CT血管成像对肝细胞癌合并肝动脉-门静脉分流的诊断价值

The clinical significance of CT angiography in the diagnosis of arterioportal shunts associated with hepatocellular carcinoma

目的探讨 CT 血管成像(CTA)对肝细胞癌(HCC)合并肝动脉-门静脉分流(APS)的诊断价值。方法 127例 HCC 患者分别接受肝脏多层螺旋 CT 动态增强扫描和 DSA 检查,间隔时间3～15 d。所有患者进行 CTA 检查,并以 DSA 为标准,对照分析 CT 动态增强扫描基础上进行 CTA 成像对 APS 的诊断价值。结果 DSA 证实52例(40.94%)HCC 患者合并 APS,中央型33例,周围型19例。CT 横断面与横断面基础上结合 CTA 诊断 APS 的敏感度均为94.23%(49/52),特异度分别为84.00%(63/75)和97.33%(73/75),正确率分别为88.19%(112/127)和96.06%(122/127),阳性预测值分别为80.33%(49/61)和96.08%(49/51),阴性预测值分别为95.45%(63/66)和96.05%(73/76)。CTA 排除了横断面 CT 对4例中央型 APS 和6例周围型 APS 的假阳性诊断。与 DSA 比较,多层螺旋 CT 对 APS 的分型符合率达88.46%(46/52),其中,中央型90.91%(30/33),周围型84.21%(16/19)。CTA 还直观地显示23例重度分流中央型 APS 的供血动脉,其中19例为肝固有动脉分支,4例为胃十二指肠动脉分支。结论在多层螺旋 CT 动态增强扫描基础上进行 CTA 成像,能有效提高 APS 诊断的特异度和正确率。

Objective To evaluate the clinical significance of CT angiography （CTA） in the diagnosis of arterioportal shunts （APS） associated with hepatocellular carcinoma （HCC）. Methods One hundred and twenty-seven consecutive HCC patients accepted both dynamic enhancement CT and DSA examinations. The interval between CT and DSA exam was from 3 to 15 days. Based on transverse CT images in hepatic artery phase, CTA was performed for all the patients. By contrast with DSA results, the capabilities of transverse CT and transverse images combined with CTA in APS diagnosis were analyzed. Results In all 127 HCC cases, 52 cases with APS were confirmed by DSA （ 40. 94% ）, 33 with central type of APS and 19 with peripheral type. Diagnostic sensitivity of APS based on transverse CT and combined CTA with transverse CT images were both 94. 23% （49/52）. However, specificity was 84.00% （63/75） and 97.33% （73/75）, respectively, accuracy was 88.19% （112/127） and 96. 06% （ 122/127）, the predictive value of positive cases was 80. 33% （49/61） and 96. 08% （49/51）, and the predictive value of negative cases was 95.45% （63/66） and 96. 05% （73/76）. Combined with CTA, false positive cases of 4 central type of APS and 6 peripheral type of APS were excluded which were demonstrated by transverse CT images. By contrast with DSA, the coincidence rate of the type of APS diagnosed by transverse images combined with CTA was 88.46% （ 46/52 ）, including 90. 91% （ 30/33 ） of central type of APS and 84. 21% （ 16/19 ） of peripheral type. The supplying arteries of central type of APS were intuitively displayed by CTA in 23 cases, 19 from proper hepatic artery and 4 from gastro-duodenal artery. Conclusion CTA techniques based on the dynamic enhancement CT exams could effectively promote the specificity and the accuracy of APS diagnosis.