Diagnostic value of 16 slices spiral-CT for portal vein disorders

The diagnostic value of 16-slices spiral computed tomography (CT) for portal vein disorders was evaluated. Forty-one patients were scanned by the 16-slices spiral-CT. The celiac trunk,portal vein and their branches were reconstructed by volume rendering (VR), multiplanar volume reconstruction (MPVR) and maximum intensity projection (MIP) technique, and the results were compared with digital subtraction angiography (DSA), VR, MPVR and MIP could display celiac trunk, portal vein, inferior vena cava and their branches and extent of portal vein-vena cava shunt,portal vein emboli and the fistula of hepatic artery-portal vein. The results from 16-slices CT were better than DSA and identical with pathologic ones. The vessel three-dimension reconstruction technioue of 16-slices soiral CT is valuable for evaluating the oortal systemic disorders.     

The clinical significance of intrahepatic arteriovenous shunt in patients with hepatic carcinoma

Objective To investigate the clinical features of intrahepatic arteriovenous shunt (AVS) in patients with hepatic carcinoma. Methods The clinical data including results of therapy of 538 hepatic carcinoma patients admitted between 1996 and 2001 were retrospectively reviewed. Results There were 71 cases of AVS altogether with 61 cases of arterio-portal shunt and 8 cases of hepatic arterior-venous shunt. Thirty out of 39 AVS cases with fistula formed between hepatic artery and main portal branch developed portal hypertension. The patients received a total of 84 sessions of transarterial chemotherapy and embolization (TACE) with a success rate of 61% (51 sessions). After TACE liver failure ensued in 3 cases. The mean survival time of these patients was 5. 77 months. Conclusion Arterio-portal /venous fistula is a common complication among hepatic carcinoma patients which ofter predicts poor prognosis. A high percentage of AVS patients will not tolerate TACE and in which the portal hypertension will be exace     

Clinical and pathological features and surgical treatment of Budd-Chiari syndrome-associated hepatocellular carcinoma

Background Budd-Chiari syndrome （BCS） is characterized by liver sinusoidal congestion,ischemic liver cell damage,and liver portal hypertension caused by hepatic venous outflow constriction.The aim of this research was to investigate the clinicopathological features of BCS-associated hepatocellular carcinoma （HCC） and explore its surgical treatment and prognosis.Methods Clinical data from 38 patients with BCS-associated HCC who were surgically treated in our hospital from July 1998 to August 2010 were retrospectively analyzed.The clinicopathological features and prognosis of patients with BCS-associated HCC and surgical treatment for BCS-associated HCC were investigated.Results Compared to the patients with hepatitis B virus （HBV）-associated HCC,the patients with BCS-associated HCC showed a female predominance,and had significantly higher cirrhosis rate,higher incidence of solitary tumors,lower incidence of infiltrative growth,higher proportion of marginal or exogenous growth,lower rate of portal vein invasion,and higher degree of differentiation.Median survival was longer in patients with BCS-associated HCC （76 months） than in those with HBV associated HCC （38 months）.Of 38 patients with BCS-associated HCC,22 patients who received combined surgery mainly by liver resection plus cavoatrial shunts exhibited hepatic venous outflow constriction relief,while the other 16 patients only underwent liver resection.The combined surgery group had significantly longer survival and lower incidences of post-operative lethal complications （P 〈0.05）.Multivariate analysis showed that relief of hepatic venous outflow obstruction was a protective factor for survival of patients with BCS-associated HCC,whereas portal vein invasion was a risk factor.Conclusions BCS-associated HCC has a more favorable biological behavior and prognosis than HBV-associated HCC.For patients with BCS-associated HCC,tumor resection accompanied with relief of hepatic venous outflow obstruction can reduce the incidence of complications and extend survival.     

Permanent hepatic artery embolization with dextran microspheres in 131 patients with unresectable hepatocellular carcinoma.

