多切層電腦斷層的血管斷層攝影對肝腫瘤術前評估之應用

Application of CT Angiography of Multislice CT for Liver Carcinoma to Preoperative Evaluation

陳昭宏(Chau-Hong Chen) ； 劉永錡(Yung-Chi Lio) ； 葉志盛(Chih-Sheng Yeh) ； 鐘正國(Cheng-Kuo Chung) ； 呂嘉偉(Kar-Wai Lui)

《中華放射線技術學雜誌》 34卷1期 (2010/03) Pp. 35-41

https://doi.org/10.30045/CJRT.201003.0006

摘要

主要目的是在研究應用多切層電腦斷層儀進行血管攝影，作為肝腫瘤病患手術前肝臟血管檢查時的工具，在影像診斷上的價值，及評估使用多切層電腦斷層儀血管攝影(multidector CT angiography, MDCTA)的適應症，希望能夠利用電腦斷層非侵入性的優點進行血管攝影檢查，以減少手術前檢查引起併發症的風險，並能提供一張手術時的血管圖。研究的對象為四十二位經評估為需要切除手術治療的肝臟惡性腫瘤患者，長期接受多切層電腦斷層攝影的追蹤研究，以動脈相、靜脈相、延遲相三相掃描方式進行掃描，再利用影像處理工作站將原始影像的軸位數據，重新重組成多重平面資料，包括肝臟門靜脈、動脈及靜脈的肝臟血管容積重建技術(volume rendering technique, VRT)的三維影像，及最高密度投影(maximum intensity projection, MIP)的二維影像。將重組處理的影像分析註解指出重要血管變異處。然後將血管導管攝影、電腦斷層血管攝影及接受手術患者的實際結果互相比較及驗證。結果在四十二位病患中有十七位被檢查出有動脈異常的影像，包括右肝動脈異常五位，左肝動脈異常六位，上腸系膜動脈的附屬分枝異常供應肝臟右葉三位，左胃動脈的附屬分枝異常供應到肝臟左葉一位，腹腔動脈早期分支異常一位，腹腔動脈與上腸系膜動脈異常於同一開口一位。另外在門靜脈、肝臟靜脈的異常也能清楚的判讀出來。電腦斷層血管攝影提供了所有臨床相關資訊，這其中包括肝動脈、門靜脈和肝靜脈的解剖位置及肝臟腫瘤與相鄰靜脈構造的關係都能被顯示在電腦斷層的檢查影像上。如果手術前不能確切知道肝臟血管的相關資訊，百分之四十二左右的病患肝動脈供應將產生變化而且有可能會造成手術時間的延長，而多切層斷層掃描能在手術前提供肝臟血管結構一個有價值的資訊。

關鍵字

多切層電腦斷層儀 ； 電腦斷層血管攝影 ； 血管導管攝影

並列摘要

This study was aimed to evaluate the efficacy and the indication of CT angiogram for the preoperative survey of hepatic vessels in order to establish a complete hepatic vessels mapping and avoid the potential complications of operation. In our series, 42 patients of pathological proven hepatocellular carcinoma, who underwent surgical treatment, received mutli-detector dynamic CT scan examination without and with intravenous contrast administration. Post contrasted imaging could be divided into arterial, portovenous and delay phases. VRT and MIP of arterial and portovenous images were performed on post processing with focus on vascular variation. Hepatic artery variation on CT angiogram was then compared with conventional angiogram and surgical finding. In our study, 17 of 42 patients were found to have hepatic artery variation, including 5 right hepatic arteries, 6 left hepatic arteries, 3 replaced hepatic arteries from superior mesenteric arteries, 1 left accessory artery from left gastric artery, 1 celiac trunk variation, 1 common trunk of celiac trunk and superior mesenteric artery. Portal vein and hepatic vein variation were well demonstrated in our all patients. Conclusively, dynamic liver CT scan could provide a good mapping of hepatic artery, portal vein, hepatic vein and demonstrate the relation between the hepatic vessels and hepatomas in detail. Lack of preoperative hepatic vessel evaluation with CT scan study, operative time might be prolonged in about 42% patients.

並列關鍵字

Multidetector CT MDCT ； CT angiography ； Angiography