MSCT can well display R IPA in normal and hepatocellular carcinoma patients. It can be used as the noninvasive imaging modality for preoperative and postoperative hepatocellular carcinoma for extrahepatic donation of TACE.