彩色多普勒超声诊断肝内门静脉-肝静脉瘘的价值

The value of color Doppler flow imaging in diagnosing intrahepatic portosystemic venous shunts

目的 :探讨彩色多普勒超声对肝内门静脉-肝静脉瘘的诊断价值。方法 :回顾性分析25例彩色多普勒超声诊断为门静脉-肝静脉瘘的患者临床资料和超声图像特征。结果 :25例门静脉-肝静脉瘘中,发生于肝右叶17例,肝左叶8例;7例伴肝硬化,4例伴脂肪肝,2例伴肝癌,12例为孤立性门静脉-肝静脉瘘;以门静脉右支-肝右静脉瘘最多见(12/25,48%)。门静脉-肝静脉瘘的主要超声声像图特征有:肝内可见不规则的囊状液性暗区或扭曲走行的管状液性暗区,彩色多普勒血流显像示其内充满血流信号,并与门静脉分支及肝静脉交通,PW于病灶处探及高速门静脉样连续性频谱。25例中4例曾多次超声漏诊,1例曾误诊为肝囊肿,1例曾误诊为门静脉局部瘤样扩张,漏误诊率24%。结论 :彩色多普勒超声对门静脉-肝静脉瘘有较高的诊断价值,掌握其超声声像图特征可有效降低漏误诊率。

Objective To investigate the value of color Doppler flow imaging in the diagnosis of intrahepatic portosystemic venous shunts. Methods The clinical data and ultrasonic characteristics of intrahepatic portosystemic venous shunts in 25 cases were analyzed retrospectively in this study. Results Among the 25 patients with intrahepatic portosystemic venous shunts, 17cases occurred in the right lobe of liver, 8 cases in the left lobe of liver, 7 cases with liver cirrhosis, 4 cases with fatty liver and 2 cases with liver cancer, the remaining 12 cases were isolated portal-hepatic vein fistulas;The right portal vein-right hepatic vein fistula(12/25, 48%) accounts for the majority. The main ultrasonic characteristics of intrahepatic portosystemic venous shunts included the following: Irregular cystic or twisted tubular fluid dark area could be seen in the liver, which was the communication of portal vein and hepatic vein, and color Doppler flow imaging showed that it was full of blood flow signals, and the spectrum of the involved hepatic vein changed into a high-speed single-phase continuous blood flow. Among the 25 cases in this study, 4 cases were missed for many times, 1 case was misdiagnosed as hepatic cyst and 1 case was misdiagnosed as aneurysm-like dilatation of portal vein. The misdiagnosis rate was 24%. Conclusion Color Doppler flow imaging has high diagnostic value for intrahepatic portosystemic venous shunts. Mastering its ultrasonic characteristics can effectively reduce the rate of missed diagnosis and misdiagnosis.