肝细胞癌合并门静脉癌栓的多层螺旋CT诊断及临床意义

Tumor thrombus of the portal vein in hepatocellular carcinoma: multi-slice spiral CT features and clinical significance

目的探讨肝细胞癌(HCC)合并门静脉癌栓(TTPV)的发生机制与多层螺旋CT(MSCT)动态增强表现的关系,评价MSCT在诊断TTPV中的优势及临床意义。方法对268例HCC患者进行肝脏MSCT动态增强检查,共发现56例TTPV,结合DSA表现综合分析。结果56例TTPV患者在MSCT动态增强扫描时均显示出门静脉内癌栓及相关的阳性征象:表现为门静脉扩张、门静脉腔内充盈缺损及“门静脉铸形”、门静脉癌栓内及其周围可见网状供血动脉、肝动脉门静脉分流(APS)以及肝脏灌注异常等。有3例TTPV在DSA上显示不明显。结论MSCT可判断TTPV的发生机制、供血来源及血供的丰富程度、栓子的良恶性及范围、有否合并APS及分流量大小以及与周围组织结构的关系。TTPV的MSCT诊断对指导肝癌的治疗具有重要意义。

Objective To evaluate the relation of dynamic enhanced multi-slice spiral CT (MSCT) features and the generative mechanisms of tumor thrombus of the portal vein (TTPV) in hepatocellular carcinoma (HCC), and to assess the CT diagnostic advantage and clinical value. Methods Two hundred and sixty-eight patients with HCC received dynamic enhanced MSCT scan of the liver and 56 cases with TTPV were found. MSCT signs of 56 cases with TTPV were studied and analyzed with DSA findings. Results All the 56 patients with TTPV had positive CT findings related to TTPV, which were dilation of portal vein (PV), filling defect within PV and 'PV casting', network artery in embolus and surroundings of PV, arterioportal shunt (APS) and hepatic abnormal perfusion. Three cases had no positive DSA findings related to TTPV. Conclusion The dynamic enhanced MSCT can assess the TTPV's generative mechanisms, blood-supplying source and abundance, benignity or malignancy and extend of embolus, combined APS or not and shunting quantity, and relationship with surrounding structures. MSCT diagnosis of TTPV is of important clinical significance in the treatment of HCC.