Diagnosis of benign and malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma: color Doppler US, contrast-enhanced US, and fine-needle biopsy

Background We assessed the role of contrast-enhanced ultrasound (CEUS) in the differential diagnosis between benign and malignant portal vein thrombosis in patients who had cirrhosis with hepatocellular carcinoma (HCC). Methods Fifty-four consecutive patients who had cirrhosis, biopsy-proved HCC, and thrombosis of the main portal vein and/or left/right portal vein on US were prospectively studied with color Doppler US (CDUS) and CEUS. CEUS was performed at low mechanical index after intravenous administration of a second-generation contrast agent (SonoVue, Bracco, Milan, Italy). Presence or absence of CDUS signals or thrombus enhancement on CEUS were considered diagnostic for malignant or benign portal vein thrombosis. Twenty-eight patients also underwent percutaneous portal vein fine-needle biopsy (FNB) under US guidance. All patients were followed-up bimonthly by CDUS. Shrinkage of the thrombus and/or recanalization of the vessels on CDUS during follow-up were considered definitive evidence of the benign nature of the thrombosis, whereas enlargement of the thrombus, disruption of the vessel wall, and parenchymal infiltration over follow-up were considered consistent with malignancy. CDUS, CEUS, and FNB results were compared with those at follow-up. Results Follow-up (4 to 21 months) showed signs of malignant thrombosis in 34 of 54 patients. FNB produced a true-positive result for malignancy in 19 of 25 patients, a false-negative result in six of 25 patients, and a true-negative result in three of three patients. CDUS was positive in seven of 54 patients. CEUS showed enhancement of the thrombus in 30 of 54 patients. No false-positive result was observed at CDUS, CEUS, and FNB. Sensitivities of CDUS, CEUS, and FNB in detecting malignant thrombi were 20%, 88%, and 76% respectively. Three patients showed negative CDUS and CEUS and positive FNB results; follow-up confirmed malignant thrombosis in these patients. One patient showed negative CDUS, CEUS, and FNB findings. Howewer, follow-up of the thrombus showed US signs of malignancy. Another FNB confirmed HCC infiltration of the portal vein. Conclusion CEUS seems to be the most sensitive and specific test for diagnosing malignant portal vein thrombosis in patients with cirrhosis.     

超声造影、常规超声、增强CT鉴别诊断门静脉癌栓与血栓的比较

目的 比较超声造影(CEUS)、常规超声(B型超声+彩色多普勒超声)和增强CT(CTP)定性诊断门静脉栓子的准确性.方法 回顾性分析经手术或临床确诊的43例门静脉栓子的常规超声、CEUS和CTP图像资料,比较3种手段对门静脉栓子的定性诊断准确性.结果 常规超声、CEUS和CTP定性诊断门静脉栓子的符合率分别为60.5％、100％和76.7％,3种方法两两比较差异均有统计学意义(P＜0.05).结论 CEUS可以准确鉴别门静脉癌栓与血栓,较目前临床常用的常规超声和CTP更为准确,值得推广应用.     

彩色多普勒血流显像及超声造影鉴别诊断门静脉良恶性栓子

目的 探讨CDFI及CEUS鉴别诊断门静脉良恶性栓子的价值.方法 回顾性分析33例门静脉栓塞患者门静脉栓子的CDFI及CEUS灌注表现,包括门静脉癌栓23例,血栓10例.结果 23例癌栓中,完全填充17例,部分填充6例;10例血栓中,完全填充3例,部分填充7例.癌栓完全填充率高于血栓完全填充率(P=0.026),表明门静脉癌栓以完全填充为主,血栓以部分填充为主.CDFI显示癌栓自肝内向肝外生长多见,回声较强且不均匀;血栓则相反,且多见于脾切除后、肝硬化等患者.CEUS示门静脉癌栓均呈“快进快出”表现,而血栓内始终未见造影剂填充.结论 CDFI对定性诊断门静脉栓子具有一定价值;CEUS对鉴别门静脉血栓及癌栓有较高价值.     

