螺旋CT和DSA诊断肝细胞癌合并肝动脉-门静脉分流及癌栓的诊断对照分析

Arterioportal Shunt and Portal Vein Tumor Thrombosis Related to Hepatoma:a Correlative Study of Spiral CT and DSA

目的:探讨肝癌并肝动脉-门静脉分流(APS)及门静脉癌栓(PVTT)的CT和DSA表现,评价CT和DSA诊断不同类型APS及PVTT的临床应用价值。材料和方法:回顾性分析35例肝细胞癌并肝动脉-门静脉分流及门静脉癌栓患者的CT动态增强和DSA资料,将APS分为中央型、周围型和弥漫型;将PVTT分为Ⅰ、Ⅱ、Ⅲ、Ⅳ型,分析3种类型APS及四种类型PVTT的三期动态增强CT和DSA表现。结果:35例肝细胞癌合并肝动脉-门静脉分流及门静脉癌栓的病例中,CT动态增强共检出APS19例,其中中央型12例、周围型4例、弥漫型3例;DSA共检出APS27例,其中中央型12例、周围型10例、弥漫型5例。CT动态增强共检出PVTT20例,其中Ⅰ型1例、Ⅱ型9例、Ⅲ型8例、Ⅳ型2例;DSA共检出PVTT26例,其中Ⅰ型5例、Ⅱ型9例、Ⅲ型8例、Ⅳ型4例。对于APS合并PVTT的病例,CT动态增强共检出12例,DSA共检出16例。在周围型APS、Ⅰ型和Ⅳ型PVTT及周围型APS合并PVTT的诊断上,螺旋CT不及DSA(P<0.05)。结论:肝癌合并APS及PVTT具有特征性的CT和DSA表现。CT可准确地评价中央型和弥漫型APS及Ⅱ型和Ⅲ型PVTT,但在评价周围型APS、Ⅰ型和Ⅳ型PVTT及周围型APS合并PVTT方面较DSA仍存在一定差距。

Purpose： To investigate the CT and DSA features of arterio-portal shunts （APS） and porortal vein tumor thrombosis （PVTT） related to hepatoma and to evaluate the diagnostic value of CT and DSA in different types of APS and PVTT. Mater＇Ms and Methods： Thirty five cases with APS and PVTT related to hepatoma were studied using dynamic enhanced CT and DSA. APS was divided into three types, i. e. central type,peripheral type and diffuse type,PVTT was divided into four types,i, e. I type, Ⅱ type, Ⅲtype and Ⅳtype. CT and DSA findings of APS of these three types and PVTT of these four types were analyzed retrospectively. The value of CT and DSA in the diagnosis of APS and PVTT was evaluated. Results： Of the 35 cases with APS and PVTT related to hepatoma, 19 APS were depicted by CT;there were central APS （n = 12）,peripheral APS （n =4） and diffuse APS （n = 3 ）. Twenty seven APS were depicted by DSA;there were central APS （n = 12） ,peripheral APS （n = 10） and diffuse APS （n =5）. Twenty PVTT were depicted by CT;there were I type（n = 1 ）, Ⅱ type（n =9） , Ⅲtype （ n = 8） and Ⅳtype （ n = 2） ; Twenty six PVTT were depicted by DSA. There were I type （ n = 5 ）, Ⅱ type （ n = 9） , Ⅲtype （ n = 8 ） and Ⅳtype （n = 4）. Of the cases with APS merger PVTT related to hepatoma, 12 cases were depicted by dynamic enhanced CT, 16 cases were depicted by DSA. For the diagnosis of peripheral APS, of I type and IVtype PVTT, of peripheral APS merger PVTT, spiral CT was inferior to DSA （P 〈 0.05 ）. Conclusions： APS and PVTT related to hepatoma had characteristic CT and DSA features. Central APS and diffuse APS and Ⅱ type PVTT and m type PVTT could be accurately evaluated by dynamic enhanced CT,but for the diagnosis of peripheral APS and I type PVTT and IVtype PVTT and peripheral APS merger PVTT ,spiral CT was inferior to DSA.