肝门静脉血流分布的多层螺旋CT研究

Investigation of Intraportal Venous Flow Distribution Multislice Spiral CT

目的运用多层螺旋CT研究脾静脉(Sp V)和肠系膜上静脉(SMV)血流在门静脉内和肝内的分布规律,为临床提供相应的影像解剖学数据。方法回顾性分析在重庆医科大学附属第一医院行上腹部CT平扫及增强检查,动脉期Sp V强化而SMV未强化的165例患者的CT资料,观察门静脉主干内Sp V与SMV血流的分布情况。分别测量平扫和增强动脉期门静脉左支(LPV)与门静脉右支(RPV)、肝脏左叶与右叶CT值;分析Sp V和SMV的血流在门静脉内和肝脏内的分布区域及规律。结果 (1)Sp V和SMV血流在门静脉主干内分布情况:分层分布(A组)占61.81%(102/165);螺旋形分布(B组)占24.85%(41/165);紊乱分布(C组)占13.33%(22/165)。(2)动脉期LPV的CT值>RPV占84.24%(139/165),<RPV占15.76%(26/165),肝脏左叶CT值>右叶占85.45%(141/165),<右叶占14.55%(24/165);动脉期门静脉左右支、肝脏左右叶CT值差异有显著统计学意义(P<0.01),平扫无统计学差异(P>0.05)。A、B、C三组组内动脉期门静脉左右支、肝脏左右叶CT值差异有统计学意义(P<0.05),平扫差异均无统计学意义。结论 Sp V和SMV血流在肝门静脉内存在分层分布、螺旋形分布、紊乱分布。84.24%的患者Sp V血液主要流入LPV进入肝左叶,SMV血液主要流入RPV进入肝右叶。

Objective To investigate intraportal and intrahepatic venous flow distribution rules between SpV and SMV with muhislice spiral CT in order to provide imaging data for clinical research. Methods The data of 165 patients that had undergone contrast -enhanced abdominal CT scan which can distinguish between the enhanced SpV and the non -en- hanced SMV in the arterial phase was analyzed retrospectively at the First Affiliated Hospital of Chongqing Medical University. To observe the venous flow distribution in the main portal vein from the SpV and the SMV. To measure the CT num- bers of the plain scan and contrast - enhanced arterial phase in the left portal vein （ LPV ） , the right portal vein （ RPV ） , the left lobe of liver and the right lobe of liver. To analyze the blood distribution rules of the portal vein. Results （ 1 ） We divided all the 165 cases into three groups A, B and C according to the different patterns of SpV and SMV blood distri- bution in the main portal vein. There was a streamline distribution （group A） whose ratio was 61.81% （ 102/165 ） , spiral distribution （group B） whose ratio was 24.84% （41/165）, turbulence distribution （group C） whose ratio was 13.33% （22/165）. （2）In the arterial phase,by contrasting the ratio of the CT numbers in the LPV and the RPV, there were two outcomes; 84.24% （139/165） higher and 15.76% （26/165） lower. By contrasting the ratio of the CT numbers in the left and right lobe of liver, there were 85.45 % （ 141/165 ） higher and 15.55 % （ 24/165 ） lower outcomes. Of all the 165 cases including A, B and C group, the CT numbers had significant difference between the LPV and RPV and between the left and right lobe of liver （P 〈 0.01 ） in the arterial phase. However there was no significant difference between them in plain scan （ P 〉 0. 05 ）. Conclusion Our results suggest that the distribution patterns of intraportal venous flow are streamline, spiral, and turbulence. There were 84.24% cases of venous flow return from the SpV which tends to be directed into the LPV and drains into the left lobe of liver, and venous flow return from the SMV tends to be inflow into RPV and drains into the right lobe of liver.