上腔静脉阻塞综合征患者肝脏CT异常强化灶(附12例分析)

目的 分析上腔静脉阻塞综合征(SVCS)患者CT增强扫描肝内异常强化灶的影像学特征,以提高对该征象的认识.资料与方法 回顾性分析12例SVCS CT肝内出现异常强化灶的患者资料,以电影回放(CT Cine)方式对所有CT图像进行复阅,结合调窗功能观察肝内强化灶位置、数目、形态、大小及强化特征,并追踪供血的侧支血管.将SVCS上腔静脉狭窄分为3度,并结合复诊情况评价上腔静脉受压情况与肝内出现异常强化灶的关系.结果 所有强化灶均位于肝左叶,单发多见,共计检出强化灶20个.强化灶呈不规则片状或类圆形结节状,1例呈多发结节状强化.10例表现为中心高、周边低的分层强化特征.全部病例均可显示供血的侧支静脉,分别来自内乳静脉和下段食管静脉.6例复诊病例中,2例上腔静脉狭窄减轻,肝内异常强化灶消失或缩小;2例上腔静脉受压加重,肝内出现强化灶或范围扩大.结论 SVCS患者CT肝内异常强化灶具有一定影像学特征,复查时可随上腔静脉阻塞程度的变化而发生改变,正确认识相关征象可减少误诊.

The Analysis of Abnormal CT Enhancement of Liver in 12 Patients with Super Vena Cava Syndrome

Objective To investigate the imaging characteristics of abnormal CT liver enhancement in patients with Super Vena Cava Syndrome (SVCS). Materials and Methods CT data of 12 cases with SVCS were analyzed retrospectively. All of the CT images were browsed using CT Cine. The location, number, contour, size, and enhancement characteristics of the abnormal enhancing areas were observed, and the collateral vessels were traced. The narrowing of SVC was divided into 3 degrees, and the correlation of SVC compression and enhanced areas were evaluated through the assistance of follow up. Results All of the 20 enhanced areas were located at the left lobe of liver. Among them, the solitary lesion was most commonly appeared. The enhanced areas appeared as irregular or round nodules. Most of the areas displayed laminating enhancement with center hyperdensity and peripheral hypodensity. All of the cases manifested the blood-supply collateral vessels, which originated from internal thoracic vein and lower part of esophageal vein. Of the 6 follow up cases, 2 SVC compressions relieved and the enhancement areas disappeared or diminished, 2 SVC compressions developed and the enhancement areas appeared or enlarged. Conclusion The abnormal CT enhancement of live in patients with SVCS has special imaging characteristics, which can change following with the extent of SVCS. Misdiagnosis can be avoided through correct cognitions.