One hundred thirty-one patients with hepatocellular carcinoma were subjected to permanent hepatic artery embolization with dextran microspheres (G-25, 50-150 mu). Dextran hepatic artery embolization is indicated for massive, nodular or multinodular hepatocellular carcinoma with total bilirubin less than 3 mg/dl, serum albumin greater than 3.0 g/dl, tumor involvement area less than 50% or without involvement of the main portal vein. Following hepatic angiography a catheter was inserted superselectively into the hepatic artery feeding the tumor. Adriamycin (60-80 mg) or cisplatin (60-100 mg) was infused immediately before embolization. Under fluoroscopic guidance, 0.3-0.5 g of dextran microsphere embolizer permeated with 10 mg of mitomycin C was infused into the feeding artery through the catheter. Dextran microspheres caused marked homogeneous and distal micro-arterial embolization, especially in the arteriole with a caliber of about 100 mu. Dextran microspheres were not resorbed in a period of 16 weeks in humans, thus reducing or preventing the formation of intrahepatic and extrahepatic collaterals after hepatic artery embolization. Dextran hepatic artery embolization was very effective for not only main tumor but also daughter foci or metastatic nodules, as was confirmed histologically in 8 cases. The 1-year, 2-year and 3-year survival rates were 57.0%, 31.4% and 24.2% respectively.

     

Transarterial chemoembolization combined with sorafenib and iodine-125 seed brachytherapy for hepatocellular carcinoma with portal vein tumor thrombus: a retrospective controlled study

<正>To the Editor: Portal vein tumor thrombus (PVTT) is present in 10% to 40% of patients with hepatocellular carcinoma (HCC) at diagnosis and has a profound adverse effect on progno-sis.[1] Sorafenib is     

Hepatic carcinoma. The possibility of transcatheter chemoembolization through the portal vein.

A suspension of iodized oil and anticancer agent was injected into the portal veins of 20 rats with hepatic carcinoma and of 20 normal rats to observe its distribution in the liver and the effect on cancer tissue and normal cells. Microscopic and transmission electron microscopic examinations were carried out. Oil drops were seen in tumor cell lines, small blood vessels inside the cancer nest, the sinusoids, and the central veins. More oil drops were found in the peripheral parts of the tumor than in the central part. The distal small vessels were embolized with necrotic change of tumor cells and their subordinate normal liver cells. We conclude that portal vein part takes in the blood supply of liver cancer and tumor cell necrosis can be achieved after administration of iodized oil and anticancer agent mixture through the portal vein. Hence transcatheter treatment through the portal vein may be helpful as a supplement to intraarterial treatment of primary liver cancer and transcatheter embolization via the portal vein to reinforce the intraarterial therapy may be recommended. This procedure may cause necrosis of normal liver cells and care must be taken in clinical application.

     

Relationship between abnormal characteristics of sublingual collateral and portal vein hemodynamic changes in patients with primary hepatic carcinoma

Objective： To investigate the relationship between the abnormal characteristics of sublingual collateral （SC） and portal vein hemodynamic changes in patients with primary hepatic carcinoma （PHC）. Methods： A total of 123 patients of PHC with abnormal SC were enrolled. The SC characteristics were classified and evaluated. The principal components （PC） of SC extracted from them by principal component analysis and the relationship between PC and the dynamic changes of portal vein flow were analyzed by correlation analysis. Results： Three groups of PC were extracted, namely PC-1 （length, width, presentation type of visualization）, PC-2 （circuitous, vesicular change）, and PC-3 （color, collateral hemostasis, petechiae, ecchymosis）. Their total accumulative contribution degree reached 56.803%. Correlation analysis shows that PC-1 was significantly positively correlated with the hemodynamic parameters of the portal vein （P〈0.01）, while PC-2 and PC-3 were not （P〉0.05）. Conclusion： Length, width and presentation type of SC could be used for predicting the changes of portal venous pressure in PHC patients.     

Applicability of prostaglandin E1 indirect portal vein angiography in patients with portal hypertension.

The imaging quality of the portal vein was obviously improved with prostaglandin E1 (PGE1) indirect portal vein digital subtraction angiography (DSA) in 23 cases. The time-density curve showed that the occurrence rate of opposite hepatic blood flow of splenic vein (SV) was the highest (17.4%). The total visualization rate of the left gastric vein (LGV) was 78.3%, and the visualization rate of the short gastric vein (SGV) was 36.4%. 38.9% of the LGV and all the SGV were visualized with indirect portal vein DSA through SA. Indirect portal vein angiography through superior mesenteric artery and that through splenic artery were of equal importance. In portal hypertension patients with hemorrhage of the digestive tract, when LGV and SGV could not be visualized in PGE1 indirect portal vein DSA, the possibility of non-varices vein bleeding should be considered. When opposite hepatic blood flow with obvious dilation appeared in LGV and SGV, devascularization of the pericardial blood vessels would be justifiable.     

