超声影像学诊断肝脏血管畸形

目的:总结各种肝脏血管畸形的主要超声影像学特点,提高肝脏血管畸形的超声诊断率.方法:回顾性分析18例先天性肝脏血管畸形和肝移植术后血管畸形的临床就诊原因及其超声诊断契机与模式,对其中6例典型病例进行详细分析,观察各种肝脏血管畸形的主要超声影像学特点,总结超声诊断经验.结果:本组病例包括了肝血管畸形的主要类型,如先天性门静脉闭锁、动静脉瘘、门体静脉瘘、门静脉海绵样变、门静脉瘤等,其中门静脉闭锁、肝动脉-肝静脉-门静脉共同参与形成的复合型瘘报道甚少.彩色多普勒超声是一线的发现和诊断手段,造影超声因能显示血流时相而对发现动静脉瘘具有高度的敏感性和特异性.结论:多普勒超声和造影超声检查的普及提高了肝脏血管畸形的发现和诊断率,但必须依赖于科学的诊断模式和严谨的诊断思维.

Color Doppler flow imaging and contrast enhanced ultrasound in diagnosis of hepatic vascular anomalies

Objective:To summarize the major ultrasonic manifestations of various hepatic vascular anomaly(HVA), so as to improve the ultrasonic diagnosis rate of HVA.Methods: The chief complaints, timing and mode of ultrasonic diagnosis of 18 patients with congenital HVA or post liver transplantation HVA were retrospectively analyzed.Six of the 18 patients were subjected to detailed analysis.The major ultrasonic manifestations of various HVA were observed and experience of ultrasonic diagnosis was summarized.Results: The major vascular abnormalities in our group included hepatic vascular fistula (including fistulas between artery and vein, artery and portal vein, portal vein and hepatic vein, also a complex fistula among artery, portal vein and hepatic vein), portal aneurysm, congenital portal atresia and portal vein cavernous transformation; among which the portal atresia and the complex hepatic fistula involving hepatic artery, hepatic vein and portal vein were rarely described in the literature.Color Doppler ultrasound was the first choice for detection and diagnosis of HVA;contrast enhanced ultrasound was sensitive and specific in diagnosis of all vascular fistulas due to its ability to display homodynamic phase.Conclusion: The wide application of Doppler and contrast enhanced ultrasound examination improves the detection and diagnosis of HVA; diagnosis should be made based on scientific diagnosis mode and precise diagnosis planning.