门静脉癌栓螺旋CT及CT门静脉造影的诊断价值

The value of helical CT and CT portography in diagnosis of the portal vein tumor thrombosis

目的:评价门静脉癌栓螺旋CT及其门静脉血管造影（CTP）的特征及诊断价值。方法:43例门静脉癌栓形成的患者作了螺旋CT平扫和增强扫描,30例进行了多平面重组（MPR）和CTP成像,15例患者治疗后作了CT随访。结果:螺旋CT轴位和MPR图像能清晰显示门静脉癌栓,直接的CT征象为门静脉增粗及充盈缺损,23％在动脉期癌栓有不均匀强化;间接征象包括门静脉管壁强化（42％）、侧支循环形成（100％）、门静脉海绵样变（44％）及周围肝脏血流动力学的改变。CTP能直现地评价门静脉的癌栓位置、管径及阻塞程度和侧支循环的情况。CT扫描可很好地显示门静脉癌栓治疗后的变化情况。结论:螺旋CT轴位图像结合MPR和CTP图像,可以更完整地提供门静脉癌栓的全面资料。

Objective:To evaluate the characteristics of portal vein tumor thrombosis on helical CT and CT portogra-phy (CTP). Methods:The pre-and postcontrast helical CT scans were performed in 43 cases with portal vein tumor thrombosis , multiplanar reformation (MPR) and additional CTP was done in 30 cases. After therapy, 15 patients were followed up using CT. Results:The portal vein tumor thrombosis could be clearly demonstrated on axial and MPR images. The direct CT features of the portal vein tumor thrombosis were the enlarged portal vein and intraluminal hypodensity or filling defect,and 23% of tumor thrombosis were heterogeneously enhanced on arterial phase images. The indirect findings included enhancement of vessel wall (42%) .demonstration of collateral circulation formation (100% ),cavernous transformation of the portal vein (44%) and hemodynamic changes in the peripheral hepatic parenchyma. CTP could directly display the location,diameter, degree of the occlusion and the extent of collateral circulation. CT scans could also show the changes of portal vein tumor thrombosis responding to the therapy clearly. Conclusion: Axial helical CT scans, together with the MPR and CTP images,can provide a comprehensive information about the portal vein tumor thrombosis.