食管胃静脉曲张供血与分流血管CT三维成像研究

CT study on the blood supply and vein shunt of esophageal and gastric varices

目的:应用64层螺旋CT肝门静脉成像(CTPV)技术,探讨食管胃静脉曲张供血血管与分流血管解剖特征。方法:收集并分析我院64层螺旋CT肝门静脉成像及胃镜检查证实的食管胃静脉曲张50例。先常规平扫,后三期增强扫描,三维重建方法采用MIP、VR、MPR。结果:本组50例,食管静脉曲张几乎全部由胃左静脉供血,单纯由胃左静脉前支供血57.8%(26例),伴有食管旁静脉曲张82.2%(37例);胃底静脉曲张由单纯胃左静脉供血61.1%(22例),由胃短、胃后静脉供血11.1%(4例),由胃短、胃后、胃左静脉双重供血27.8%(10例)。脾/胃-肾静脉分流20%(10例)。结论:64层螺旋CT肝门静脉成像能立体、清晰地显示食管胃静脉曲张的供血与分流血管,对临床选择治疗方案具有重要价值。

Objective： To explore anatomic features of blood supply and vein shunt of different esophageal and gastric varices adopting CT portal venography （CTPV）. Methods：50 cases of esophageal and gastric varices verified by CTPV were selected and studied. After plain scanning, enhancement scanning of three phrases, the imageing data were reconstructed by technique of volume rendering （VR）, maximum intensity projection （MIP） and multi-planar reconstruction （MPR）. Results： Variceal resophageal veins were supplied mainly by the left gastric vein（LGV）, with 26 cases（57.8 % ） by anterior branch of LGV, 37 cases （82.2 % ） by paraesophageal veins. Variceal gastric fundal veins origined from LGV in 22 of 36 patients （61.1% ）, short gastric veins / posterior gastric veins in 4 of 36 patients （11.1% ）, short gastric veins / posterior gastric veins and LGV in 10 of 36 patients （27.8 % ）. Spontaneous splenic/gastric-renal vein shunt was observed in 10 cases （20%）. Conclusions.64 channel multidector row CT venography can display noninvasively blood supply and shunt status of different types of esophageal gastric varices, which is valuable for selecting suitable therapeutic proposal.