Changes in serum ammonia concentration in cirrhotic patients with Helicobacter pylori infection

Objective To study whether liver cirrhosis associated with Helicobacter pylori (H. pylori) infection will induce increased serum ammonia and whether the peripher al serum ammonia reflects the level of portal vein serum ammonia. Methods Blood was taken from the portal vein and the cubital vein in cirrhotic patients with and without H. pylori infection and non-cirrhotic patients (splenic rupture) with and without H. pylori infection, and the serum ammonia was measured.Results The mean levels of serum ammonia in the group of cirrhotic patients with H. pylori infection were 167.82±8.97 μmol/L (portal vein) and 142.2±13.35 μmol/L (cubital vein). They were increased significantly as compared with cirrhotic patients without H. pylori infection (47.68±12.03 μmol/L portal vein and 37.23±7.04 μmol/L cubital vein), and also compared with the groups of splenic rupture patients with and without H. pylori infection ( P &lt;0.01). There was no significant difference between the serum ammonia level of the cubital vein and portal vein (P&gt;0.05).Conclusions H. pylori infection can induce an increase in serum ammonia in patients with liver dysfunction, and the peripheral serum ammonia measurement may replace the portal vein serum ammonia as a monitoring method. Eradication of H. pylori in cirrhotic patients may prevent hepatic encephalopathy (HE).     

Effects of portal venous arterialization on acute occlusion of hepatic artery in rats

Background A fatal complication after liver transplantation is anastomotic embolization of the hepatic artery. In order to solve this problem, the portal venous arterialization （PVA） is used to reconstruct the hepatic arterial blood flow. The purpose of this study was to investigate the influence of PVA on rats with acute occlusion of hepatic artery.
Methods Rat PVA models were established and then randomly divided into Group 1 （control group）, Group 2 （jaundice group）, Group 3 （bile duct recanalization group）, and Group 4 （portal vein arterilization group）. Recanalization of the common bile duct and PVA were performed 5 days after bile duct ligation in the rats. The influence of the PVA on general conditions, hepatic changes of structure and function, portal vein pressure and hepatic micrangium were observed for one month.
Results Five days after common bile duct ligation the serum bilirubin, transaminase and alkaline phosphatase levels were significantly increased. Compared with group 1, there was a statistically significant difference （P 〈0.01）. These rats then underwent bile duct recanalization and PVA. After a month, the liver functions and microscopic structures completely returned to normal and, compared with group 1, there was no statistically significant difference in portal vein pressure （P 〉0.05）. Vascular casting samples showed that hepatic sinusoids were slightly thicker and more filled than normal ones and although they had some deformations, the hepatic sinusoids were still distributed around the central vein in radial form.
Conclusion Within a month after operation, bile duct recanalization and PVA do not show obvious adverse effects on liver hemodynamics and hepatic micrangium, and the liver function and microscopic structure can return to normal.     

CT引导下125I粒子植入联合TACE治疗原发性肝癌合并门静脉癌栓的价值

目的探讨CT引导下125I粒子植入联合TACE治疗原发性肝癌合并门静脉癌栓的临床价值。方法抽取佛山南海社会福利中心康复医院放射科2010年1月～2013年10月收治的18例原发性肝癌合并门静脉癌栓患者作为研究对象,并给予6个月～2年的随访,同时结合其临床资料进行回顾性分析。结果经治疗后随访发现,18例患者中,共有14例获得有效治愈,总有效率为77.8%。结论给予原发性肝癌合并门静脉癌栓患者CT引导下125I粒子植入联合TACE治疗,能够有效保证临床治疗效果,值得推广。     

125I粒子植入联合TACE治疗原发性肝癌合并门静脉癌栓

目的本文旨在探讨1251粒子门脉癌栓植入联合TACE治疗原发性肝癌合并门脉癌栓的有效性及安全性。方法选取2007年8月～20f0年8月收治的原发性肝癌合并门脉癌栓患者72例,行TAOE治疗后1周,在GT或彩超影像引导下对门脉癌栓行125t放射粒子植入术。根据计算机三维治疗计划系统（TP8）进行布源,粒子活度为29．6MBq,粒子间距5～10mm,肿瘤周边匹配剂量为（matched peripheraldose,MPD）90～120Gy,随访观察局部控制率,总体生存率。结果随访6～24个月,6个月后局部病灶评价CE2／12,Pg7／12,NC3／12,临床有效率75％（Cg＋PE）;总生存率6个月、12个月、24个月生存率分别为916％（11／12）、75％（9／12）33．3％（4／12）。结论eT导向下1251粒子植入联合TAOE治疗肝癌合并门脉癌栓,临床疗效确切,并发症发生率低,是一种简单、安全、有效的方法。     

