肝细胞癌肝动脉-门静脉分流的多层螺旋CT表现及在介入治疗中的意义

目的探讨肝细胞癌(HCC)肝动脉—门静脉分流(APS)的多层螺旋CT动态增强表现、形成机制及相关介入治疗方案的选择。资料与方法回顾性分析56例经肝动脉造影证实为合并APS HCC患者的肝脏螺旋CT动态增强表现，并与其肝动脉造影表现进行对比。同时随机选择同期肝动脉造影证实无APS的56例作为对照。结果经肝动脉造影证实为合并APS的56例HCC患者中，46例在CT增强动脉期发现与APS相关的阳性征象。CT像亡，动脉期APS的直接征象有：(1)门静脉主干和正常肝的门静脉分支提早显影25例；其中24例肝动脉造影证实为高流量性APS。(2)肿瘤同侧肝叶的门静脉分支提早显影5例；其肝动脉造影证实为低流量性APS。动脉期APS的间接征象有：(1)肿瘤所在肝叶或肝段的非癌变肝实质提早强化8例；其中6例肝动脉造影证实为低流量性APS。(2)肿瘤外周出现楔形或不规则的强化区8例；肝动脉造影证实为小流量性APS。10例CT阴性者，其肝动脉造影均表现为动脉期外周门静脉小支显影。对照组，2例肝动脉期出现门静脉较大分支显影。结论HCC APS的形成与多种因素有关。多层螺旋CT动态增强扫描有利于诊断APS及判断APS分流量大小。高流量性APS应及时行肝动脉拴塞术，以减轻因APS所致的门静脉高压性的上消化道出血、腹水、腹泻等消化道症状。

Arterioportal Shunt in Hepatocellular Carcinoma: Multislice Spiral CT Features and Their Significance in Interventional Therapy

Objective To study dynamic enhanced multislice spiral CT features and the formation mechanism of arterioportal shunt (APS) associated with hepatocellular carcinoma (HCC), and to discuss the interventional therapy related to APS.Materials and Methods Dynamic enhanced multislice spiral CT findings in 56 HCC patients with angiographically proved APS (study group) were retrospectively analyzed, the signs were compared with the hepatic angiographic results. Another 56 HCC patients who showed no evidence of APS on angiographs were used as control group. Results Of 56 patients in the study group, 46 had positive CT signs related to APS in arterial phase. Two direct signs of APS were as follows. (1) Early opacification of portal trunk and portal vein branches within normal hepatic area was seen in 25 cases, in 24 of which the APS was angiographically proved to be high flow type. (2) Early visualization of portal vein branches in the diseased lobe (n=5). The APS was angiographically proved to be low flow type. In arterial phase, APS showed two indirect CT signs. (1) High attenuation of normal hepatic parenchyma in the affected lobe or segment was seen in 8 cases, in 6 of which the APS was low flow type. (2) Wedge shaped or irregularly shaped enhancement adjacent to the tumor was seen in 8 cases, in which the APS was low flow type. In 10 patients showing no positive CT signs related to APS, peripheral small portal branches were visualized during arterial phase. In control group, early opacification of the major portal branches during arterial phase was seen in 2 cases.Conclusion Many factors are contributed to the formation of APS in HCC. Dynamic enhanced spiral CT is of value in detecting APS and judging its flow. For high flow APS in patients with HCC, hepatic embolization should be carried out in time to relieve ascites and upper digestive tract hemorrhage cause by portal hypertension related to APS.