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目的探讨CT血管造影(CT angiography,CTA)显示胃周动脉及其变异在胃癌术前评估中的应用价值。资料与方法对连续67例经胃镜活检证实或高度怀疑胃癌的患者,采用多层螺旋CT在患者服用产气粉和水(500～1000 ml)充分扩张胃后经静脉用压力注射器以3～4 ml/s的流率团注碘对比剂100 ml(碘必乐或碘普罗胺370),采用Bolus-Tracking追踪触发技术行三期增强扫描。在CT工作站采用容积再现(VR)和最大密度投影(MIP)重组CTA以显示胃周血管影像,重点分析变异动脉对手术方案的抉择与实施的影响,并与手术发现比较。结果 67例胃左动脉(LGA)均被显示,胃右动脉(RGA)的显示率为52.24%(35/67)。CTA显示12例胃周动脉变异。其中61例实施手术治疗,CTA获得的血管解剖信息与手术所见取得较好的一致性。结论 CTA能显示胃周主要动脉及其解剖变异,特别是与胃癌原发灶解剖密切相关并对手术实施有影响的血管,附加的CTA可以提高胃癌CT检查的成本效益比。
Objective To investigate the value of CT angiography (CTA) in the preoperative evaluation of gastric artery and its variation in gastric cancer. Materials and Methods A total of 67 patients with gastric cancer confirmed by biopsy or highly suspected gastric cancer were treated with multi-slice spiral CT in patients with gas-generating powder and water (500-1000 ml) to fully expand the stomach and intravenous pressure syringe to 3-4 ml iodine contrast bolus 100 ml (ibuprofen or iopromide 370) bolus-tracking follow-up triggering technique for three-phase enhanced scanning. In the CT workstation, Volume Reproduction (VR) and Maximum Density Projection (MIP) were used to display the images of the perivascular vessels. The focus was on the influence of the variant artery on the choice and implementation of the surgical plan, and compared with the surgical findings. Results 67 cases of left gastric artery (LGA) were shown, the rate of right gastric artery (RGA) was 52.24% (35/67). CTA showed 12 cases of gastric artery variability. Sixty-one patients underwent surgical treatment. The anatomic information obtained by CTA was consistent with the surgical findings. Conclusion CTA can show the main perineal arteries and their anatomical variations, especially those vessels that are closely related to the anatomy of gastric cancer and affect the operation. Additional CTA can improve the cost-effectiveness of CT in gastric cancer.