肝硬化门脉高压不常见门腔分流的MSCT表现

目的:探讨肝硬化门静脉高压不常见门腔分流的MSCT表现及诊断价值。方法:搜集256例肝炎后肝硬化并门静脉高压侧支血管形成患者的MSCT资料。受检者均行上腹部CT平扫及3期增强扫描,83例采用多平面重组(MPR)、曲面重组(CPR)、最大密度投影(MIP)、表面遮蔽显示(SSD)和容积再现(VR)等后处理方法进行血管成像。结果:本组共发现不常见门腔分流243处:食管旁静脉曲张61处(其中伴假肿瘤征16处)、胃肾静脉分流42处、脾肾静脉分流20处、椎旁静脉丛曲张21处、脐静脉和/或副脐静脉再通95处(其中脐静脉再通59处、副脐静脉再通30处、脐静脉和副脐静脉同时再通6处)、门静脉右后支瘤样扩张并向下腔静脉分流4处。门腔分流的主要CT表现为门静脉期可见门静脉属支与腔静脉系血管之间有异常交通。结论:MSCT可较好地显示肝硬化门静脉高压不常见门腔分流,对肝硬化门脉高压的临床诊断和治疗方案的确定有重要意义。

Multislice Spiral CT Manifestations of Uncommon Portocaval Shunt in Patients with Liver Cirrhosis and Portal Hypertension

Objective:To evaluate the multislice spiral CT (MSCT) manifestations of several uncommon porto-caval shunt in patients with liver cirrhosis and portal hypertension.Methods:Two hundred and fifty six cases with liver cirrhosis and portal hypertension were included in this group and underwent upper abdomen examination with MSCT.For each patient,CT scanning of pre- and post-triphasic enhancement (arterial phase,portal phase and delayed phase) was undertaken.Post-processing including multi-planar reformation (MPR),curved multiplanar reformation (CPR),maximum intensity projection (MIP),shaded surface display (SSD) and volume rendering (VR) were done in 83 cases in order to assess the vessels.Results:Two hundred and forty three uncommon portocaval shunts were demonstrated.Paraesophageal varies including dilated azygos or hemiazygos veins with mediastinal pseudotumors sign (n=16) were shown (n=61),gastrorenal shunts (n= 42),splenorenal shunt (n=20),paravertebral varices (n=21),reopened umbilical vein (n=59),reopened para-umbilical vein (n=30),reopened umbilical vein and para-umbilical vein (n=6),markedly dilated right posterior portal vein connecting the inferior vena cava (n=4) were shown.Their common features were abnormal communication between branches of portal vein and caval system during portal vein phase.Conclusion:Uncommon porto-caval shunt could be much more clearly revealed by MSCT,it plays a significant role in the diagnosis and treatment planning for the patients with liver cirrhosis and portal hypertension.