多层螺旋CT在门静脉高压病人门脉系统侧枝循环建立的应用研究

Application study on the anatomy characteristics of portal collaterals of patients with portal hypertension: evaluated by multi-detector row CT

目的探讨肝硬化门静脉高压患者侧枝循环建立的影像学特点。方法随机选取我院从2014年1月至2015年5月,经临床、实验室检查、超声、内镜等检查诊断有肝硬化门静脉高压病人105例,行上腹部CT增强扫描。其中男85例,女20例。乙肝肝硬化99例,酒精性肝硬化3例,淤血性肝硬化2例,药物性肝硬化1例。另选非肝硬化病人作为对照组,共75例,男50例,女25例。使用GE公司双源CT。对比剂使用碘海醇(350 mgl/ml)高压注射。增强扫描时对比剂量按1.4ml/kg静脉注射,注射速度设定为4.5ml/s。动脉期扫描时间为腹主动脉强化峰值时间延迟2s,门静脉期的扫描时间以测得小剂量预注射峰值时间相应延迟3s、5s、7s、9s。图像中采用MPR、MIP、VR三维重建及曲面重建。轴位像及重建图像结合分析门静脉侧枝循环的解剖路径。结果 105例被检者门静脉侧枝开放通路中常见通路有:胃底及胃小弯侧静脉曲张74.29%,食管静脉曲张48.57%,附脐静脉开放占25.71%。结论 MPR、MIP、VR重建方法能够很好地显示门静脉侧枝循环通路的解剖特点,其中以胃底、胃体部曲张静脉最为多见,是门静脉高压侧枝循环开放情况的定位、定性诊断的有效工具。

Objective： To analyze the anatomic characteristics of collateral pathways in patients with portal hypertension. Methods： From January 2014 to May 2015,the 105 patients with portal hypertension were diagnosed by clinic,laboratory examination,ultrasonic and endoscopy,and were explained to undergo CT test. There were 85 males and 20 females,and portal hypertension was induced by liver cirrhosis which was due to Virus B hepatitis（ n = 99）,alcohol（ n =3）,constrictive pericarditis（ n = 2）,and drug-induced hepatitis（ n = 1）. The control group was composed of the same patients with non liver cirrhosis. All the CT scans were performed on GE dual-source CT. Contrast agent（ non-ionic contrast agent iohexol 350 mgl / ml） was injected by double tube high pressure syringe at a rate of 4. 5ml / s. The volume of contrast medium was intravenously injected according to the body weight of patients（ 1. 4ml / kg） during the formal scan and the upper limit was 120 ml. The trigger time of arterial phase was 2 seconds later than the time of peak enhancement of aorta,and portal venous scan was triggered at 3s,5s,7s,9s after the peak time of portal vein respectively. All the primary imagings were reconstructed by using Multiplanar Reconstruction（ MPR）,Maximun Intensity Projection（ MIP） and Volum Reconstraction（ VR） in Syngo Multi Modality Workplace. All the anatomic structures were analyzed,combined with the axial and reconstructed pictures. Results： In 105 cases,the most commen varices included： the gastric varices accounting for 74.29%,esophageal varices 48. 57%,paraumbilical vein 25. 71%. Conclusion： MSCTP and the reprocessing reconstruction are effective methods to display the anatomy structure of portal collaterals,which will help for making the localized and qualitative diagnosis. The most common varices are gastroesophageal and paraumbilical varices.