肝移植术前门静脉系统栓子超声造影参数成像的临床应用

目的 探讨CEUS参数成像在诊断及鉴别诊断肝移植术前门脉系统栓子中的临床应用价值。方法 回顾性分析接受CEUS检查并经临床或病理证实的41例肝移植术前门脉系统栓子患者,观察造影剂灌注模式,并利用sonoliver CAP定量分析,以门静脉栓子与周围肝实质的增强水平差值为参数进行动态血管模型(DVP)参数成像构建。结果 门静脉瘤栓动脉期呈快速增强,门脉期及延迟期明显消退。门静脉瘤栓的上升时间、达峰时间、平均渡越时间分别快于周围肝实质,差异均有统计学意义(P均＜0.01);门静脉瘤栓的峰值强度高于周围肝实质,差异有统计学意义(P=0.001)。门静脉血栓三期均无造影剂灌注,各参数值均为0。结论 CEUS参数成像能直观反映门脉系统栓子与周围肝实质间灌注差异,鉴别栓子性质。     

Differentiating malignant from benign thrombosis in hepatocellular carcinoma: contrast-enhanced ultrasound

Background

To determine the accuracy of contrast-enhanced ultrasonography (CEUS) in differentiating malignant and benign venous thrombosis complicating hepatocellular carcinoma (HCC).

Methods

Fifty patients (M:F = 41:9; age range 46–83 years) with HCC and venous thrombosis [portal vein (PV) in 45 and hepatic vein (HV) in 5] detected on CT or MR scan were evaluated with CEUS. Reference standard of malignant and benign thrombosis was based on serial clinicoradiologic follow-up (n = 43) or pathology (n = 7). Two independent, blinded readers retrospectively recorded the enhancement features of the venous thrombosis and diagnosed as benign or malignant thrombosis with a five-point confidence scale. Receiver operating characteristic (ROC) curves were calculated to determine the diagnostic performance of CEUS in differentiating malignant from benign thrombosis. Confidence level ratings were also used to calculate the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the diagnosis of malignant thrombosis. Inter-reader agreement was calculated using κ statistics in each assessed finding. Gray scale and Doppler characteristics of primary tumor and thrombosis were also assessed.

Results

Of the 50 patients, 37 were malignant (33 with PV thrombosis and 4 with HV thrombosis) and 13 were benign (12 with PV thrombosis and 1 with HV thrombosis). In ROC curve analysis for differentiating malignant from benign thrombosis, Az was 0.947 (CI 0.841–0.991) for reader 1 and 0.958 (CI 0.861–0.995) for reader 2 with excellent inter-reader agreement (κ = 0.86). When the confidence level ratings of 1 or 2 were considered malignant thrombosis, the sensitivity, specificity, PPV, and NPV in differentiating malignant from benign thrombosis were 100%, 83%, 95%, and 100% for reader 1 and 100%, 92%, 97%, and 100% for reader 2.

Conclusion

CEUS is useful to differentiate malignant and benign venous thrombosis associated with HCC with high diagnostic accuracy.     

实时灰阶超声造影评价肝移植术前门脉系统栓子的价值

目的探讨实时灰阶超声造影在肝移植术前门脉系统栓子诊断及良恶性鉴别诊断中的价值。方法应用SonoVue造影剂及对比脉冲序列（CPS）技术对37例肝移植术前门脉系统栓子患者,共84条血管进行低机械指数实时灰阶超声造影检查。结果经过肝移植手术或螺旋CT门静脉成像证实,78条血管栓子形成（瘤栓50个,血栓28个）,6条血管通畅。超声造影诊断门脉系统栓子的敏感性98.7%,特异性100%,以栓子内动脉相早期造影剂灌注为标准,诊断门脉系统瘤栓的敏感性100%,特异性100%。结论实时灰阶超声造影可评价肝移植术前门脉系统的通畅性,提高栓子的检出率,并可鉴别栓子的良恶性,为肝移植手术方案的确定提供重要准确的信息。     

彩色多普勒超声检测门静脉栓塞者肝移植术后并发症的价值

目的探讨彩色多普勒超声对合并门静脉栓塞者进行肝移植术后并发症的诊断价值。方法回顾分析了20例合并门静脉栓塞的患者肝移植术后并发症的发生情况及彩色多普勒超声检查结果。结果发生门静脉再栓塞5例,均为术前门静脉完全栓塞者;发生下腔静脉栓塞3例;发生胆道并发症2例;胸腔及腹腔积液各20例。结论合并门静脉栓塞者肝移植术后并发症发生率较高,彩色多普勒超声对移植术后并发症的诊断具有重要价值。     

