肝硬化合并门静脉血栓与门静脉癌栓多层螺旋CT分析

Analysis of Imaging Features of Liver Cirrhosis with Portal Vein Thrombosis and Tumor Thrombus Based on Multi-slice Spiral CT

目的探讨肝硬化合并门静脉血栓(portal vein thrombosis,PVT)及门静脉癌栓(portal vein tumor thrombus,PVTT)多层螺旋CT影像特征及诊断价值。方法收集经临床、甲胎蛋白(AFP)及影像学特征综合诊断的PVTT患者79例、PVT患者75例。应用血管容积重建(VR)、多平面重组(MPR)等方法对门静脉及其主要分支行三维重建,观察各组栓子在平扫及增强扫描各期CT值的差异,并分析PVT与PVTT各征象的差别。结果本研究共纳入病例154例,其中PVTT患者79例,PVT患者75例,所有患者均合并不同程度肝硬化。PVTT患者血清AFP水平、丙氨酸转氨酶(ALT)及天冬氨酸转移酶(AST)水平均高于PVT患者(P均<0.05)。在影像征象上,PVTT易累及门静脉左右支,PVT易累及门静脉主干及肠系膜上静脉(P<0.05);在附栓管壁是否光滑、栓子是否完全填充、门静脉有无局限性增宽等方面差异均有统计学意义(P均<0.05);但在肝外侧支循环、腹腔积液上差异均无统计学意义(P>0.05);PVTT和PVT在动脉期、门静脉期及动脉期与平扫期的差值上,PVTT的密度高于PVT(P均<0.05);PVTT与PVT在平扫期及延迟期密度差异无统计学意义(P>0.05)。结论AFP、ALT、AST值及栓子密度、累及位置、强化方式、附栓管壁光滑度、门静脉局限性增宽等能为PVT与PVTT的诊断与鉴别诊断提供较为可靠的依据。

Objective The study was to explore image feature and diagnostic value between portal vein thrombosis(PVT)and portal vein tumor thrombus(PVTT)based on the characteristics of multi-slice spiral CT.Methods 79 cases of PVTT and 75 cases of PVT comprehensively diagnosed by clinic,α-fetoprotein(AFP)and imaging features were collected.Volume reconstruction(VR),multi-planar reformation(MPR)were used to reconstruct the portal vein and its main branches.The differences of CT values between the two groups were observed in each phase of plain and enhanced phases,and the differences of characteristics between portal vein thrombosis and tumor thrombus were analyzed.Results Among the 154 patients with liver cirrhosis,79 cases had hepatic carcinoma(PVTT group),and 75 had no hepatic carcinoma(PVT group).The study showed that the levels of AFP,alanine aminotransferase(ALT)and aspartate aminotransferase(AST)in PVTT group were significantly higher than those in PVT group(P all<0.05)on the imaging characteristics,PVTT was more likely to involve the left and right branches of portal vein,and PVT was more likely to involve the main portal vein and superior mesenteric vein.The differences was statistically significant(P<0.05).There were also statistically significant differences in whether the wall of embolus was smooth,whether the embolus was completely filled,and whether the portal vein was locally widened(P all<0.05);but there was no statistical significance in extrahepatic collateral circulation and ascites(P>0.05);the attenuation of PVTT was significantly higher than that of PVT in arterial phase,portal phase and the difference between arterial phase and plain phase(P all<0.05).There was no statistically significant difference in the attenuation of PVTT and PVT in the plain phase and delay phase(P>0.05).Conclusion The differences of AFP,ALT and AST values,embolus attenuation,enhancement pattern,the smoothness of portal vein in the embolus part,local widening of portal vein between PVT and PVTT can provide a more reliable basis for the diagnosis and defferential diagnosis for both embolus.