肝细胞肝癌合并门静脉癌栓的双期增强螺旋CT诊断

Dual-phase enhanced spiral CT in the diagnosis of hepatocellular carcinoma with tumor thrombus in portal vein

目的:探讨肝细胞肝癌合并门静脉癌栓的双期增强螺旋CT诊断价值。 方法:用高压注射器经肘正中静脉注入造影剂后分别于20s和60s行全肝螺旋CT动脉期和门脉期扫描。每例CT片均经三名有经验的医师分别按双盲法阅读后,再共同讨论分析,并达成一致共识。 结果:46例中,门静脉主干发生癌栓者5例,右支癌栓3例,左支癌栓13例,主干和右支同时受累者4例,主干和左支受累者7例,主干和左右支均有癌栓者14例。正常肝组织异常灌注者11例,表现为动脉期不规则片状或楔形较均匀高密度影,而门脉期恢复为等密度,按叶、段、亚段分布者分别为2例、4例和5例。门静脉海绵样变者9例。 结论:动脉性门脉造影的DSA检查对显示和诊断原发性肝癌合并门静脉癌栓具有较高的敏感性和特异性,并能为其介入治疗提供重要的信息。

AIM: To evaluate the diagnostic value of the hepatocellular carcinoma with portal tumor thrombus (PTT) on dual-phase enhanced spiral CT (SCT).METHODS:Total 46 patients with PTT who underwent dual-phase enhanced spiral CT were reviewed. The arterial phase (AP) images were obtained at 20 s after the initiation of the contrast medium into the median cubital vein with automatic pressure injector, and the portal phase (PVP) were obtained after 60 s. The CT findings were observed in a double blind method by three experienced radiologists together and formed a consensus interpretation.RESULTS: In the 46 cases, there were tumor thrombi of the main portal vein in 5 cases, right portal branch in 3 cases, left portal branch in 13 cases, portal trunk with right portal branch in 4 cases, portal trunk with left portal branch in 7cases, and tumor thrombi of portal trunk with left and right portal branch in 14 cases. In the 46 cases, hepatic perfusion abnormalities were seen in 11 cases, presenting as irregular patchy or pyramid-shaped hyperperfusion abnormality in AP and isodensity in IPVP. Lobar, segmental and subsegmental abnormalities were seen in 2, 4, 5 cases, respectively. The cavernous transformation of portal vein (CTPV) was detected in 9 of 46 patients.CONCLUSION: The dual-phase enhanced spiral CT has high sensitivity and specificity for the diagnosis of the primary hepatocellular carcinoma with portal tumor thrombi, and it can provide important information to the transarterial chemoembolization (TACE) of hepatocellular carcinoma with PTT.