超声造影评估门静脉通畅性的适应证探讨

目的 评估常规超声和超声造影(CEUS)在门静脉通畅性诊断中的实用性及CEUS适应证.方法 比较不同声窗条件下常规超声和CEUS对64例门静脉通畅性的诊断水平.根据常规超声门静脉观测声窗条件的好坏分为3级:1级,声窗条件好;2级,声窗条件欠佳;3级,声窗条件差.结果 64例中证实门静脉栓塞35例,门静脉通畅29例.在诊断门静脉通畅性方面,常规超声和CEUS总体诊断准确性分别为76.6%和92.2%.声窗条件好时,常规超声和CEUS的诊断准确性相当,分别为93.1%、96.6%;声窗条件欠佳时,CEUS的诊断准确性较常规超声提高31.2%(87.5%对56.3%);声窗条件差时,CEUS的诊断准确性较常规超声提高21.1%(89.5%对68.4%).结论 在声窗条件好、门静脉显示清晰的条件下,常规超声诊断门静脉血流通畅性的准确程度与CEUS相当,并不一定需要行造影检查.若不具备上述条件,CEUS是值得推荐的.     

Hypoechoic focal liver lesions: characterization with contrast enhanced ultrasonography

PURPOSE: To evaluate the late sinusoidal phase of contrast enhancement with a 2nd-generation ultrasound contrast enhanced medium in the characterization of hypoechoic focal liver lesions. METHODS: We studied 88 hypoechoic liver lesions (diameter range, 1-18 cm; with 18 lesions 2 cm or less) found on conventional grayscale sonography (US) with contrast-enhanced ultrasonography (CEUS). Final diagnosis was made using contrast enhanced helical CT, contrast enhanced MR, angiography (DSA), and/or histopathic confirmation or clinical imaging follow-up. RESULTS: There were 37/88 benign lesions demonstrated: 17 cavernous hemangiomas, 3 capillary hemangiomas, 11 focal nodular hyperplasias (FNH), 3 focal areas of sparing in hepatic steatosis, 2 adenomas, and 1 intrahepatic necrotic area. Malignant lesions demonstrated included 51/88: 27 hepatocellular carcinomas (HCC) in cirrhosis, 11 metastatic carcinomas, 10 metastatic endocrine tumors, 2 cholangiocellular carcinomas (CCC) and 1 non-Hodgkin's lymphoma (NHL). CEUS characterized 30/37 (81%) benign lesions and 45/51 (88%) malignant lesions. On the basis of the results obtained during the sinusoidal contrast enhanced phase of CEUS, diagnosis of benignancy was possible in 35/37 (95%) of benign liver lesions and diagnosis of malignancy in 49/51 (96%) of malignant liver lesions. The enhancement pattern of 13 small (< or = 2 cm in diameter) hypervascular liver lesions (3 capillary hemangiomas, 2 FNHs, 4 HCCs, 4 metastatic endocrine tumors) was better demonstrated on CEUS than on helical CT. In these cases the hyper vascularization of the lesions shown on CEUS was not confirmed on CT. CONCLUSIONS: CEUS distinguished malignant from benign hypoechoic liver lesions with an accuracy of 95%.     

超声引导细针抽吸活检对门静脉癌栓的鉴别诊断价值

目的　探讨超声引导细针抽吸活检对门静脉癌栓 (PVTT)的鉴别诊断价值。方法　对 2 2例原发性肝细胞癌 (HCC)伴发门静脉栓子 (PVT )及 8例肝硬化伴发PVT在超声引导下行细针穿刺抽吸活检 ,并对其中 8例门静脉分支充满型栓子行 18G自动组织切割活检。计算细针抽吸细胞学、组织学的阳性率并与自动活检阳性率进行比较。结果　细针抽吸活检细胞学、组织学阳性率分别为 93 .3 % ( 2 8/3 0 )和90 .0 % ( 2 7/3 0 ) ,与同部位自动活检阳性率 91.7% ( 11/12 )比较差异无显著性意义 ( P >0 .0 5 )。 2 2例HCC伴PVT抽吸活检肝细胞癌阳性 17例 ( 77.3 % ) ,组织学阳性 18例 ( 81.8% ) ,综合后 2 0例诊断为癌栓 ,余 2例为血栓。 8例肝硬化伴发PVT活检均未发现肝癌细胞和 (或 )组织。结论　超声引导门静脉栓子细针抽吸活检有较高的阳性率与诊断价值 ,且与自动活检阳性率无明显差异 ,因此对于彩色多普勒血流显像与脉冲多普勒诊断尚不明确的病例采用细针抽吸活检可达到早期明确诊断的目的。     

