64层螺旋CT门静脉造影对门静脉高压侧支循环的研究

Portography diagnotic value of collateral circulation of portal hypertension on 64-slice spiral CT

目的评价64层螺旋CT门静脉造影对门静脉高压侧支循环的诊断价值。方法正常者30例、肝硬化患者27例,行64层螺旋CT门静脉造影检查,容积数据采用最大强度投影法(MIP)、容积再现法(VR)及多平面重组法(MPR)三维重建,观察门静脉高压肝内门静脉、属支及侧支循环的影像学特征。结果64层螺旋CT门静脉造影能准确显示侧支循环分布范围、初步评估病变程度;门静脉高压症组门静脉属支管径显著大于正常组(P=0.000);肝功能对于其管径改变无显著影响(P值分别为0.343、0.778、0.367、0.370);脾/胃-肾静脉分流的存在对门静脉直径有影响(P=0.000);脾静脉与胃左静脉共同分担门静脉压力及参与胃脾区高压形成,两者直径呈正相关性(r=0.653,P=0.000);64层螺旋CT诊断食管胃底静脉曲张与胃镜诊断有高度一致性(Kappa值为0.832)。结论64层螺旋CT门静脉造影能够多角度、立体观察侧支循环情况,对预测其并发症、手术方案的制定具有重要的指导意义。

Objective To evaluate the portography diagnotic value in portosystemic collateral shunts of portal hypertension with 64-slice spiral CT.Methods Thirty normal subjects and 27 liver cirrhosis patients were performed by MSCTP.MIP,VR and MPR were employed for three-dimensional reconstruction.The images of portal venous grades and collateral shunts were estimated and compared.Results Collateral circulation in liver cirrhosis cases were displayed well,and the extent was accessed preliminarily.The portal system diameter of liver cirrhosis group was larger than normal group significantly（main portal vein,splenic vein,superior mesenteric vein,P=0.000）.The portal system diameter of different groups according to hepatic function showed no significant deviation（P=0.343,0.778,0.367,0.370）.There was significant deviation between gastro-renal or spleno-renal shunt and no gastro-renal or spleno-renal shunt cases.The width of portal vein was influenced by congenital shunt（P=0.000）.There was positive correlation between the width of splenic vein and left gastric vein were contrasted（r=0.653,P=0.000）.Both of them shared the pressure of portal vein and participated high pressure of the stomach and spleen regions simultaneouly.There was high consistence between 64-slice spiral CT and the gastroscope in the diagnosis of esophageal and gastric varices were diagnosed（Kappa=0.832）.Conclusion The portalgraphy of 64-slice CT can display portal venous system and compensatory circulation distinctly and stereoscopically.The portography of 64-slice CT can predicate the complication and the decision of approaches for the surgical treatment.