多排螺旋CT血管成像技术对门静脉海绵样变性侧支血管的显示

Demonstration of Collateral Cavernous Vessels of Portal Vein by Multi-Detector-Row Spiral CT Angiography

目的 探讨肝细胞癌门静脉癌栓所致门静脉海绵样变性 (cavernoustransformationoftheportalvein ,CTPV)侧支血管的多排螺旋CT血管成像显示技术。方法 18例肝细胞癌门静脉癌栓所致CTPV患者 ,注入造影剂后行门脉期增强扫描 ,采用薄层图像重建后再行二维和三维血管成像 ,包括最大强度投影法 (MIP)、表面遮盖法(SSD)及容积再现技术 (VRT)。结果 MIP法血管成像能准确显示门静脉癌栓和CTPV侧支血管的情况 ,包括门静脉胆支 (胆囊静脉、胆管周围静脉丛 )和胃支 (胃左、右静脉 )等 ,而VRT效果较差 ,SSD效果最差。结论 采用MIP法重建的多排螺旋CT门静脉血管成像是显示门静脉癌栓和CTPV侧支血管的较好方法。

Objective To investigate the appropriate reconstruction techniques of multi-detector-row spiral CT angiography (MDCTA) to depict the collateral vessels in cavernous transformation of the portal vein (CTPV) caused by tumor thrombosis of hepatocellular carcinoma (HCC). Methods MDCTA scanning was performed during the portal venous phase after intravenous contrast materials in 18 HCC patients with CTPV induced by tumor thrombosis. Raw data were reconstructed with thin slice thickness followed by 2D and 3D angiographic reconstruction methods, including maximum intensity projection(MIP), shade surface display (SSD) and volume rendering technique(VRT). Results MDCTA with MIP reconstruction accurately depicted both the tumor thrombus within the portal vein and the collateral vessels of CTPV including the biliary (cystic vein and pericholedochal veinous plexus) and the gastric (left and right gastric veins) branches. However, VRT and SSD methods did poorly in showing the tumor thrombus and the collateral vessels. Conclusion MDCTA with MIP reconstruction is the method of choice to evaluate the collateral vessels of CTPV.