多层CT血管成像诊断肝癌门静脉癌栓

Multi-slice CT angiography in diagnosis of portal vein tumor thrombus associated with hepatocellular carcinoma

目的 探讨多层CT血管成像 (MSCTA)技术在肝细胞癌 (HCC)合并门静脉癌栓 (PVTT)诊断中的应用价值。方法 对 12 7例行多层螺旋CT动态增强检查的HCC患者 ,分别以最大密度投影法 (MIP)、容积成像法 (VR )和多平面重建 (MPR)技术进行MSCTA成像 ,比较其中 62例HCC合并PVTT患者横断面与CTA图像在PVTT诊断中的差异。结果 MSCTA与横断面图像均能显示全部 43例门脉主干和 /或一级分支癌栓 ;横断面和CTA成像对门脉二级和三级以下分支PVTT以及长度 2cm以下PVTT的显示具有显著统计学差异。结论 MSCTA可明显增加门脉分支癌栓和门脉内较小癌栓的检出率 。

Objective To investigate value of multi-slice helical CT angiography (MSCTA) in the diagnosis of portal vein tumor thrombus (PVTT) in patients of hepatocellular carcinoma (HCC). Methods Total 127 consecutive HCC patients accepted dynamic enhancement examinations with MSCT. CTA was performed respectively with MIP, VR and MPR techniques for all patients, and PVTT were found in 62 patients. Transverse images and CTA images were compared in the diagnosis of PVTT. Results Both transverse and CTA images showed all nutritious artery of PVTT in 43 cases, but the source of nutritious artery were only depictted in CTA images in 14 cases. In all 30 cases with PVTT in class two branches and 15 cases in class three and smaller branches, transverse images respectively displayed 24 and 3 cases, and CTA images respectively displayed 30 and 14 cases. All PVTT beyond 2 cm in length were clearly displayed both in transverse and CTA images. CTA images displayed 20 cases and transverse images displayed in 5 of 21 cases with PVTT within 2 cm in length. Statistical analysis indicated significant statistical difference between transverse and CTA images in displaying PVTT located in class two, class three and smaller branches of portal vein, and PVTT within 2 cm in length. Conclusion Dynamic enhancement examination with MSCT combined with CTA techniques can preoperatively display the source of the nutritious artery of PVTT in the main trunk and class one branches, remarkably improve the detection rate of PVTT in the branches of portal vein and smaller PVTT.