门静脉高压经肾静脉自发性分流的多层CT诊断

Multi-slice CT diagnosis of spontaneous renal vein shunt in portal hypertension

目的:探讨肝硬化门静脉高压时经肾静脉自发分流的CT表现与诊断。方法:220例临床确诊为肝硬化门静脉高压的患者行多层螺旋CT检查,扫描参数:准直/有效层厚/重建间隔为5 mm/6.5 mm/2.0 mm(180例)或2.5 mm/3.2 mm/1.6mm(40例)。双期增强扫描:动脉期延迟26～28 s,门脉期延迟55～60 s。对图像进行电影显示,对有异常血管的病例分别完成薄层块最大强度投影(TS—MIP)和容积显示(VR)三维血管成像。结果:经肾静脉分流26例(11.8％),其中脾左肾静脉分流20例,胃左肾静脉分流16例(同时有此2种分流12例),门脉右肾静脉分流2例。肾门周围静脉增多、增粗7例。结论:自发性门脉-肾静脉分流并不少见,多层螺旋CT增强扫描及血管造影可有效显示分流血管,有助于指导临床诊断和治疗。

Objective: To study the CT features and its diagnosis of spontaneous renal vein shunt (SPVA) in portal hypertension. Methods: Totally 220 cirrhosis patients with portal hypertension diagnosed clinically underwent multi-slice CT scanning. The parameters were 5 mm/6. 5 mm/2. 0 mm(collimation/effective thickness/interval) in 180 patients and 2. 5 mm/3. 2 mm/1. 6 mm in 40 patients. An arterial-phase (delaying 26-28 s) and a portal venous phase (55-60 s) were included. All images were showed by cine and CTA was displayed with volume rendering and thin-slab maximum projection when ah normal vessels were suspected. Results: The spontaneous renal shunt were found in 26 patients (11. 8%), including spleno left renal shunt(20 patients), gastro-left renal shunt (16 patients), and portal-right renal shunt(2 patients). The veins sur rounding renal hilum were rich and thick in 7 patients. Conclusion: The SPVA is not rare in portal hypertension, enhanced CT scan and angiography with multi-slice CT can effectively display the shunt vessels, contributing to the correct diagnosis and right therapy.