CAJ | 학술논문

目的探讨CT动态增强扫描在兔钝性肝损伤(rabbit hepatic injury,BHI)模型中的诊断价值.方法新西兰大白兔40只,采用钢球自由落体对剑突直接撞击,建立兔BHI模型.采用美国通用(GE)公司Hispeed双螺旋CT机行肝脏平扫及增强,注射对比剂开始后8～10 s、35～40 s、120～150 s分别为肝动脉期、门脉期及平衡期.观察增强前后损伤的位置、范围、边界、肝包膜撕裂、有无活动性出血、主要肝静脉有无受累及腹腔积血的CT特征,并与大体解剖情况对比.结果动态增强扫描显示率明显高于平扫,单一撕裂13只,多发性撕裂伤18只,肝包膜下血肿7处,肝实质内血肿9处,肝包膜裂口17只25处,活动性出血9处,主要肝静脉损伤5处;与大体解剖符合情况分别为13/13(只),18/18(只),7/9(处),9/9(处),25/30(处),9/5(处),5/4(处).按Moore分级,CT/剖腹探查结果分别为:Ⅰ级5/4只,Ⅱ级15/13只,Ⅲ级9/11只,Ⅳ级6/6只,Ⅴ级1/2只,Ⅵ级0只.结论动态CT增强扫描尤其静脉期和平衡期对明确有无肝脏损伤及判断损伤程度具有重要的价值.
목적 탐토CT동태증강소묘재토둔성간손상(rabbit hepatic injury,BHI)모형중적진단개치.방법 신서란대백토40지,채용강구자유락체대검돌직접당격,건립토BHI모형.채용미국통용(GE)공사Hispeed쌍라선CT궤행간장평소급증강,주사대비제개시후8～10 s、35～40 s、120～150 s분별위간동맥기、문맥기급평형기.관찰증강전후손상적위치、범위、변계、간포막시렬、유무활동성출혈、주요간정맥유무수루급복강적혈적CT특정,병여대체해부정황대비.결과 동태증강소묘현시솔명현고우평소,단일시렬13지,다발성시렬상18지,간포막하혈종7처,간실질내혈종9처,간포막렬구17지25처,활동성출혈9처,주요간정맥손상5처;여대체해부부합정황분별위13/13(지),18/18(지),7/9(처),9/9(처),25/30(처),9/5(처),5/4(처).안Moore분급,CT/부복탐사결과분별위:Ⅰ급5/4지,Ⅱ급15/13지,Ⅲ급9/11지,Ⅳ급6/6지,Ⅴ급1/2지,Ⅵ급0지.결론 동태CT증강소묘우기정맥기화평형기대명학유무간장손상급판단손상정도구유중요적개치.
Objective To analyze the features of dynamic contrast-enhanced CT of blunt hepatic injury in rabbits. Methods The model of blunt hepatic injury was established in 40 New Zealand white rabbits with a steel ball falling down to the xiphoid process of the animals. Plain CT scan and dynamic contrast-enhanced CT scan (Hispeed spiral CT/2i, GE, America) of the liver were performed. Arterial,portal and balanced phases were respectively at 8-10 s, 35-40 s and 120-150 s after initiation of the contrast medium injection. The non-enhanced and enhanced images were compared in aspects of location and range of injury, tear of the liver capsule, active bleeding, involvement of the main hepatic veins and CT features of abdominal hemorrhage, which was further compared with the results of gross anatomy. Results The rate of plain CT scan was obviously lower than that of dynamic contrast-enhanced CT scan,which defined single tear in 13 patients, multiple lacerations in 18, liver subcapsular hematoma in seven,liver hematoma in nine, liver coated gap in 17, active bleeding in nine and main hepatic vein injury in five, with coincidence rates with the results of gross observation for 13/13,18/18,7/9,9/9,25/30,9/5and 5/4 respectively. According to Moore' s classification, CT/Laparotomy performed from grade Ⅰ to grade Ⅵ were 5/4 patients at grade Ⅰ , 15/13 at grade Ⅱ, 9/11 at grade, 5/6 at grade Ⅳ, 1/2 at grade Ⅴ, O at grade respectively. Conclusion Dynamic contrast-enhanced CT scan, especially at portal and balanced phases, is of great value for diagnoses of liver injuries and determination of injury severity.