The Clinical Application Of Multi-slice Spiral CT Angiography For Common Abdominal Tumors

There are so many organs in the abdomen,whose anatomy are complex,with plentiful blood supply.The tumor of abdimenal organs is common.Surgeons need to get the message of the vessel in the tumor and the blood-supply vessel of the tumor,when they draw up the treatment prescription.,which is the essential condition of formulating operation plan,meanwhile,is the critical evidence of determination whether it can put the surgical operation into practice for the patient. Digital subtraction angiography (DSA) is always used in the examination,which is conditionally considered as gold standard in observing the vessel.But this examination has high traumatic occlusion,high cost,high radiation dose,and it is nonselective.It can only supply the information of vessel while any other extravascular strctural information.It is inferior to MSCTA ,when displaying the scleratheroma and calcification of arterial well.MRA is a new nontraumatic technique of observing vessel .It can disply abdominal aorta very well without any contrast agent,but,it can not disply the abdominal aorta and small branch literally when imaging,with the reason of saturation in thedeck.It is apt to have pseudomorph of arterial stenosis. The patients with metal clips is prohibit to do this examination.After the appearance of the MSCT,it is spreaded rapidly.The superiority of MSCT,compared with conditional CT,is higher time resolution rate,higher special resolution on Z epaxial,less contrast agent dose,lower picture noise,larger coverage of dissection.Almost all the pathological changes of the large and medium-sized artery can be diagnosised with MSCTA .It can get more worthy message,and make the vascular evaluation of tumor preoperation to come true.Objective:to plan to apply 16-channel multi–detector row CT scanner to take the examination of CTA in abdominal common neoplastic disease.Rebuilded with VR,MPR,MIP and so on,to observe the feeding artery of the mass and the encroachment of the mass,to estimate the clinical value of the MSCTA in vascular evaluation of abdominal neoplastic disease,in order to choose correct treatment prescription for the clinic. Method:collected 110 patients with abdominal occupying lesion from 2006 to 2007.25 cases of primary hepatic carcinoma(PHC);13 cases of hepatic metastatic tumor(MHT);11 cases of hepatic focal nodularhyperplasia(FNH);10 cases of hemangiomas of liver(HCH);19 cases of pancreatic carcinoma(PC);2 cases of islet cell adenoma(ICA);20 cases of renal carcinoma(RC);10 cases of hamartoma of kidney(AML). All of the patient were examined by enhancedment scanning,supine position,drank 600-800ml water 10-15 minuts before scanning to engorge the gastrointestinal tract.The time of arterial phase is 20-25s.Reconstructed with 1.25 thickness and intermission,with the standard reconstruction.Then sent to the workstation (AW4.1) .Selected the arterial phase to reconstruct vessel,with the methods of VR, MPR and MIP respectively. Combined the reconstructive and primitive images to observe.Result: Volume rendering (VR),maximum intensity projection (MIP) and multiplanar reformation (MPR) were adopted and combind with original images to observe 110cases of common abdominal tumors. In 18 cases of feeding arteris were not seen. 105 feeding arteries were observed in 92 cases(83.6%).40 cases manifested with thickening and winding (59.7%),the branches of feeding arteries increased,33 cases manifested with derangement (49.2%),14 cases could be observed the arteries hang together.Theshap of mass feeding artery wasn't seen obviously abnormality in 40cases.In 13 cases of metastatic hepatic tumor(MHT);11 cases of hepatic focal nodular hyperplasia(FNH);10 cases of hepatic cavernous hemangiomas (HCH); 2 cases of islet cell adenoma(ICA);20 cases of renal Cell carcinoma(RCC);10 cases of renal amgioleiomyolipoma (AML),the mass lapsed and oppressed the vessel proximal ,but without destruction ,irregularity nor stiffness of the vessel wall.Refer to the relationship of pancreatic carcinoma and vessel proximal,we divided the HCC,PC and RC into four kinds of relationships:there was fat interspace between mass and vessel;convex contact between them;concave contact or partial encasement between them; tumor totally encased vessel.We discovered that arteries were encroached mainly in the way of encasement,vessel wall irregularity,lumina stenosis;veins were encroached in the way of mass invasion,vessel wall destruction, lumina stenosis even occlusion.These manifestations were related to histological characteristics of artery and vein.Conclusion:We undertook the research of the relationship between abdominal neoplastic process and vessel with MSCT , through VR,MIP andMPR reconstruction.The results indicated that MSCT could find the feeding artery of the mass,and show the shape of feeding artery and the relationship between the mass and vessel.It is helpful to diagnose the malignance of the mass to certain extents or malignant,and was instructive to provide a way of treatment and evaluation pre-operation and postoperation in clinical works.