64排容积CT多期增强扫描及3D重建在肝细胞癌诊疗中的应用价值

目的探讨64层容积cT肝脏多期增强扫描和三维重建技术在肝细胞癌诊断中的应用价值。方法回顾性分析154例经病理证实的肝细胞癌患者的临床资料和64排容积cT增强后多期扫描图像,然后利用薄层图像数据进行三维重建。结果154例肝细胞癌中,（142／154）例在动脉晚期呈高密度,（138／154）例显示供血动脉。（8／154）例在门静脉期呈等或高密度,（146／154）例在门静脉期呈相对低的密度。（154／154）例在延迟期呈相对低密度。（32／154）例显示门静脉癌栓,（8／154）例显示下腔静脉瘤栓。结论64排容积cT增强多期扫描及3D重建不仅能显示肝细胞癌的增强表现特征,而且提高了肝细胞癌的检出率,还能直观地显示肝动脉、肝静脉及门静脉受侵情况,在临床早期诊疗中具有重要的价值。     

肝癌CT三期扫描与DSA图像对比

目的 探讨肝癌CT三期扫描与DSA图像对比,以及不同的影像表现对介入治疗方法选择的指导.方法 入选150例资料完整的肝癌患者,原发性肝癌103例,肝转移癌47例.所有患者均有完整的CT三期扫描和DSA造影图像.结果 部分小肝癌、转移癌在动脉期强化不明显,DSA能明确供瘤动脉且能看到肿瘤染色.肝转移癌亦为肝动脉供血.结论 强化不明显的肝癌,瘤体多为肝动脉的三级或四级分支供血.对肝动脉-门静脉瘘,肝动脉-肝静脉瘘采取不同的栓塞方法,均能封闭瘘口且取得较好的疗效.     

碘-125 (125I)粒子条治疗肝癌合并门脉主干癌栓(MPVTT)的随机对照研究

 目的  随机分组对照探讨经动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)及门脉内植入支架联合或未联合血管内植入碘-125 (125Ⅰ)粒子条治疗原发性肝癌(hepatocellular carcinoma,HCC)伴门脉主干癌栓(main portal vein tumor thrombus,MPVTT)的临床疗效。方法   选择2009年2月至2011年4月于我院接受肝癌TACE治疗的60例HCC合并MPVTT患者(男52例,女8例,平均年龄53岁)进行随机分组。A组在门脉内植入支架及125Ⅰ 粒子条,B组仅在门脉内植入支架,每组30例。分别对两组患者进行生存期、支架通畅率及相关不良事件的分析。结果  门脉内植入支架及125Ⅰ粒子条介入技术成功率为100%,无严重手术并发症及相关不良事件发生。A 组和B组患者的中位生存期分别为335天及142天(P=0.002,HR=2.683)。A组和B组患者支架的中位通畅期分别为340天及190天(P=0.038,HR= 2.252)。结论  门脉支架及TACE联合血管内植入125Ｉ粒子条能明显延长HCC伴MPVTT患者的支架通畅期、生存期,提高患者生存质量,是临床治疗HCC合并MPVTT的重大突破。     

单发肝细胞癌合并门静脉癌栓手术切除与肝动脉化疗栓塞的疗效比较

目的：比较单发肝细胞癌（肝癌）合并门静脉癌栓患者行手术切除与肝动脉化疗栓塞术（TACE）治疗的疗效.方法：收集单发肝癌合并门静脉癌栓患者113例的临床资料,其中单纯TACE治疗（TACE治疗组）72例、单纯手术切除组（手术治疗组）41例,分析其临床资料以及随访结果.结果：（1）手术治疗组的中位生存时间21.5个月,TACE治疗组的中位生存时间13.8个月,两组比较差异有统计学意义（P=0.008）.（2）Ⅰ型门静脉癌栓患者中位生存时间20.4个月,Ⅱ型门静脉癌栓患者中位生存时间9.9个月,Ⅲ型门静脉癌栓患者中位生存时间8.0个月,I型门静脉癌栓患者累计生存率较Ⅱ、Ⅲ型门静脉癌栓患者有显著差异（P=0.003）.Ⅱ型门静脉癌栓与Ⅲ型门静脉癌栓病人生存时间比较差异有统计学意义（P=0.021）.（3）手术治疗组与TACE治疗组分别有4例（9.8％）、11例（15.9％）术后发生肺转移,肺转移中位时间分别7.6,4.2个月.结论：单发肝癌合并门静脉癌栓手术切除疗效优于单纯TACE治疗.对符合手术适应证患者行手术切除联合门静脉癌栓切除或取栓是首选治疗方案.术前行门静脉癌栓分型对肝癌合并门静脉癌栓治疗方案的制定和判断预后有指导作用.     

