Matsuki Mitsuru, Tanikake Masato, Kani Hiroyuki, Tatsugami Fuminari, Kanazawa Shuji, Kanamoto Takaaki, Inada Yuki, Yoshikawa Syushi, Narabayashi Isamu, Lee Sang-Woong, Nomura Eiji, Okuda Junji, Tanigawa Nobuhiko
Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka 569-8686, Japan.
AJR Am J Roentgenol. 2006 Apr;186(4):1079-85. doi: 10.2214/AJR.04.0733.
In this study, we evaluated the efficacy of dual-phase 3D CT angiography (CTA) during a single breath-hold using 16-MDCT in the assessment of vascular anatomy before laparoscopic gastrectomy.
The study involved 20 consecutive patients (10 men, 10 women; mean age, 59 years) scheduled for laparoscopic gastrectomy for the treatment of early gastric cancer. A dual-phase contrast-enhanced CT scan using 16-MDCT was obtained before laparoscopic gastrectomy. After rapid infusion of a nonionic contrast agent, arterial and venous phase scans were obtained serially with an interval of 15 sec during a single breath-hold of 31 sec. Three-dimensional CTA images in the arterial phase (3D CT arteriography) and venous phase (3D CT venography) were individually reconstructed using the volume-rendering technique, and then the images were fused together. We evaluated the detectability of the celiac trunk, left gastric artery (LGA), right gastric artery (RGA), left gastric coronary vein (LCV), Henle's gastrocolic trunk, right gastroepiploic vein (RGEV), and accessory right colic vein on 3D CTA to compare with surgical findings.
In all 20 patients, 3D CT arteriography and venography clearly showed the celiac trunk, LGA, RGA, Henle's gastrocolic trunk, RGEV, and accessory right colic vein, which were correctly identified during surgery. The branching pattern of the celiac trunk was classified as Michels type I in 19 patients and Michels type II in one patient. Imaging showed the RGA originating from the proper hepatic artery (PHA) in nine patients; from the gastroduodenal artery (GDA) in seven patients; and from the left hepatic artery (LHA) in four patients. In 12 patients, the LCV joined the portal vein (PV) and in eight, the splenic vein (SV). In all patients, the accessory right colic vein joined the RGEV, and Henle's gastrocolic trunk proximal to the joining point flowed to the superior mesenteric vein (SMV). In all 20 patients, the fused image simultaneously showed arteries and veins around the stomach, with no mismatch between the arterial and venous phase images. In 10 patients, the LCV joined the PV after running along the dorsal side of the PHA, common hepatic artery (CHA), or splenic artery (SA). In eight patients, the LCV joined the SV after running along the ventral side of the PHA, CHA, or SA. In two patients, the LCV joined the PV after running along the ventral side of the CHA, which correlated with the surgical findings. Both the sensitivity and positive predictive values of 3D CTA revealed 100% correct identification of the celiac trunk, LGA, RGA, LCV, Henle's gastrocolic trunk, RGEV, and accessory right colic vein.
Dual-phase 3D CTA using 16-MDCT clearly revealed individual arteries and veins around the stomach before laparoscopic gastrectomy. The fused image of 3D CT arteriography and venography during a single breath-hold enabled the simultaneous assessment of arteries and veins before laparoscopic gastrectomy.
在本研究中，我们评估了使用16层螺旋CT在单次屏气期间进行双期三维CT血管造影（CTA）在腹腔镜胃切除术术前评估血管解剖结构中的有效性。
本研究纳入了20例连续的计划行腹腔镜胃切除术治疗早期胃癌的患者（10例男性，10例女性；平均年龄59岁）。在腹腔镜胃切除术前行16层螺旋CT双期对比增强CT扫描。快速注入非离子型对比剂后，在31秒的单次屏气期间，每隔15秒连续进行动脉期和静脉期扫描。使用容积再现技术分别重建动脉期（三维CT动脉造影）和静脉期（三维CT静脉造影）的三维CTA图像，然后将图像融合在一起。我们在三维CTA上评估腹腔干、胃左动脉（LGA）、胃右动脉（RGA）、胃左冠状静脉（LCV）、亨氏胃结肠干、胃网膜右静脉（RGEV）和副右结肠静脉的可显示性，并与手术结果进行比较。
在所有20例患者中，三维CT动脉造影和静脉造影均清晰显示了腹腔干、LGA、RGA、亨氏胃结肠干、RGEV和副右结肠静脉，这些在手术中均被正确识别。腹腔干的分支模式在19例患者中被分类为米歇尔I型，1例患者为米歇尔II型。影像显示9例患者的RGA起源于肝固有动脉（PHA）；7例患者起源于胃十二指肠动脉（GDA）；4例患者起源于肝左动脉（LHA）。12例患者中，LCV汇入门静脉（PV），8例患者中，LCV汇入脾静脉（SV）。在所有患者中，副右结肠静脉汇入RGEV，且在汇入点近端的亨氏胃结肠干流向肠系膜上静脉（SMV）。在所有20例患者中，融合图像同时显示了胃周围的动脉和静脉，动脉期和静脉期图像之间无不匹配。10例患者中，LCV在沿PHA、肝总动脉（CHA）或脾动脉（SA）背侧走行后汇入PV。8例患者中，LCV在沿PHA、CHA或SA腹侧走行后汇入SV。2例患者中，LCV在沿CHA腹侧走行后汇入PV，这与手术结果相符。三维CTA的敏感性和阳性预测值均显示对腹腔干、LGA、RGA、LCV、亨氏胃结肠干、RGEV和副右结肠静脉的识别均100%正确。
使用16层螺旋CT的双期三维CTA在腹腔镜胃切除术术前清晰显示了胃周围的各条动脉和静脉。单次屏气期间的三维CT动脉造影和静脉造影融合图像能够在腹腔镜胃切除术术前同时评估动脉和静脉。
