经肠系膜上动脉行间接门静脉造影的技术改进

目的 探讨原发性肝癌化疗栓塞中经肠系膜上动脉行间接门静脉造影的技术改进方法.资料与方法选取68例行介入治疗的原发性肝癌患者,其中20例未评级,不设定动-静脉期间隔时间,使用相同造影程序;48例评级,依据个体情况设定动-静脉期间隔时间,制定相应造影程序.分别分析68例造影图像,依据是否清晰显示门静脉系统分为高、中、低质量图像.结果 20例未评级患者,3例造影图像为高质量,10例为中质量,7例为低质量;48例评级患者,35例造影图像为高质量,13例中质量.结论 在经肠系膜上动脉行间接门静脉造影前根据患者的肝功能、有无门静脉癌栓及门静脉高压等因素来设定动-静脉期间隔时间,确定个体化造影程序,能保证取得高质量的图像.     

64层螺旋CT门静脉造影在显示肝硬化门静脉高压侧支循环中的价值

目的：评价64层螺旋CT门静脉造影对肝硬化门静脉高压侧支循环显示的价值.材料和方法：肝硬化患者28例,采用64层螺旋CT行动脉期、门脉期及平衡期扫描后,运用容积重建法（VR）、多层面重建法（MPR）和最大密度投影法（MIP）对门静脉及其分支进行重建,观察门静脉高压肝内门静脉、属支及侧支循环的影像学特征.结果：64层螺旋CT门静脉造影能准确显示侧支循环分布范围,初步评估病变程度;门静脉高压时,门静脉属支管径显著扩张（门静脉主干、脾静脉、肠系膜上静脉、胃冠状静脉）.胃冠状静脉曲张24例、食管胃底静脉曲张21例、食管周围静脉曲张17例、胃短静脉曲张10例、脾/胃-肾分流6例、脐静脉和腹壁静脉曲张5例、腹膜后静脉曲张2例和直肠上静脉曲张2例,门静脉海绵状变性1例.结论：64层螺旋CT门静脉造影能够多角度、准确地显示门静脉高压时侧支循环开放的情况,对判断病变程度、预测其并发症、选择治疗方案具有重要意义.     

64层螺旋CT对急性门静脉和肠系膜上静脉血栓的诊断价值

目的 探讨64层螺旋CT对急性门静脉和肠系膜上静脉血栓的诊断价值.资料与方法回顾性分析经手术及临床确诊的19例急性门静脉和肠系膜上静脉血栓形成患者的64层螺旋CT表现.19例均行平扫,14例加行增强扫描,并应用多平面重组(MPR)、曲面重组(CPR)、最大密度投影(MIP)和容积再现(VR)行多层螺旋CT血管成像(MSCTA).结果 19例平扫均显示门静脉和肠系膜上静脉增粗,12例肠系膜周围脂肪密度增高,13例管腔内高密度,10例有不同程度腹腔积液,14例肠管扩张、积气积液,10例肠壁增厚水肿;14例增强扫描均显示静脉内低密度充盈缺损,门静脉和肠系膜上静脉管壁环形强化,肠管管壁强化呈"靶征",3例肠管未强化,5例显示肝脏一过性供血不足,门静脉期供血减少.结论 64层螺旋CT平扫及增强扫描,以及三维重组技术相结合能够早期发现急性门静脉和肠系膜上静脉血栓形成.     

