肝脏肿瘤性灌注缺损的经脾门静脉造形CTSP影像与病理对照研究

Hepatic parenchymal tumorous perfusion defects in CT during splenoportography: com- parison with pathology

目的 探讨经脾门静脉造影ＣＴ（ＣＴＳＰ）肝肿瘤性灌注缺损影像学表现与病理基础，提高其影像解释的准确性。方 法 以病理确诊且行ＣＴＳＰ检查的３０例肝占位病变患者为研究对象，对ＣＴＳＰ肿瘤性灌注缺损影像和病理进行对比观 察。结果（１）得出病变的ＣＴ值与肿瘤良恶性的相关性；（２）提出了瘤旁小门静脉分支受侵的ＣＴＳＰ征像，并得到病理 检查证实；（３）描述了“直线征”的ＣＴＳＰ表现，并结合文献讨论了其产生的原因及临床意义。结论（ｌ）局灶性肿瘤性灌 注缺损的ＣＴ值有助于肿瘤良恶性的鉴别，软组织ＣＴ值密度者多代表恶性占位病变，而中等ＣＴ值密度者多代表良性 占位病变；（２）瘤旁小门静脉分支受侵是肿瘤恶性征像的提示。

Objective: To study the features of the perfusion defects in the images of hepatic parenchymal tumors produced by CT during aplenoportography (CTSP) in comparison with the pathological changes. Methods Thirty patients with hepatic space-occupying leisions that were pathologically examined were enrolled in this study. CTSP were performed in all the cases and the paterns of hepaptic parenchymal tumorous perfusion defects studied and compared with the pathologic findings. Results and Conclusion The attenuated intensity of the images of the perfusion defects proved to be associated with the malignancy of the leision,and soft-tissue-line attenuation can often be indicative of malignant tumors which seldom cause intermediate attenuation.The typical CTSP features of vascular invasion into the portal venules adjacent to the tumors were described and pathologically verified.When focal tumorous perfusion defects with vascular invasion of the portal venules are present, malignant tumors should be highly suspected.