肝囊性包虫病的术前msct评价.pdf

摘 要 — 1 — D174192 肝囊性包虫病的术前多层螺旋CT 评价 研究生:王健导师:刘文亚教授摘要目的:分析肝囊性包虫病的多层螺旋 CT ( MSCT )表现,探讨 MSCT 以及三维重建图像在肝囊性包虫病术前评估的价值。方法:收集实施了外囊完整切除术并在术前有完善的影像学检查的 38 例肝囊性包虫病患者资料, 术前均行 64 层螺旋 CT 多期扫描,进行三维血管重建;怀疑病灶破入胆道的 3 例患者行阴性法胆管重建。与手术结果进行对照,评价 MSCT 及三维重建图像在病灶诊断、分型、并发症的判断及三维重图像判断血管/ 胆管受累的准确性。结果: 38 例患者 CT 检出 48 个病灶,判断病灶破入胆道 3例,其检出率和诊断准确率均为 100% ; CT 对病灶分型,单囊型 4 个,多子囊 29 个,内囊塌陷型 1 个,实变型 12 个、钙化型 4 个,错误分型 2 个病灶;血管重建图像显示病灶累及肝动脉一级血管 20 例、门静脉一级血管 22 例、下腔静脉 10 例,影像表现与术中所见完全相符;病灶累及肝动脉二级血管( 26 例) 、门静脉二级血管( 27 例) 、肝静脉( 31 例) 与手术对照的 Kappa 指数分别为 , , ; 3 例胆管成像所显示胆管与病灶的空间关系与术中所见相符。结论: MSCT 及三维重建图像能够对囊性肝包虫病灶进行准确诊断、分型, 能够判断其并发症,而且能够真实反映病灶与肝内血管/ 胆管的毗邻关系,与术中所见对照有较高的一致性,为临床医师客观评估手术风险及决定术式提供全面的影像学信息。关键词: 肝包虫;术前评价;三维成像;体层摄影术, X 线计算机新疆医科大学医学硕士学位论文 — 2 — Preoperative multi-slice spiral CT evaluation of hepatic cystic osis Postgraduate:Wang Jian Supervisor: Wen-ya Abstract Objective: To analyze the multi-slice spiral CT(MSCT) imaging and the three-dimensional reconstruction imaging of hepatic cystic osis (HCE) , and to evaluate the preoperative value of MSCT and its three-dimensional image. Method: Thirty-eight cases with HCE for pr eoperative diagnosis of the disease confirmed by radical surgery were collected in this study. All cases underwent multi-phase scanning with 64-slices CT, three-dimensiona l image reconstruction of hepatic vessels were performed. 3 cases suspected with bile plications were examined with negative CT cholangiograph. All the imaging dates were acquired before surgery. The diagnosis 、 type 、complication detected and spatial re lationships between cyst and the neighbor vessels/bile ducts were co mpared with the findings during operation. Results: Altogether 48 lesions were detected by MSCT before surgery. All the lesions were found and diagnosed correctly, including 3 cases ru ptured into biliary duct. The classification of the le sions with MSCT were T 1 4 lesions 、 T 2 29 lesions 、 T 3 1 lesion 、 T 4 14 lesions and