肝细胞癌合并门静脉癌栓、继发门静脉海绵样变多层螺旋CT表现

Multi-slice spiral CT manifestations of portal vein cavernous transformation secondary to tumor emboli from hepatocellular carcinoma

目的探讨肝细胞癌合并门静脉癌栓、继发门静脉海绵样变的多层螺旋CT表现。方法收集31例经病理证实为肝细胞癌合并门脉癌栓继发门静脉海绵样变的多层螺旋CT资料,与手术病理相对照,回顾分析其栓塞部位、CT表现及侧支循环开放情况。结果栓塞部位:门静脉主干及左、右支栓塞23例,其中4例合并肠系膜上静脉和(或)脾静脉、下腔静脉栓塞,1例合并胆囊浸润;门静脉主干及左支栓塞1例;门静脉主干及右支栓塞5例,其中2例合并肝右静脉和(或)下腔静脉栓塞;门静脉主干及肠系膜上静脉栓塞1例;单纯右支栓塞1例。CT表现:平扫癌栓均为等密度;增强扫描动脉期明显不均匀强化,门静脉期强化程度减退呈等密度,相应血管内可见充盈缺损。侧支循环开放与血管扩张情况:肝门胆管周围侧支开放31例(100%),胆囊窝周围侧支开放19例(61.29%),胃底、胃小弯区侧支开放21例(67.74%),食管下段侧支开放7例(22.58%),脾静脉扩张15例(48.38%)。结论HCC并门静脉癌栓继发门静脉海绵样变的多排螺旋CT表现具有一定的特征性,可为临床提供准确的参考信息,有助于该病的诊断。

Objective To observe the multi-slice spiral CT manifestations of cavernous transformation of the portal vein （CTPV） secondary to tumor emboli from hepatocellular carcinoma （HCC）. Methods MSCT manifestations of 31 patients of HCC with tumor emboli-induced CTPV proved by operation and pathology were collected and the data were retrospec- tively analyzed. Results Tumor embolus was detected in both the trunk, left and right branches of PV in 23 patients, ac- companied with superior mesenteric vein and/or splenic vein and inferior vena cava＇s tumor embolus in 4 and infiltration of gallbladder in 1 of 23 patients, as well as in the trunk and left branch in 1, and in the trunk and right branch of PV in 5 pa- tients, accompanied with right hepatic vein and/or inferior vena cava＇s tumor embolus in 2 and in the portal trunk and superior mesenteric vein in 1, only in the right branch in 1 patient, respectively. Tumor emboli were isodense in plain CT scan, but enhanced with obvious degrees in arterial phase and filling defects in portal venous phase. There were collateral vessels around portal vein. Lateral branches around hilar bile duct, the open of vehous plexus around fossa of gallbladder, lateral veins around gastric fundus and lesser curvature, lateral veins of lower part of esophagus and expansion of splenic vein were found in 31 （100%）, 19 （61.29%）, 21 （67.74%）, 7 （22.58%） and 15 patients （48.38%）, respectively. Conclusion Tumor emboli-induced CTPV from HCC has specific MSCT findings being helpful to the diagnosis.