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目的:探讨64层螺旋CT在活体肝移植供体术前评估中的临床应用价值。方法:活体肝移植术前对拟捐肝者257例行64层螺旋CT检查。扫描序列包括碘浓度监测扫描,自动触发技术进行的肝动脉期、门脉期以及肝静脉期等3期扫描。延迟扫描时间,动脉期22~25 s(中位数23 s),门脉期42~53 s(中位数47 s),肝静脉期65~75 s(中位数70 s)。对比剂注射模式为5 mL/s生理盐水20 mL+暂停+4~5 mL/s对比剂70~120 mL+5 mL/s生理盐水30 mL。图像后处理包括肝脏管道系统重组和肝体积测量。用多平面重组、最大密度投影和容积再现等方法,显示肝动脉、门脉和肝静脉。活体肝体积测量有全肝体积,包括肝中静脉的右半肝体积和不包括肝中静脉的右半肝体积。在同一扫描时相上,测量肝脏和脾脏的CT值,并计算肝脾CT值比值。结果:拟捐肝者257例中,184例行肝移植手术。其中,179例供体接受不包含肝中静脉的右半肝移植。4例双供肝,1例合肝。全部捐肝供体术后恢复良好,无重大并发症和死亡发生。利用64层螺旋CT可对肝脏进行多时相扫描,以及二维、三维图像重组和肝体积测量。结论:64层螺旋CT多时相扫描,二维、三维图像重组和肝体积测量,可为临床活体肝移植术前的供体影像学评估,提供准确、全面的信息。
Objective: To investigate the clinical value of 64-slice spiral CT in preoperative evaluation of living donor liver transplantation. Methods: Before living donor liver transplantation, 257 spiral CT was performed on 257 patients who were to be donated. Scanning sequences included iodine concentration monitoring and scanning, automatic triggering of the hepatic artery phase, portal phase and hepatic venous phase and other 3 stages of scanning. Delayed scan time ranged from 22 to 25 s (median 23 s) in the arterial phase, 42 to 53 s (median 47 s) in the portal phase and 65 to 75 s in the hepatic vein (median 70 s). Contrast injection mode was 5 mL / s saline 20 mL + pause + 4 ~ 5 mL / s contrast agent 70 ~ 120 mL + 5 mL / s saline 30 mL. Image post-processing includes liver duct system remodeling and liver volume measurement. Hepatic arteries, portal veins, and hepatic veins were shown by multiplanar reconstruction, maximum density projection, and volumetric rendering. The living liver volume is measured as total liver volume, including the volume of the right hepatic half of the middle hepatic vein and the volume of the right hepatic half of the liver excluding the middle hepatic vein. In the same scanning phase, the measurement of liver and spleen CT value, and calculate the ratio of liver and spleen CT value. Results: Among the 257 cases to be donated, 184 cases underwent liver transplantation. Of these, 179 donors underwent right-sided liver transplantation without a medial hepatic vein. 4 cases of double donor liver, 1 case of liver. All donor liver donor recovered well without major complications and death. Multistep phase scanning of the liver, as well as 2D and 3D image reconstruction and liver volume measurements, were performed using 64-slice spiral CT. Conclusion: 64-slice spiral CT multi-time phase scan, two-dimensional, three-dimensional image reconstruction and liver volume measurement can provide accurate and comprehensive information for preoperative donor liver imaging.