多普勒超声在原发性肝癌肝动-静脉瘘检测中的应用

Application of Doppler ultrasonography in detection of hepatocellular carcinoma-associated hepatic arteriovenous fistula

目的:应用二维及多普勒超声观察原发性肝癌肝动-静脉瘘(HAVF)的图像特征及血流动力学改变,评估超声在HAVF检测中的应用价值.方法:超声观察78例原发性肝癌患者门静脉、肝动脉、肝静脉、肝周以及肿瘤周围和内部血管走行及血流状态,测定血流动力学指标,并将超声检查结果与数字减影血管造影(DSA)对照.随访观察10例HAVF患者栓塞术后疗效.结果:①超声检出HAVF 25例,诊断灵敏度、特异度、准确度、假阳性率、假阴性率分别为83.33%,90.74%,88.46%,9.26%,16.67%;②与无HAVF的肝癌患者相比,伴有HAVF的患者肝动脉内径增宽[(0.42±0.09)cmvs(0.36±0.09)cm,P<0.01],血流阻力指数及搏动指数减低(P<0.01),发生瘘的静脉内可见五彩镶嵌样血流束,呈“高速低阻”样反向脉动样血流频谱,最大血流速度(96.8±30.1)cm/s;③复查10例肝动脉-门静脉瘘的患者,7例栓塞完全,3例仍可于门脉内检测到异常脉动样血流.结论:HAVF患者肝动脉及发生瘘的静脉多普勒指标呈特征性改变,可作为超声检测原发性肝癌HAVF的标准.多普勒超声有助于该病的临床诊断及治疗后随访观察.

AIM： To investigate the ultrasonographic characteristics and hemodynamics of hepatocellular carcinoma-associated hepatic arteriovenous fistula （HAVF） and evaluate the capability of two-dimensional and Doppler ultrasonography in detection of HAVF. METHODS： Seventy-eight patients diagnosed as hepatocellular carcinoma were enrolled in this study. The portal and hepatic veins, hepatic arteries and vessels around and inside the tumor were detected and the hemodynamic indices were recorded .with ultrasonography. The results from Doppler were compared with those from digital substraction angiography （DSA）. Ten patients with HAVF were followed up after the therapy of arterial embolization. RESULTS：① Twenty-five HAVF were detected by Doppler. The sensitivity, specificity, accuracy, false-positive rate and false-negative rate were 83.33%, 90.74%, 88.46%, 9.26% and 16.67%, respectively.② The diameters of hepatic artery of patients with HAVF were larger than those of patients without HAVF [（0.42 ±0.09） cm vs （0.36 ±0.09） cm,P〈 0.01 ]. Aliasing mosaic blood flow signals were displayed in the affected veins of HAVF with CDFI. The spectrum showed the characteristics of high velocity [ Vmax = （96.8 ± 30. 1 ） cm/s ] and the resistance and pulsatility indices of hepatic artery in HAVF were lower significantly than those of non-HAVF （P 〈 0.01 ）. ③ Ten patients with hepatic artery-portal vein fistula were followed up after embolization. Abnormal blood flow of portal vein disappeared in 7 and remained in 3 of them. CONCLUSION： HAVF in patients with hepatocellular carcinoma can be detected by ultrasonography, which is characterized by changes of hepatic arteries and veins involved in fistulas. These could be used for diagnosing HAVF and evaluating its arterial embolization effect in patients with hepatocellular carcinoma.