三维对比剂增强MR门静脉成像与直接门静脉造影术对照

目的通过与直接门静脉造影术的比较，评价三维对比剂增强MR门静脉成像（3D CE MRP）的准确性。方法26例患者行3D CE MRP和直接门静脉造影检查。分析3D CE MRP上门静脉主干、肝内左右分支的开放性和侧支循环发生情况，其结果与直接门静脉造影对照，评价两者符合情况，并分析两者不符的原因。结果3D CE MRP和直接门静脉造影显示门静脉主干的结果完全一致。对肝内门静脉分支，有21例2种检查结果符合，但有5例不符。1例肝右叶巨大肿瘤，3D CE MRP显示门静脉右后支闭塞，但直接门静脉造影显示明显狭窄。3例左叶肝癌患者，3D CE MRP显示门静脉左支闭塞，但直接门静脉造影显示其近段狭窄和远端闭塞。另有1例肝癌患者，3D CE MRP显示门静脉左支矢状段小癌栓，而直接门静脉造影却未能显示。除1例脐静脉重开由于扫描范围较小未显示之外，3D CE MRP显示侧支循环的结果和直接门静脉造影相符。结论多数病例，3D CE MRP的显示结果与直接门静脉造影符合。3D CE MRP在鉴别肝内门静脉分支狭窄或闭塞时有一定限度，而在显示门静脉小栓子方面却有优势。     

Abernethy畸形的影像学表现

目的提高对Abemethy畸形（Abemethy malformation）的认识。方法报告2例经DSA证实的罕见Abemethy畸形的影像学表现，2例分别行内科保守治疗和部分性脾动脉栓塞术，并作文献复习。结果例1CT增强扫描及三维血管成像示：肝下段下腔静脉增宽，门静脉干及分支变细，胃和脾周可见迂曲扩张的血管。经肠系膜上动脉间接门静脉DSA可见门静脉干及分支明显变细，肠道静脉血少部分回流入门静脉，大部分经一迂曲扩张的分流道人左。肾静脉；脾动脉DSA示脾静脉血主要经分流道人左。肾静脉。例2CT示：肝叶比例失调，右叶稍大，肝裂宽，脾大，脾门血管迂曲扩张。经肠系膜上动脉间接门静脉DSA可见门静脉干闭塞，周围可见细小迂曲的血管，肠道静脉血大部分经一分流道人左肾静脉；脾动脉DSA显示脾静脉血主要经分流道人左。肾静脉和下腔静脉。结论Abemethy畸形的诊断主要依据影像学，以间接或直接门静脉造影为金标准。治疗方法应根据畸形的不同类型及病人的情况决定。     

经皮脾穿刺CO2门静脉造影与动脉法间接门静脉造影的对照研究

目的 对经皮脾穿刺CO2门静脉造影与动脉法间接门静脉造影进行对照研究，评价其造影效果及临床应用价值。方法 21例患者（男16例，女5例），原发性肝癌15例，转移性肝癌6例。分别同时行肠系膜上动脉间接门静脉造影和经皮脾穿刺CO2门静脉造影，对造影结果进行统计学分析，并对经皮脾穿刺CO2门静脉造影的安全性进行评估。结果 21例经皮脾穿刺CO2门静脉造影中20例造影成功，图像质量明显优于动脉间接法门静脉造影（t=6．815，P〈0．01）。木中有10例患者（10／21）CO2造影术中有一过性轻度腹部不适，1例术后脾脏出血。结论 经皮细针穿刺脾脏CO2造影可清晰显示门静脉结构，图像质量优于动脉法间接门静脉造影，造影方法简便、创伤小、经济；熟练的操作可以提高其安全性。     

急性门静脉和肠系膜上静脉血栓形成的CT诊断

目的:分析急性门静脉及肠系膜上静脉血栓形成的临床及CT表现。方法:回顾性分析9例经手术及临床综合诊断证实的急性门静脉及肠系膜上静脉血栓形成病例的CT表现,9例均行CT平扫,3例行增强扫描。结果:9例CT平扫均显示门静脉或肠系膜上静脉增粗,7例见腔内高密度影,8例见腹腔积液,5例见小肠管壁增厚、水肿;3例强化扫描示静脉内低密度充盈缺损。结论:CT对诊断急性门静脉及肠系膜上静脉血栓形成具有重要意义;临床上对急性腹痛,不明原因腹水及可疑肠梗阻的病例,应注意观察其门脉系统情况。     

