先天性脾肾静脉分流的影像学表现与临床价值

Imaging and clinical significance of congenital splenorenal venous shunt

目的 探讨先天性脾肾静脉分流的影像学表现及其临床应用价值.方法 回顾性分析我院2009年3月至2014年5月127 283例上腹部CT检查资料,共发现6例先天性脾肾静脉分流,分析其影像学资料.患者均行CT平扫及增强扫描和多普勒超声检查.结果 先天性脾肾分流的发生率约为47/100万.6例患者均为女性,年龄32～67岁,平均48.8岁.增强MSCT均显示脾与左肾静脉间异常粗大的分流血管影.4例分流血管直径大于脾静脉及门静脉.2例分流血管管径较细;1例同时合并肝内门脉右支缺如.2例合并门脉及脾静脉发育细小.多平面重组（MPR）、曲面重建（CPR）、最大密度投影（MIP）和容积再现（VR）图像可立体显示分流血管走行、开口及入口.多普勒超声检查均显示门脾静脉倒流,血液经分流血管向左肾静脉分流.结论 先天性脾肾静脉分流是一种少见的肝外门体分流畸形.MSCT增强扫描结合后处理技术可清晰显示先天性脾肾静脉分流患者的分流血管及其伴发病变.多普勒超声检查可进一步明确血流分流的方向.

Objective To study the imaging appearances of congenital splenorenal venous shunt,and to evaluate their clinical significances.Methods Of 127 283 patients who underwent upper abdominal CT scanning,6 patients were diagnosed to have congenital splenorenal venous shunt.The imagings were studied retrospectively.Plain scanning,enhanced CT and Doppler ultrasonography were performed on all these patients.Results The incidence was about 47/million.The six patients were all females,the age was between 32 to 67 years.The mean age was 48.8 years.Enhanced CT demonstrated that there were twisted and dilated shunting blood vessels between the splenic and renal veins.The diameters in four patients were larger than the splenic and portal veins.In the remaining two patients,they were smaller shunting blood vessels.One patient had an associated absence of right portal vein.Two patients had associated dysplasia of portal veins and splenic veins.MPR,CPR,MIP and VR could three-dimensionally depict the courses,the beginnings and the ends of the splenorenal shunts.Doppler ultrasonography showed counterflow between the portal and splenic veins,and showed the blood in the splenic vein to flow into the left renal vein.Conclusions A congenital splenorenal venous shunt is one of the rare form of congenital extrahepatic portosystemic venous shunts.Enhanced MSCT scan combining with its post-processing techniques could clearly demonstrate the shunt vessels and the associated lesions.Doppler ultrasonography could further demonstrate the shunt direction.