| Background: Ever since the coming out of CT in twenty century seventy era , with the prompt development of microelectronics and computer technology within these twenty years,CT equipments has also been developed and consummated.Spiral CT scanning is a new technique that invented recent years.It has lots of advantages such as high speed,wide covering surface,non-gap,collecting volume data,easing to reconstruct images from various forms and various angles.In the past,the observation of endo-hepatic blood vessels(hepatic artery,portal vein) from CT cross section enhanced images was not full-scale,and the space impression was vague,and hepatic segments and subsegments were nearly hard to display.With the application of MSCT(Multi-Slice Spiral CT) and its powerful image postprocessing workstation in clinic. The blood vessels above-mentioned could be imaged clearly and precisely though three-dimensional reconstruction technique.Multi-slice spiral CT angiography is an atraumatic method,which is a multiple utilization of CT scanning and three-dimensional reconstruction technique.Only need to inject contrast agent intravenously,we could obtain clearly,stereo,integrated blood vessel images without using arterial cannulation.Three-dimensional reconstruction technique is a method which is one of the image postprocessing technique.It means that the primary data processed by computer from spiral CT scanning will be experienced projection transition and negative image displaying disposition for purpose of reconstructing visualized stereo graph. The major image reconstruction techniques include Multi-planar reformation(MPR),Maximum intensity projection(MIP),Minimum intensity projection(MinP),Shaded surface display(SSD),Intracavitary reconstruction technique,Volume rendering(VR),Ray-sum projection(RSP)and so on.Hepatocellular carcinoma is one of the most common malignant tumors around the world. It has high morbidity which is ranging at the 5th position among the most common cancers around the world,and its high mortality range at the 3th position.There are more than half a million new cases per year. The carcinogenesis is so complicated that includes multifactor,multistep,polygene,multimutation and et al.Nowadays,it has been indicated that HBV and HCV are major factors contributing to hepatocarcinogenesis. HBV infection is main factor in our country,and patients of hepatocellular carcinoma who have been reported everywhere have gotten a anti-HCV infection rate at thirty percentage left and right.The diagnosis for this desease can be divided into qualitation diagnosis and level diagnosis.the former relies to AFP checking principally,and the later which have been commonly used as follow:ultrasonic imaging method,computerized tomography(CT),nuclear magnetic resonance(MRI),selectively hepatic angiography,radionuclide imaging,laparoscope,per cutem fine needle aspiration biopsy and so on.With the quick development of liver surgery,the therapeutic mode of hepatocellular carcinoma have been diversified gradually.now we believe that the best mode is operation. Generally,we believe that the tumor wholely cutted down,whose stump and remnant liver not yet be seen or touched by as tumor tissue,carcino- thrombus not be found in portal vein or hepatic vein,and non- metastasis should be considered as radical cure. Further more,while reaching the purpose of radical cure,how to protecting remnant liver function is still a hot spot in the research of liver surgery.Objective : Research the superiority of angiography of liver with three-dimensional reconstruction technique in MSCT and its instructive significance and application value in hepatocellular carcinoma according to preoperative evaluation,making operation scheme,estimating postoperative compensative function of liver and so on.Methods: From February,2005 to February ,2008,38 examples of patients who had been definitely diagnosed as hepatocellular carcinoma in China Japan Union Hospital of Ji Lin University were chosen. After preoperative plain scan and enhancement scanning in liver by using 64-Slice Spiral CT, we use MPR,MIP and VR techniques to reconstruct hepatic vessels,and then we could understand the construction,branches,courser,variation of hepatic artery,portal vein,hepatic vein and relationships between tumor and them,and we also compare the capability in displaying hepatic artery,portal vein and their branches across these three styles;Before operation we adopt the method of volume accumulation to measure tumor volume,prepared resecting volume,and we use MSCT to measure gross tumor volume,prepared resecting volume;After operation ,we adopt water displacement method to measure actual tumor volume and actual resected volume,and we use the method of surface area to measure adult standard liver volume and then calculate the remnant percentage.We distinguish three groups as A,B and C according to Child-Pugh system after operation ,and then we compare them according to the remnant percentage. Results: The reconstructed images in these 38 examples can clearly display abdominal aorta,celiac axis,hepatic artery,hepatic vein,portal system and their branches after reconstruction, the vessel wall is smooth and integrity,yielding,and the branches can be identified clearly,and some images could display branches above the 5th grade.It can display minimum branches of portal vein to the 6 grade and also in hepatic artery (common hepatic artery is the first grade).Though reconstructed images we can clearly understand structural relationship between liver and tumor,the location of tumor,surrounding blood supply,variation of hepatic artery.These three reconstruction styles(MPR,MIP,VR)have differences respectively which have significance in displaying origination and branches of blood vessel.MIP,VR have an advantage obviously to MPR from displaying tiny branches;MIP is a little better than VR in displaying branches of the 5th grade above;VR has an advantage obviously to MPR and MIP in displaying stereochemical structure of blood vessels;Comparing the estimating volume and prepared resecting volume by using MSCT with the actual volume and actual resected volume,the variance has not statistical significance (P>0.05).The comparision of hepatic function among these three groups after operation shows: The comparisions in ALT,AST,TBIL respectively between A and B all have results as P>0.05,the opposite results appear in comparing A with C,and comparing B with C as P<0.05,the comparisions in CHE and ALB though three groups have results as P>0.05. The comparision of remnant percentage among these three groups:A compares with B and C respectively getting results as P<0.05 each;the comparision between B and C get a result as P<0.05. Conclusion:Angiography of liver with three-dimensional reconstruction technique in MSCT has the characteristics of quickness,accuracy,high resolution,strong space sense,which is a atraumatic checking method for understanding the blood vessels of liver.While used in hepatocellular carcinoma,it can make surgeon understand clearly the construction and courser about the endo-hepatic vascular tissue,if there is any blood vessel variation and realm,blood supply,diversion and et al. of the tumor,it can reduce the risk and blindness while in operation to some extent; Though MSCT we can accurately measure the volume of liver tumor,prepared resecting volume and remnant percentage.It has fateful instructive significance to hepatocellular carcinoma according to the recovery of hepatic function after operation. |
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