Thrombosis of the portal venous system

Portal vein thrombosis (PVT) is a rare cause of portal hypertension. Its diagnosis has been facilitated by improvements in imaging techniques, in particular Doppler sonography. The prevalence is about 1% in the general population, but much higher rates are observed in patients with hepatic cirrhosis (7%, range 0.6–17%), particularly those who also have hepatocellular carcinoma (HCC) (35%). The most common causes of PVT are myeloproliferative disorders, deficiencies of anticoagulant proteins, prothrombotic gene mutations, cirrhosis with portal hypertension, and HCC. Its development often requires the presence of two or more risk factors (local and/or systemic), e.g., a genetically determined thrombophilic state plus an infectious episode or abdominal surgery. It is clinically useful to distinguish between cirrhotic and noncirrhotic forms. Portal vein thrombosis is also traditionally classified as acute or chronic, but this distinction is often difficult. Color Doppler ultrasound is the first-line imaging study for diagnosis of PVT; magnetic resonance angiography and CT angiography are valid alternatives. The main complications are ischemic intestinal necrosis (in acute PVT) and esophageal varices (in chronic cases); the natural history of the latter differs depending on whether or not the thrombosis is associated with cirrhosis. The treatment of choice for PVT has never been adequately investigated. It is currently based on the use of anticoagulants associated, in some cases, with thrombolytics, but experience with the latter agents is too limited to draw any definite conclusions. In chronic thrombosis (even forms associated with cirrhosis), anticoagulant therapy is recommended and possibly, beta-blockers as well. Naturally, treatment of the underlying pathology is essential.     

门静脉癌栓的彩色多普勒血流显像

目的 探讨彩色多普勒血流显像(CDFI)在肝癌伴门静脉癌栓的诊断价值。方法 应用CDFI对28例肝癌伴门静脉癌栓的肝内血流进行分析。结果 CDFI能准确显示全部病例的门静脉出现异常血流信号；血流变细或充盈缺损，斑点状血流束等，89％的病例出现肝内动脉扩张。结论 本认为CDFI对肝癌伴门静脉癌栓的诊断提供重要帮助。     

Characterization of portal vein thrombus with the use of contrast-enhanced sonography.

OBJECTIVES: To select an appropriate treatment regimen, it is essential to accurately characterize the nature of a thrombus. This study prospectively assessed the ability of contrast-enhanced sonography to differentiate between benign and malignant portal vein thrombosis in a population of high-risk patients. METHODS: Fifty-five patients (43 men and 12 women; mean age, 66 years; range, 55-83 years) with thrombi of the portal venous system were examined by power Doppler sonography and contrast-enhanced sonography with the intravenous contrast agent SH U 508A (Levovist; Schering AG, Berlin, Germany). Of the thrombi, 40 were characterized as malignant and 15 as benign. Pulsatile flow in the thrombus on power Doppler sonography and positive enhancement of the thrombus on contrast-enhanced sonography were judged as indications of a malignant thrombus. The sensitivity and specificity of both methods in differentiating the nature of the thrombus were evaluated. RESULTS: The detection of pulsatile flow in a portal vein thrombus as the criterion for diagnosing malignant portal vein thrombus yielded overall sensitivity of 82.5% and specificity of 100%, whereas positive enhancement of the portal vein thrombus itself as a criterion for diagnosing malignancy yielded overall sensitivity and specificity of 100% for each. CONCLUSIONS: Contrast-enhanced sonography can be helpful in discriminating between benign and malignant portal vein thrombi.     

Incidence of portal vein thrombosis complicating liver metastasis as detected by duplex ultrasound

In a prospective study of 100 patients with liver metastasis using real-time ultrasound, 8 patients (8%) were found to have portal vein thrombosis (PVT). Sixty seven of these patients, which included all with PVT, also underwent duplex examination. Pulsed Doppler showed absent flow in 4 of 8 patients, indicating complete obstruction. The other 4 showed different degrees of flow suggesting incomplete obstruction or collateral formation. We conclude that PVT complicating liver metastasis is not a rare finding.     