三维动态增强磁共振门静脉造影

目的　探讨三维动态增强磁共振门静脉造影 (3DDCE -MRP)的方法及其临床应用价值。方法　共对 35例临床上疑有肝脏疾患的病人进行了 3DDCE -MRP检查 ,用TEST -BOLUS序列测定循环时间 ,然后根据公式 :延时时间 =造影剂循环时间 -1 /4采集时间 ,推算出延时时间。从肘静脉快速推注Gd-DTPA 0 .2mmol/kg,用 3DFLASH序列 (TR/TE 4 .6ms/1 .8ms)屏气冠状位扫描获得 3组三维原始图像 ,行最大信号投影处理。观察 3DDCE -MRP对门静脉正常结构和病理状况的显示情况。结果　35例中 1 0例MRP表现为正常 ,原发性肝癌 1 4例 ,门静脉高压 8例 ,肝血管瘤 3例。 3DDCE -MRP能清晰显示门静脉系正常解剖结构 ,门静脉肝内分支能显示至 4～ 6级 ,能较满意显示门脉内瘤栓及门脉高压症患者的侧枝循环情况 ,并能直观地显示门静脉、肝静脉和下腔静脉的立体关系 ,为临床提供全面的肝脏血管结构。结论　 3DDCE -MRP能很好地显示门静脉结构 ,并能准确地评价门静脉病变     

改善间接门静脉DSA造影图像质量

随着介入放射学的广泛开展，肝癌介入治疗的疗效已被肯定。但中晚期肝癌常伴门静癌栓或动静脉瘘，可影响经导管灌注栓塞，我们知道肝脏3／4的血供来自门静脉，该血管由脾静脉的肠系膜上静脉在胰腺上方汇合而成。通过间接法门静脉造影，目的是了解门静脉情况，为介入医生提供参考依据。为此，在DSA下行门静脉造影时，务必要清晰显示门静脉情况，下列几点技术控制措施有利改善门静脉DSA图像质量。     

常规MRI和三维对比增强MR血管成像对门肠系膜静脉血栓的诊断

目的 探讨常规MRI和三维对比增强MR血管成像(3D CE MRA)在门肠系膜静脉血栓诊断中的价值.资料与方法 回顾性分析经临床、手术证实的14例门肠系膜静脉血栓的平扫、增强MRI和3D CE MRA资料.结果 14例中,门肠系膜静脉及分支累及10例,门静脉及分支累及2例,2例仅累及肠系膜上静脉及分支;其中5例并发侧支血管形成.3D CE MRA准确地显示了相应病理解剖改变;平扫MRI能够显示门静脉、肠系膜上静脉主干内的血栓,但难以确切显示门肠系膜静脉属支、门静脉肝内分支血栓和较小血栓;增强后快速扰相稳态梯度回复采集序列(FSPGR)图像由于血管内和血管壁的强化及更高信噪比可更好地显示血栓.结论 平扫时重视对血管形态的观察有利于发现血栓,同时行3D CE MRA及增强后FSPGR,可以准确地诊断门肠系膜静脉血栓,为临床提供重要的诊断信息.     

Vascular changes in hepatocellular carcinoma: correlation of radiologic and pathologic findings.

