肝动脉-门静脉瘘多层螺旋CT诊断及临床意义

Multidetector Spiral CT Features and its Clinical Significance of Arterioportal Shunt

目的探讨肝动脉门静脉瘘(arterioportal shunt,APS)的多层螺旋CT(Multidetector spiral CT,MSCT)增强特征及形成机制,评价MSCT在APS诊断中的作用和临床意义。方法45例APS病变患者,采用8排螺旋CT平扫及增强扫描后,应用容积重建(volume rendering,VR)、多平面重组(Multi planar reconstructions,MPB)、最大密度投影(Maximum intensity projection,MIP)等方法对腹腔干、门静脉、下腔静脉及其主要分支进行三维重建分析。分析APS的CT特征及分流类型、程度。结果45例均有动脉期门静脉主干或分支提前显影。动脉期肝实质呈楔形、三角形、不规则形片异常强化39例。按分流部位分:中央型21例,周围型9例,混合型14例,弥漫型1例。按分流程度分为:轻度6例,中度26例,重度13例。结论MSCT能够明确APS诊断,初步判断APS的分流部位、类型和程度,对肝癌的综合治疗及APS的栓塞治疗有重要意义。

Objective To discuss Multidetector spiral CT features of arterioportal shunt（APS） and its mechanism and to evaluate MSCT diagnostic ability and clinical significance for APS. Methods Forty - five patients with APS were scanned by 8- detectors spiral CT, plan and enhancement were performed. We reconstructed the celiac mink,portal vein and their branches to three- dimensional vessel analysis by volume rendering（VR） technique, multiplanar reconstructions （MPR）and maximum intensity projection （MIP）technique. CT features of APS were analyzed and the category and degree of shunts were evaluate. Results Early opacification of main portal vein and its branches was seen in 45cases and triangular shape or irregular patchy enhancement was found in 39 cases during arterial phase. There were 45 APS, including 21 central, 9 peripheral, 14 mixed and 1 diffuse or 13 severe,26 moderate,6 mild APS. Conclusion MSCT can diagnose APS and judge position,the category and degree of shunt. MSCT diagnosis of APS is of important clinical significance in the treatment of HCC and APS.