肝硬化非肿瘤性肝动脉门静脉分流DSA诊断价值

DSA diagnosis of nontumorous arterioportal shunt in cirrhosis

目的评价DSA对肝硬化非肿瘤性肝动脉门静脉分流(APS)的诊断价值。方法170例非肿瘤肝硬化患者在接受经肝动脉自体骨髓干细胞移植前行DSA检查。对造影图像进行动态播放观察,记录APS出现时相、持续时间和相应区域肝实质染色特点,对非肿瘤性APS和肝癌造影特征作鉴别。对术中发现的小肝癌行节段性TACE治疗。结果170例肝硬化患者DSA检查中31．7%显示了APS相关征象(54/170)。术前CT检查未见APS的142例中21．8%在DSA中显示了APS(31/142)。23例增强CT不均匀强化病例均有DSA阳性发现,其中16例诊断非肿瘤性APS,7例因CT动脉期局部密度增高区在门静脉期无明显低密度表现而不能确诊肿瘤者,经DSA诊断为小肝癌,其中1例伴有肿瘤性APS。结论DSA对肝硬化患者APS的发现率高,有助于肝内非肿瘤性改变与肝癌的鉴别诊断并指导介入治疗。

Objective To assess the diagnostic value of DSA for nontumorous arterioportal shunt in cirrhosis. Methods One hundred seventy cirrhotic patients without HCC under going transhepatic artery self bone marrow stem cell transplantation were taken liver arterial DSA together with 165 CT data. Arterioportal shunt （APS）appearance phase, persisting time and characteristics of liver parenchyma staining caused by APS were analyzed dynamically. Small HCC was differentiated from nontumorous APS. TACE procedure was done when HCC lesion was confirmed by DSA findings. Results 31.7%（54/170）DSA presented the sign of APS. Among the 142 cases with no evidence of APS on CT examinations, but APS was seen in DSA of 31 cases （21,8%）, All patients with CT findings of liver abnormal enhancement of AlaS, 23 cases including 16 cases as nontermorous and 7 cases whose CT arterial phase showing local persistant enhancement without declination in portal venous phase which were recognized to be HCC later by DSA characteristics with only one having tumorous APS. Conclusions DSA has a comparative high visualization rate of nontumorous APS in liver cirrhosis and benefits the differentiation with malignant lesions guiding the interventional procedure.