OBJECTIVE: Our objective was to analyze the hemodynamic properties and vascular supply changes in the carcinogenesis of hepatocellular carcinoma. MATERIALS AND METHODS: Ten nodules (nine patients) (one early, three early-advanced, and six advanced cases of hepatocellular carcinoma) less than 3 cm in diameter were selected from 45 patients (50 nodules) who underwent CT arteriography and CT during arterial portography. These images were correlated with histopathologic findings. Ratios of all microscopically counted (normal hepatic and abnormal) arteries, normal hepatic arteries, and portal veins in each nodule to those in the surrounding liver were calculated. RESULTS: Early hepatocellular carcinoma (one early case and early areas in three early-advanced cases) had low attenuation on CT arteriography and isoattenuation on CT during arterial portography. Advanced hepatocellular carcinoma (six advanced cases and advanced areas in three early-advanced cases) had high attenuation on CT arteriography and low attenuation on CT during arterial portography. In early hepatocellular carcinoma, the ratios of all arteries, normal hepatic arteries, and portal veins were 1.21 +/- 0.07, 0.60 +/- 0.07, and 0.73 +/- 0.06, respectively. In advanced hepatocellular carcinoma, the ratios were 2.66 +/- 0.26, 0.08 +/- 0.04, and 0.07 +/- 0.03, respectively. CONCLUSION: In early hepatocellular carcinoma, the combination of normal hepatic artery degeneration and preserved portal veins results in low attenuation on CT arteriography and isoattenuation on CT during arterial portography. In advanced hepatocellular carcinoma, the combination of neoplastic (abnormal) arterial development by angiogenesis and obliteration of portal veins results in high attenuation on CT arteriography and low attenuation on CT during arterial portography. These findings are a characteristic difference between early and advanced hepatocellular carcinoma.     

The aetiology of non-tumorous enhancement in the hepatic hilum shown on CT hepatic arteriography

The causes of non-tumorous abnormalities in the hepatic hilum seen on CT hepatic arteriography were investigated. 13 patients with non-tumorous defects of portal perfusion in the hepatic hilum on CT arterial portography underwent both CT hepatic arteriography from the common hepatic artery and CT obtained during proper hepatic arteriography. The findings of non-tumorous portal defects on these two angiographic studies using helical CT were compared. In the 13 patients, 14 non-tumorous defects of portal perfusion in the hepatic hilum on CT arterial portography were detected as enhanced areas in 10 regions (dorsum of segment IV, 7/10; dorsum of the lateral segment, 3/4) on CT hepatic arteriography via the common hepatic artery, but none were enhanced on CT obtained during proper hepatic arteriography. In conclusion, the main cause of non-tumorous enhancement in the hepatic hilum seen on CT hepatic arteriography is non-portal direct inflow via the parabiliary venous system.     

螺旋CT门静脉成像评价门脉高压的价值

目的 评价螺旋CT门静脉成像（SCTP）显示门静脉高压的价值。材料与方法 51例患者分别进行了SCTP和常规门静脉造影,间隔时间0－3天。其中42例为肝癌患者伴或不伴门静脉高压,9例为单纯肝硬化伴门静脉高压患者。分析SCTP图像上门静脉主干及左、右分支的开放性;侧支循环发生的部位和分布范围,结果与常规门静脉造影（直接和间接法）相对照,评价两者的符合情况。结果 在51例患者共153支门静脉主干和左、右分支中,SCTP显示107支通畅中的104支,46支充盈缺损、闭塞中的44支,总符合率为96．7％（148／153）。除1例冠状静脉曲张及1例脐静脉开放未显示外,SCTP清楚显影其余侧支血管,总符合率为95．3％（41／43）。结论 SCTP与常规门静脉造影诊断符合率高,能准确显示门静脉开放性和门静脉高压侧支循环分布情况,基本能取代有创性的传统门静脉造影术。     

CT arteriography of hepatic tumors]

The liver has dual blood supply from the portal vein and hepatic artery. Computed tomographic findings of hepatic neoplasms are greatly influenced by hepatic blood flow, and abnormal portal and hepatic arterial blood flow needs to be examined separately by CT arteriography (CTA) and CT during arterial portography (CTAP). Both CTA and CTAP have advantages over conventional CT in that they can provide greater contrast enhancement of hepatic tumors by injecting contrast material directly into the hepatic or superior mesenteric arteries. The methods of CTA and CTAP are described. CTA and CTAP were useful in the detection of small hepatic lesions, evaluation of changes in hepatic parenchymal blood flow, and evaluation of portal flow in hepatocellular carcinoma, which contribute to the classification of HCC. In conclusion, CTA and CTAP were indispensable in selecting a therapeutic approach.     

