肝血管瘤合并动-门静脉瘘的CT与DSA表现对比

CT and DSA manifestations of Hepatic Hemangiomas with Arterioportal Shunt and its comparation

目的:对比分析肝血管瘤合并动-门静脉瘘(APS)的CT与DSA表现。方法:回顾性收集20例临床确诊为肝血管瘤合并APS患者的CT及DSA影像资料,比较各自一般影像学表现,并从统计学比较两者的APS检出率、瘘口显示率及责任动脉显示率,率的比较采用χ2检验,以P <0.05认为差异有统计学意义。结果:CT平扫表现:20例患者共检出瘤体20枚,其中肝左叶6枚,肝右叶13枚,尾状叶1枚。瘤体直径6.2±3.5cm。CT增强扫描表现:检出APS18枚,其中中央型9枚,周围型9枚。检出率90%(18/20)。APS直接征象:主要表现为动脉期门静脉分支或主干提前显影。间接征象:主要表现为瘤周肝实质提前强化。其中"三角形"强化2枚,"楔形"强化6枚,"环形"强化7枚,不规则形强化3枚。3枚瘤体周围可见瘘口,显示率15%(3/20)。8枚APS周围可见责任供血动脉,显示率40%(8/20)。DSA表现:选择性肝动脉插管造影检出APS20枚。其中,中央型9枚,周围型11枚。高流量型8枚,低流量型12枚。APS检出率100%(20/20)。主要表现为"双轨征"及病变周围"树枝状"血管染色。10枚瘤体周围可见瘘口,显示率50%(10/20)。超选择性插管造影均找到责任供血动脉,显示率100%(20/20)。DSA的APS检出率与CT相比两者差异无统计学意义(P>0.05),瘘口显示率高于CT(P <0.05),责任动脉显示率高于CT(P <0.01)。结论:CT和DSA对肝血管瘤合并APS影像特征各有特点,两者对APS均具有较高的检出率,但CT对瘤体、APS直接征象以及瘤周肝实质强化间接征象的显示比DSA更直观丰富,DSA能动态观察造影剂流向及流速,对APS瘘口判断及责任动脉的显示优于CT。

Objective To compare and analyze CT and DSA manifestations of Hepatic Hemangiomas with Arterioportal Shunt(APS). Methods CT and DSA data of 20 patients who were diagnosed as Hepatic Hemangiomas with APS by clinic were retrospectively collected. Their common imaging features were compared and positive rate of APS, displaying rate of the opening of fistula and of the responsible artery were statistically compared. Chi-square test was used to compare the rates.The difference was statistically significant when P<0.05. Results CT routine scan: 20 tumors were detected in the 20 cases,of which there were 6 tumors locating in the left lobe of liver, 13 in the right lobe and 1 in the caudate lobe. Diameter of the tumor bodys was 6.2±3.5 cm. CT enhanced scan: 18 cases with APS were detected, 9 cases belongs to the central type of APS while 9 cases belong to the peripheral type. The detectable rate of APS was 90%(18/20). The direct signs of APS presented mainly as early appearance of branch or trunk of the portal vein and the indirect signs presented mainly as early enhancement of the liver parenchyma. The shapes of these enhancement included the 'triangular-shape'(n=2), 'wedge-shape'(n=6),'ring-shape'(n=7) and the irregular shape(n=3). The opening of fistula was seen in 3 cases with the the displaying rate 15%(3/20). The responsible artery was seen in 8 cases with the displaying rate 40%(8/20). DSA findings: 20 cases with APS were detected through selective arteriography of hepatic artery, of which the number of central type of APS was 9 and peripheral type was 11. The number of high-flow type of APS was 8 and the low-flow type was 12. The detectable rate reached 100%(20/20).The main signs included the 'double-track sign', 'tree- like ' vascular staining around the tumors. The opening of fistula was seen in 10 cases with a displaying rate 50%(10/20). The responsible artery was seen in 20 cases with a displaying rate 100%(10/20).Comparation of the detectable rate of APS between CT and DSA did not have statistic significance(P>0.05). DSA had a higher displaying rate of the opening of fistula and of the responsible artery than CT(P<0.05, P<0.01). Conclusion Hepatic Hemangiomas with APS exhibited typical imaging features on both CT and DSA. They both exhibited a high detectable rate of APS. However,the imaging signs of APS and enhancement of the liver parenchyma on CT were more intuitive and rich, DSA showed the flow direction and velocity of contrast medium dynamically, which was better than CT on displaying the opening of fistula and the responsible artery.