门静脉系统血栓的64层螺旋CT诊断价值

The Diagnostic Value of Thrombus in Portal Vein on 64-slice Spiral CT

目的探讨门静脉系统血栓(portal vein thrombosis,PVT)的64层螺旋CT表现特征。资料与方法15例PVT者行64层螺旋CT平扫和双期增强扫描,采用最大密度投影(MIP)、容积再现(VR)及多平面重组(MPR)观察其影像学特征。结果15例中,血栓发生于门静脉(PV)主干13例,右支6例,左支7例,脾静脉(SV)3例,肠系膜上静脉(SMV)9例,其中血栓同时累及PV主干和SMV 8例,同时累及PV左右支、主干和SMV 4例,累及PV主干和右支6例,累及PV主干和左支6例,累及SV和SMV2例,PV主干、SV、SMV三岔口处血栓1例。Yerdel分级:Ⅰ级1例,Ⅱ级10例,Ⅲ级3例,Ⅳ级1例;血栓呈高密度10例,等密度2例,低密度3例;血栓为部分偏心性栓塞12例,呈小条状、"柴捆"状;附栓管壁均连续光滑、无外突结节,局部PV管壁呈典型的线样"强化征"或"轨道征";出现食管胃丛及脾丛侧支循环12例,胆管丛及胆囊丛侧支循环4例,无一例出现肝动脉-门静脉瘘。结论64层螺旋CT能够清晰、立体地显示PVT的部位、累及范围,具有特征性,是PVT重要的检查方法。

Objective To study the 64-slice spiral CT feature of the thrombus in portal vein. Materials and Methods Noncontrast-enhanced CT and contrast enhanced CT were performed in all 15 patients. MIP,VR and MPR were used for three dimensional reconstruction. The features of the thrombus in portal vein were analyzed. Results In 15 cases, 13 cases （83%） occurred in trunk vein ,6 cases in fight branch ,7 cases in left branch ,3 cases in splenic vein,9 cases in superior mesenterie vein. Yerdel Grade ： Grade I 1 case, Grade Ⅱ 10 cases, Grade Ⅲ 3 cases, Grade Ⅳ 1 case. 10 cases showed high-dense in thrombus,3 cases appeared low-dense. 12 cases presented partial filling defect, which is described as stripe and bundles in contrasted vein. All the involved vein had smooth and successive wall and had no appeared nodes protrude out at portal vein period. All the cases with thrombus showed typical track sign or line augmentation sign in involved vein wall. 12 cases displayed collateral circulation in esophag-ogastricand splenic vein,and 4 cases displayed pericholecystic and pericholedochal collateral branches. No case visualized A-P shunt. Conclusion 64-slice spiral CT can display the location,feature and cumulative branch of the thrombus in portal vein distinctly and stereoscopically. 64-slice spiral CT is very important modality for the thrombus in portal vein.