64层螺旋CT门静脉三维重组对门静脉高压侧支循环的研究及临床应用

目的：评价64层螺旋CT门静脉三维重组对门静脉高压侧支循环的诊断价值及临床应用。方法：正常者20例,肝硬化患者39例,行64层螺旋CT门静脉造影,容积数据采用最大密度投影（MIP）、容积再现法（VR）、表面遮盖法（SSD）、多平面重组（MPR）三维重组,观察门静脉高压肝内门静脉、属支及侧支循环的影像学特征。结果：64层螺旋CT门静脉三维重组能准确显示侧支循环分布范围、初步评估病变程度,门静脉高压症组门静脉属支管径显著大于正常组（P=0.000）,64层螺旋CT诊断食管胃底静脉曲张与胃镜诊断有高度一致性。结论：64层螺旋CT门静脉三维重组能够多角度、立体观察侧支循环情况,对预测其并发症、手术方案的制定具有重要的指导意义。     

Preoperative evaluation of hepatocellular carcinoma: combined use of CT with arterial portography and hepatic arteriography

OBJECTIVE: This study was undertaken to determine the usefulness of combined CT during arterial portography and CT hepatic arteriography in the preoperative evaluation of patients with known or suspected hepatocellular carcinoma and to describe the findings on CT during arterial portography and CT hepatic arteriography by which hepatocellular carcinomas may be differentiated from pseudolesions. SUBJECTS AND METHODS: This study included 137 patients who underwent combined CT during arterial portography and CT hepatic arteriography for the preoperative evaluation of known or suspected hepatocellular carcinoma. The images were prospectively evaluated to identify focal hepatic lesions and their differential diagnoses (hepatocellular carcinoma versus pseudolesion). We assessed the diagnostic accuracy of our prospective interpretation by comparing the interpretations with the results of histopathology or follow-up imaging. We also retrospectively analyzed imaging features seen on CT during arterial portography and CT hepatic arteriography-the size, shape, and location of the lesion within the liver; attenuation of the lesion; and opacification of the peripheral portal vein branches on CT hepatic arteriography. RESULTS: One hundred and forty-nine hepatocellular carcinomas (75 lesions confirmed at histopathology and 74 lesions on follow-up imaging) were found in 120 patients, and 104 pseudolesions (15 lesions confirmed at histopathology and 89 lesions on follow-up imaging) were found in 91 patients. The sensitivity of our prospective interpretations was 98.7%, and the specificity of our prospective interpretations was 90.4%. Our positive and negative predictive values were 93.6% and 97.9%, respectively. We found that hepatocellular carcinomas were larger, more frequently nodular, and more likely to be located intraparenchymally than were the pseudolesions (p < 0.01). Opacification of the peripheral portal vein branches on CT hepatic arteriography was detected in 36 pseudolesions (34.6%) but in none of the hepatocellular carcinomas (p < 0.01). CONCLUSION: Combining CT during arterial portography and CT hepatic arteriography is useful for the preoperative evaluation of patients with known or suspected hepatocellular carcinoma. Familiarity with the imaging features of hepatocellular carcinomas and pseudolesions can help in the accurate differentiation of hepatocellular carcinomas from pseudolesions.     

Portographic evaluation for recurrent esophagogastric varices following devascularization surgery

Purpose To investigate, by transhepatic portography, the changes in portosystemic collaterals and recurrent esophagogastric varices after devascularization surgery. Methods Thirty-five patients, who had undergone devascularization surgery 2–8 years previously, underwent follow-up portography and the collaterals and drainage routes were compared with preoperative portography resuts. Results Newly formed collaterals were present in 30 of 35 patients and the origins and drainage routes differed from preoperative ones. Most common were new collaterals arising from the junction of the portal and superior mesenteric veins; the next most frequent arose from a main portal branch, the portal trunk, or the superior mesenteric vein. New collaterals with recurrent varices were seen in 20 patients and without varices in 10; 5 patients had no collaterals or varices. Conclusion Since the development of new collaterals is common in portal hypertensive patients following devascularization surgery, regular follow-up for recurrent varices is necessary.     