Doppler in hepatic cirrhosis and chronic hepatitis.

Doppler ultrasound and color Doppler are being used routinely in the study of vascular structures of the abdomen, and more particularly the liver. Reports published in the literature to date have shown that all patients with hepatic cirrhosis and chronic hepatitis should be studied in the first stage of their illness and in follow-up by using Doppler techniques. With new ultrasound software and the latest generation of contrast agents, we can obtain a better and more complete vascular study of the liver, which previously could be achieved only with triple-phase CT. Therefore, hepatic cirrhosis and chronic hepatitis, as well as their vascular complications, can be followed up more closely. The vascular complications include flow alterations in the hepatic artery and veins, portal hypertension, portal vein thrombosis, portosystemic shunts, and vascularization associated with liver tumors.     

不同分型的肝硬化门静脉血栓的临床特点

目的探讨不同分型的肝硬化门静脉血栓(PVT)的临床特点及差异。方法回顾性分析2016年8月至2019年8月昆明医科大学第二附属医院消化内科收住的肝硬化合并PVT患者107例,依据解剖因素将其分为3组:单纯门静脉主干血栓形成组(主干组,n=17)、单纯分支血栓形成组(分支组,n=35)和门静脉主干并分支血栓形成组(主干+分支组,n=55)。分别从一般临床资料、实验室指标、影像学指标、肝储备及相关评分等方面对不同PVT部位进行比较分析。检验水准取α=0.05,采用分割χ²检验时,校正为α′=0.0125。结果主干+分支组患者更易合并消化道出血,主干组次之,分支组最低,三组间比较差异有统计学意义(χ²=27.832,P<0.01),两两比较示,分支组与主干+分支组、主干组与主干+分支组差异有统计学意义(P<0.0125);主干+分支组D-二聚体水平最高,主干组次之,分支组最低,三组间比较(H=37.439,P<0.01)及两两比较差异均有统计学意义(P<0.05,P<0.01);主干+分支组血浆D-二聚体和纤维蛋白原比值(D/F)最高,主干组次之,分支组最低,三组间比较(H=33.973,P<0.01)及两两比较差异均有统计学意义(P<0.05,P<0.01)。结论血栓累及主干+分支的肝硬化PVT患者,发生消化道出血的风险最高,主干次之,分支最低。D-二聚体、D/F水平的高低可能对不同部位的肝硬化PVT诊断有一定的参考价值。     

多模态超声在涎腺局灶性病变良恶性鉴别诊断中的价值

目的探讨多模态超声鉴别诊断涎腺局灶性病变性质的价值。 方法回顾性分析2018年1月至2020年12月在解放军总医院第一医学中心收治的128例涎腺局灶性病变患者的临床资料以及超声影像资料。以手术或穿刺病理结果为金标准,将其分为良性组和恶性组。128例均行常规超声（US）、实时超声弹性成像（RTE）及超声造影（CEUS）检查,记录并分析3种模态的超声图像特征。采用χ²检验比较2组间病灶的超声图像特征,绘制受试者工作特征（ROC）曲线,计算US、US+RTE、US+CEUS、US+RTE+CEUS诊断涎腺局灶性病变的诊断效能以及ROC曲线下面积。 结果128例中,病理诊断良性病灶85例,恶性病灶43例。良性组病灶中91.8%（78/85）边界清晰、58.8%（50/85）形态规则,分别高于恶性病灶的58.1%（25/43）、18.6%（8/43）,差异均有统计学意义（P均＜0.001）;恶性组病灶中46.5%（20/43）RTE分级为Ⅲ级、72.1%（31/43）CEUS模式表现为Ⅱc型,良性组病灶中仅16.5%（14/85）RTE分级为Ⅲ级、11.8%（10/85）CEUS模式表现为Ⅱc型,2组比较差异均有统计学意义（P均＜0.05）。US+RTE任意一项结果阳性即诊断恶性对涎腺病变良恶性诊断的敏感度、特异度为0.767、0.800,ROC曲线下面积和约登指数为0.784、0.567。US+CEUS任意一项结果阳性即诊断恶性的敏感度、特异度分别为0.791、0.882,ROC曲线下面积和约登指数为0.837、0.673。US+RTE+CEUS中任意2项或以上结果阳性即诊断为恶性,其敏感度、特异度、准确性、阳性预测值和阴性预测值分别为0.767、0.941、0.883、0.868、0.889,ROC曲线下面积和约登指数为0.854、0.708。 结论多模态超声联合应用有助于提高超声对涎腺局灶性病变良恶性的鉴别诊断价值。     

Can contrast-enhanced ultrasonography characterize focal liver lesions and differentiate between benign and malignant,thus providing a one-stop imaging service for patients?

