肝硬化患者CT门静脉血管成像中门静脉侧支血管的表现

目的 分析肝硬化患者在16排螺旋CT门静脉血管成像(CTPV)上门静脉侧支血管的表现.方法 对36例经临床、肝功能和影像学检查诊断为肝硬化门静脉高压的患者行腹部CTPV检查,经图像后处理,获得门静脉系统及侧支血管三维重建图像.结果 CTPV可以直观地显示门静脉系统及整个门静脉侧支循环系统.36例病例中显示胃左静脉曲张29例(80.6%),食管下段静脉曲张18例(50.0%),胃短/W后静脉曲张15例(41.7%),食管旁静脉曲张9例(25.0%),胃-肾/脾-肾分流8例(22.2%),门静脉海绵样变7例(19.4%),脐静脉与腹壁静脉曲张6例(16.7%),椎旁静脉分流4例(11.1%).结论 CTPV能很好地显示肝硬化患者门脉高压侧支循环的开放部位、范围及严重程度,对判断病情、选择治疗方案及估计预后有重要的临床应用价值.

CT portal venography manifestations of portal collateral circulation in patients with portal hypertension due to cirrhosis

Objective To analyze CT portal venography (CTPV) manifestations of portal collateral circulation in patients with cirrhosis by using a 16-detector row spiral CT scanner. Methods CTPV was performed in 36 patients with portal hypertension due to cirrhosis, the diagnosis was proved by clinical data, hepatic function findings and imaging signs. By using post-processing reconstruction technique, 3D images of portal venous system and portal collateral circulation were obtained. Results CTPV images displayed the portal venous system and its collateral circulation stereoscopically. Of 36 patients, left gastric varices were seen in 29 (80.6%), lower esophageal varices in 18 (50.0%), short gastric or posterior gastric varices in 15 (41.7%),paraesophageal varices in 9 (25.0%), gastro-renal or splenorenal shunts in 8 (22.2%), sponge-like transformation of portal vein in 7 (19.4%), paraumbilical and abdominal wall varices in 6 (16.7%), congenital cavernous in 6 (16. 7%) and paravertebral venous shunts in 4 (11.1%). Conclusion CTPV can well display the site, extent and severity of the portal collateral circulation in patients with portal hypertension due to cirrhosis, which is of great clinical importance for judging the patient's condition, for selecting therapeutic protocols and for estimating prognosis.