肝动静脉分流影像诊断和介入治疗

Imaging diagnosis and interventional treatment of hepatic arteriovenous shunts

目的探讨肝动静脉分流(AVS)的DSA、CT表现与介入治疗的相关性。方法分析220例肝脏肿瘤患者的DSA、CT图像,发现肝动脉-门静脉分流(APS)35例,肝动脉-肝静脉分流(AHVS)2例。介入治疗模式:经肝动脉化疗栓塞(TACE)和经肝动脉灌注化疗(TAI)。介入治疗方式:钢圈+明胶海绵+化疗,明胶海绵+化疗,单纯化疗。结果APS的DSA表现为门脉主干及相应大分支清楚显示18例,门脉较小分支显示9例,较细分支显示8例;AHVS的DSA动脉期为:肝静脉显示一条或多条,表现为由细到粗,边缘清楚。APS的CT动态增强扫描为门静脉提前显示,而脾静脉或肠系膜上静脉还未显示;或一过性肝脏密度差异。当存在AHVS时,动脉期在膈顶下层面可见肝静脉显示。介入治疗:TACE 38例次,TAI 5例次。35例APS中,高流量11例,低流量24例;钢圈+明胶海绵+化疗5例次,明胶海绵+化疗33例次,单纯化疗5例次。结论DSA和CT检查相结合,能准确地诊断肝脏肿瘤有无合并动静脉分流;DSA可以确定分流的性质、流量的大小及部位,对介入治疗有指导作用。

Objective To investigate the correlation between the appearance of hepatic arteriovenous shunts（AVS） of the liver in digital subtraction angiography（DSA） arid multi-slice spiral CT and interventional treatment to the patients. Methods The DSA and CT images of 220 patients with liver tumors were investigated and analyzed, among which 35 cases with arterioportal shunts （APS） and 2 cases with hepatic arteriovenous shunts （AHVS） were detected. Two interventional treatment modes, they were transcatheter arterial chemoembolization （TACE） and transcatbeter arterial infusion （TAI）. Three schemes with different combination of treatments were adopted. The first scheme used combination of steel coils, gelfoam and iatrochemistry. Combination of gelfoam and iaterochemistry was applied in the second scheme while pure iaterochemistry was adopted in the third scheme. Results The appearance of APS in DSA indicated that the main branches of portal vein and its bigger branches of 18 cases could be clearly identified. Smaller branches of 9 cases and even smaller branches of 8 cases could also be clearly identified. The appearance of AHVS in DSA showed that one or more hepatic veins and their edges, varying from thin veins to thick ones, could be clearly showed. The CT dynamic contrast-enhanced of APS revealed that portal vein appeared in advance while the splenic vein or superior mesenteric vein never appeared. Transient hepatic attenuation difference was sometimes observed. To AHVS, hepatic veins were observed under the diaphragm. TACE was intervened therapy to 38 cases and TAI to 5 cases. Among 35 cases of APS, there were 11 cases with high flux and 24 cases with low flux. 5 cases received the first treatment scheme that combined steel coil, gelfoam and iatrochemistry. Combination of gelfoam and iatrochernistry was applied to 33 cases. 5 cases received pure iatrochenaistry in the third scheme. Conclusion With the combination of DSA and CT, it will be easier so diagnose accurately whether the liver tumor is accompanied with AVS. The characteristics of shunts and magnitude of flux in different places can be determined by DSA and this can provide important guides to the interventional treatment to the patients.