胰体尾癌致脾梗塞及区域性门脉高压多层螺旋CT表现

Abnormal Splenic Vessels,Splenic Infarction and Secondary Segmental Portal Hypertension Invaded by Tumor of Body and Tail of Pancreas:Evaluation with Multi-Slice CT

目的:探讨胰体尾癌累及脾血管并发脾梗塞及胰源性区域性门脉高压(PSPH)的多层螺旋CT(MSCT)表现及临床意义。方法:对28例胰体、尾癌患者进行增强多排螺旋CT血管成像(MSCTA)检查,并进行后处理重建显示脾动、静脉受侵情况及侧支循环。结果:28例均累及脾动脉,表现为脾动脉受压、推移、包绕征象,12例受压,16例被包绕,脾脏梗塞CT表现为三角形无强化的低密度灶。累及脾静脉致胰源性门脉高压中,胃左静脉、胃短静脉、胃网膜静脉、胃结肠干、食管下段静脉曲张或扩张的比例分别为68%、77%、85%、48%、7%,无脐静脉开放。结论:MSCT不仅能显示脾动脉受侵及脾梗塞情况,而且能显示脾静脉受阻致胰源性门脉高压侧支循环的分布和走行,在胰腺体尾癌术前分期和评估PSPH方面具有重要的临床意义。

Objective To investigate the multi -slice CT （MSCT） manifestation and clinical significance of collaterals in tumor of body and tail of pancreas invading splenic vessel leading to splenic infarction and pancreatogenic segmental portal hypertension（ PSPH）. Methods MSCT findings of tumor of body and tail of pancreas in 28 cases were retrospectively analyzed. The image was reconstruced to display the splenic artery and the pattern of collateral pathways. Results The splenic arteries were invaded in all 28 cases and was displaced or embed by the tumor, in which 12 cases were displacement and 16 cases were embed. The CT manifestation of splenic infarction was non - enhancement triangle location. In splenic vein occlusion cases, leading to pancreatogenie segmental potal hypertension, some veins varicosed or dilated, including gastric left vein （68%） , gastric short vein （77%） , gastroepiploic vein （85%）, gastrocolic trunk （48%） ,and lower esophagus vein （7%） , but none of umbilical vein. Conclusion MSCT can not only demonstrate invaded splenic artery and splenic infarction, but also show characteristic anatomic distributions and pathways of PSPH. It is of clinical significance in preoperative staging of pancreatic tumors and evaluation of PSPH.