Computed tomography perfusion of the liver: assessment of pure portal blood flow studied with CT perfusion during superior mesenteric arterial portography

Purpose: To quantitatively assess the portal component of hepatic blood flow using computed tomography (CT) perfusion studies during superior mesenteric arterial portography. Material and Methods: Thirty-four patients with hepatocellular carcinoma and liver cirrhosis (LC) and 13 patients with liver metastasis without chronic liver disease were enrolled in this study. Ten milliliters of a non-ionic contrast medium (150 mgI) was injected at a rate of 5 ml/s via a catheter placed in the superior mesenteric artery. Single-slice cine CT images at the level of the main trunk or the right/left main trunk of the portal vein were acquired over 40 s. The deconvolution method was then used on these CT images to measure blood flow (BF), blood volume (BV), and mean transit time (MTT) in (a) liver parenchyma in patients with HCC and liver cirrhosis; (b) liver parenchyma in patients with liver metastasis without cirrhosis; (c) directly in the HCC; and (d) directly in one of the metastases. Results: In 34 LC patients (a), BF, BV, and MTT in the liver parenchyma were 44.7±24.5 ml/min/100 g, 3.9±2.4 ml/100 g, and 10.9±5.5 s, respectively. In 13 patients without cirrhosis (b), BF, BV, and MTT in the liver parenchyma were 89.6±52.0 ml/min/100 g, 6.3 ±3.2 ml/100 g, and 8.7±3.6 sec, respectively. A significant difference in BF and BV was seen in patients with liver cirrhosis compared to those without cirrhosis. BF, BV, and MTT measured directly in HCC (c) were 6.5±4.5 ml/min/100 g, 0.4±0.4 ml/100 g, and 3.0±3.1 sec respectively, and BF, BV, and MTT in liver metastases (d) were 19.3 ± 21.7 ml/min/100 g, 0.6±0.8 ml/100 g, and 1.8±1.6 s, respectively. Conclusion: CT perfusion studies during superior mesenteric arterial portography allow quantitative assessment of pure portal blood flow in the liver.     

Effects of prostaglandin E(1) injection through the superior mesenteric artery on the hemodynamics of hepatocellular carcinoma.

OBJECTIVE: The purpose of our study was to assess the effects of portal blood flow on contrast enhancement in hepatocellular carcinoma lesions on CT hepatic arteriography. SUBJECTS AND METHODS: We examined 43 tumors in 39 patients who simultaneously underwent CT during arterial portography and CT hepatic arteriography for examination of liver tumors and then CT hepatic arteriography with prostaglandin E(1) injection via the superior mesenteric artery. All lesions pathologically confirmed to be hepatocellular carcinomas exhibited portal perfusion defects on CT during arterial portography. Changes in CT attenuation, size, and shape of liver tumors visualized on CT hepatic arteriography after intraarterial injection of prostaglandin E(1) were studied. In addition, changes in CT attenuation of the liver parenchyma surrounding the tumor were measured. RESULTS: The CT attenuation increased significantly after injection of prostaglandin E(1) in 91% (39/43) of the lesions (mean increase from 176.4 to 206.6 H; p = 0.0006, paired t test). The size and shape of the enhanced area generally did not change. The CT attenuation of the liver parenchyma surrounding each liver tumor significantly decreased in 58% (25/43) of the hepatocellular carcinoma lesions (mean decrease from 94.8 to 92.0 H; p = 0.0166, paired t test) and lesion conspicuity increased in 91% (39/43) of the tumors. CONCLUSION: Lesion conspicuity on CT hepatic arteriography between hepatocellular carcinoma and the surrounding liver parenchyma increased because of greater portal perfusion after the prostaglandin E(1) injection.