多层螺旋CT血管成像在肝癌诊断中的应用

目的评价多层螺旋CT(MSCT)多期血管成像在肝癌诊断中的应用价值。方法回顾分析经手术、病理或临床证实的70例肝癌患者的术前CT资料。所有患者均采用多层螺旋CT多期增强扫描检查,将动脉期、门脉期图像传入三维工作站,行动脉期、门静脉期双期血管成像,采用容积再现(VR)和最大密度投影法(MIP)等重建技术,分析其对肝脏病变及与肝血管关系的显示情况。结果 MSCTA图像可清晰显示全部肿块和部分肿块的供血动脉、引流静脉和门静脉癌栓;70例患者中发现肝癌病灶81个,肝动脉解剖变异12例,供血动脉61例,显示肿瘤血管51例,动脉门脉瘘4例,门静脉受累10例,门静脉癌栓14例,与手术病理诊断符合率为93.8%。结论 16层螺旋CT血管成像能直观显示肿瘤、供血动脉、肿瘤血管、门脉系统状况,为外科手术及介入术前提供重要信息。     

肝癌合并门静脉栓子的超声表现类型及其临床意义

目的:探讨肝癌合并门静脉栓子的超声类型及临床意义。方法:选择肝癌伴门静脉癌栓32例(PVTT组),肝癌伴门静脉血栓18例(PVBT组)。肝动脉插管介入治疗后,PVTT组32例、PVBT组4例均作门静脉途径介入治疗。2组患者均排除肝动静脉瘘。结果:PVTT组门静脉完全阻塞型17例,不全阻塞型6例,侵犯门静脉管壁型9例。PVBT组门静脉完全阻塞型10例,不全阻塞型8例。PVTT组中,彩超检查显示血供29例,PVBT组仅1例疑有少许血供,2组血供差异有统计学意义(χ2=38.11,P<0.01)。结论:门静脉栓子的超声表现分型具有一定临床应用价值。     

门静脉癌栓导致肝血异常的CT研究

目的:总结肝细胞癌合并门静脉癌栓所致肝血异常CT表现,探讨其血流动力改变的机理及临床意义。方法:在2004年7月至2011年6月于我院CT检查诊断为肝细胞癌病例中,对存在肝血异常病例作为研究对象。全部病例均常规进行肝动脉期、门静脉期、平衡期增强扫描。结果:具有肝血异常CT表现者120例,全部病例见原发性肝细胞癌灶和肯定的门静脉癌栓,癌灶外肝血异常的增强扫描表现可分为三种:肝实质局部早期强化,门静脉提前显影,门静脉海绵样变。在同一病例中,可单独以一种表现,也可同时以两种表现(双重表现)或三种表现(三重表现)。结论:肝细胞癌肝血异常由门静脉癌栓引起,其发生机理为肝动脉或门静脉对肝脏的灌注异常,肝静脉或下腔静脉的引流异常,肝动脉-门静脉异常分流,侧支循环的建立等。     

MSCT诊断肝癌并门静脉癌栓及其在介入治疗中的价值

目的探讨256层螺旋CT在原发性肝癌并门静脉癌栓中的诊断价值及其在介入治疗中的临床应用价值。方法采用256层螺旋CT对我院68例肝癌合并门静脉癌栓患者行肝脏多期增强扫描,三维后处理方法包括最大密度投影、多平面重建及容积再现等技术。其中29例患者于检查后96h内接受数字减影血管造影并行肝动脉化疗栓塞术,将螺旋CT影像表现与DSA做对照观察。结果门静脉癌栓主要影像表现为门静脉主干或分支扩张、门静脉腔内充盈缺损,增强扫描可见其不同程度强化,其中门静脉海绵样变（CTPV）17例、肝实质异常灌注21例及肝动脉门静脉瘘（APS）25例。在29例行DSA检查及介入治疗的肝癌患者中,多层螺旋CT多期增强扫描在肿瘤供血动脉、血管变异及门静脉癌栓等病变的显示上与DSA一致。结论256层螺旋CT可以准确诊断、评价肝癌并门静脉癌栓及其血流动力学变化,并对介入治疗具有重要临床价值。