Blomley M J, Albrecht T, Williamson R C, Allison D J
Department of Imaging, Hammersmith Hospital, London, UK.
Br J Radiol. 1998 Mar;71(843):268-75. doi: 10.1259/bjr.71.843.9616235.
The aim of this study was to investigate three-dimensional spiral computed tomography (3DCT) as an adjunct to routine pancreatic CT scanning, with particular regard to the identification of surgically important hepatic arterial anomalies, correlated with conventional visceral angiography. 32 patients underwent spiral CT scans prior to pancreatic surgery using established protocols. Oral contrast medium was used throughout. 150 ml of intravenous contrast medium was given at 3 ml s-1 with a 24 s spiral CT sequence starting 35 s after the start of infusion. Two protocols were employed, both with a pitch of 1:3 mm table feed/collimation (n = 17) and 5 mm table feed/collimation (n = 15). Overlapping (1 mm minimum) axial reformats were reconstructed. 3DCT shaded-surface displays of the visceral arteries were assessed for visceral arterial anomalies. Visceral angiography (n = 23) was independently correlated. Satisfactory 3D angiograms were performed in all but one patient, in whom the coeliac axis was missed. (i) 3 mm protocol: 3DCT (n = 17) showed three anomalous right hepatic arteries (ARHA), one trifurcation anomaly and one splenic artery with an aortic origin. Angiography (n = 11) confirmed these findings, although one patient with an ARHA did not have angiography. A left gastric arterial supply to the left liver was not detected. (ii) 5 mm protocol: 3DCT (n = 15) showed two cases of ARHA. While confirming these findings, angiography (n = 12) showed a third case of ARHA, in which the coeliac and superior mesenteric artery had very close origins. A left gastric supply to the left liver was also missed. It is concluded that satisfactory 3DCT is possible without changing existing scanning protocols, although narrow sections are required for the confident assessment of right hepatic arterial anomalies, and any left hepatic supply via the left gastric artery was poorly assessed in this series.
本研究的目的是探讨三维螺旋计算机断层扫描（3DCT）作为常规胰腺CT扫描的辅助手段，特别是在识别具有手术重要性的肝动脉异常方面，并与传统的内脏血管造影进行相关性研究。32例患者在胰腺手术前行螺旋CT扫描，采用既定方案。全程使用口服对比剂。以3 ml s-1的速度静脉注射150 ml对比剂，在注射开始35 s后启动24 s螺旋CT序列。采用了两种方案，层厚/准直分别为1:3 mm床进（n = 17）和5 mm床进/准直（n = 15）。重建重叠（最小1 mm）的轴向图像。对内脏动脉的3DCT表面阴影显示进行评估以发现内脏动脉异常。独立进行内脏血管造影（n = 23）并进行相关性分析。除1例漏诊腹腔干的患者外，其余所有患者均获得了满意的3D血管造影图像。（i）3 mm方案：3DCT（n = 17）显示3例右肝动脉异常（ARHA）、1例三叉分支异常和1例起源于主动脉的脾动脉。血管造影（n = 11）证实了这些发现，不过1例ARHA患者未进行血管造影。未检测到左肝由胃左动脉供血的情况。（ii）5 mm方案：3DCT（n = 15）显示2例ARHA。血管造影（n = 12）在证实这些发现的同时，还显示了第3例ARHA，其中腹腔干和肠系膜上动脉起源非常靠近。同样漏诊了左肝由胃左动脉供血的情况。结论是，在不改变现有扫描方案的情况下可以获得满意的3DCT图像，不过要可靠评估右肝动脉异常需要薄层扫描，而且本研究系列中对任何经胃左动脉的左肝供血情况评估不佳。