Purpose

Contrast-enhanced ultrasonography (CEUS) displays high sensitivity and specificity in characterizing focal liver lesions (FLLs). We attempted to determine how often CEUS provides an unequivocal diagnosis of FLLs that does not require additional imaging studies.

Materials and methods

Seventy-three patients with 146 FLLs were scanned with B-mode, Doppler, and contrast-enhanced US (2 × 2.4 ml SonoVue, low MI, 4–6 MHz curved array transducer, Toshiba Aplio/Siemens–Acuson Sequoia). Data were digitally stored and transferred to a work station with the GE PACS system. Images were reviewed by a consultant radiologist experienced in CEUS and interpreted in accordance with the criteria for characterizing FLLs published by the European Federation of Societies for Ultrasound in Medicine and Biology. Diagnoses were compared with those based on computed tomography (CT) and/or magnetic resonance (MR) findings if these were available. However, our aim was to assess the frequency with which CEUS provided diagnoses that were considered reliable enough to exclude the need for other imaging studies. Therefore, the CEUS diagnoses were not necessarily confirmed by other methods.

Results

Based on CEUS findings alone, 130/146 (89.0%) FLLs could be classified as benign or malignant, and in 118/146 (80.8%) cases, the lesion could be specifically identified. The other 28/146 (19.2%) FLLs could not be characterized based on CEUS data alone. In 58 (80.8%) of the 73 patients with multiple FLLs, CEUS findings were sufficient to establish the benign vs. malignant nature of all the patient''s lesions; in 51/73 (69.9%) patients, all the lesions could also be characterized with CEUS. In the remaining cases, at least one lesion required additional imaging to determine whether it was malignant (14/73, 19.2%) or to establish its identity (22/73, 30.1%). In 4/73 (5.5%) patients, CEUS revealed additional lesions not detected on B-mode US.

Conclusions

CEUS alone was sufficient to classify 89.0% of the FLLs as benign or malignant, and in 80.8% it was also regarded as sufficient to identify the lesion. It served as a one-stop diagnostic test for 80.8% of the patients, reducing the need for CT–MR scans and providing savings in terms of radiation exposure, time, and money.keywords: Ultrasound, Contrast agents, Focal liver lesions, Cost benefit     

超声造影诊断肝脏多发性病灶

目的 探讨超声造影(CEUS)在肝脏多发性病灶中的应用价值.方法 对43例肝脏多发性病灶患者(共86个病灶)行CEUS检查,观察其造影增强模式.所有病灶均经病理或增强CT/MRI证实.结果 43例患者中恶性22例,良性21例.恶性患者中,同一患者的2个病灶增强模式不同者10例(10/22,45.45%);良性患者中,同一患者的2个病灶增强模式不同者3例(3/21,14.29%),两组间差异有统计学意义(P<0.05).结论 在肝脏多发性病灶患者中,恶性患者各病灶CEUS增强模式差异较大,而良性患者各病灶的增强模式基本相同.     

实时超声造影在肝移植术后门静脉并发症诊断中的应用

目的探讨低机械指数实时超声造影在肝移植术后门静脉并发症诊断中的价值。 方法317例肝移植术后患者进行门静脉彩色多普勒血流显像（CDFI）检查，对其中20例门静脉显像异常的患者，采用造影剂SonoVue和脉冲反向谐波技术进行低机械指数实时超声造影。并与CT血管成像（CTA）结果进行比较。 结果肝移植术后门静脉血栓发生率为2．8％，门静脉狭窄为1．3％。CDFI诊断门静脉血栓与CTA的符合率为61．5％，超声造影为88．9％（P〈0．01）；CDFI诊断门静脉狭窄与CTA的符合率为57．1%，超声造影为100％（P〈0．01）。 结论低机械指数实时超声造影可提高肝移植术后门静脉并发症的诊断能力，其诊断价值与CT血管成像相当。