64-slice Spiral CT Multi-mode Reconstruction And VR Fusion Technology In The Hilar Biliary Surgery Preoperative Evaluation

Objective: In patients who underwent laparoscopic cholecystectomy, applicationof64-slice spiral CT scan,a joint multi-mode reconstructed images(including multi-planar reconstruction,surface reconstruction and VR image fusion technology),fullydemonstrated the bile duct,hepatic artery and portal vein the anatomical relationshipbetween the variation as well as cases of stage,preoperative evaluation, surgicalplanning system,to provide detailed information.Materials and Methods: collected form June2010to April2012period at theDalian Central Hospital underwent hilar biliary surgery, preoperative64-slice CTenhanced scan,30patients (12males and18females,mean age45year), preoperativeexamination, applications for the first U.S.company GE gem spectrum of CT (theDiscover the HD750) and LightSpeedVCT128Floor,64-slice spiral CT imagingsystem, patient fasting,15min before scanning oral warm water500mL of filling thestomach cavity; supine breath, scan rang under the edge of the right-the diaphragmatictop to the second lumbar vertebra.After plain scan to determine the extent of disease,high pressure syringe(Germang Ulrich Missouri XD2001) through the antecubital veinwith4.0mL/s, the rate of injection of iodine contrast agent(Ultravist300mg/mL,BayerSchering AG),a dose of1.5mL/kg body weight, the use of intelligent trackingtechnology, select the descending aorta for monitoring the level and start a scan whenthe CT value reached150Hu capture the arterial phase,portal venous phase and venousphase three scanned images.Scan parameters: the standard reconstruction, pitch0.984:1,rotation speed0.6S,5mm thickness reconstruction interval of5mm,120KV,200~300MA,512×512matrix. Scanning is complete,the original image of complete,theoriginal image of the standard algorithm to0.625mm thickness,0.625intervals reconstruction, to obtain the axial source image processing workstation(the AxialSource Image ASI) transmitted to the GE AW4.5image, the reconstruction test resultsafter treatment were compared with intraoperative result.Results:30patients were satisfied with the image, including30cases of hepatic artery andhepatic clear left-right hepatic artery images,25cases of portal images to obtain theimage of the right hepatic artery branch of the cystic artery in10cases,10cases ofexpansion of the bile ductclearly show the successful integration of the images ofarteries, veins, bile duct,10cases.30patients,25cases of diagnostic imaging inpatients with gallstone and cholecystitis, laparoscopy of the above conclusions areconfirmed.Conclusion：In this study, a64-slice spiral CT in the country for the first time thesuccessful completion of the artery, portal vein and biliary system integration of theimage, fully depicts the anatomical relationship of three of the artery, portal vein andbiliary system, found that the anatomical variation, a detailed assessment of thelaparoscopic cholecystectomyand the laparotomy feasibility and difficulty. One cases ofdiagnostic imaging in patients with common bile duct stones. One cases of diagnosticimaging in patients with hilar cholangiocarcinoma, turn outside the hospital surgicaltreatment, follow-up confirmed.One patient diagnostic imaging for Mirizzi syndrome.Laparotomy, and surgery confirmed.