超声检测门脉高压患者肝脾动脉阻抗指数与门脉压力相关性研究

目的探讨肝动脉、脾动脉阻力指数（HARI、SpARI）及门脉高压指数（PHI）在评价门脉高压中的应用价值。方法57例临床确诊门脉高压并行门奇断流或脾肾分流术的患者被纳为门脉高压组,对照组为25例健康志愿者。门脉高压组均在术前1d行超声检查,对照组在空腹8h以上行超声检查。采用频谱多普勒检测门静脉平均血流速度（PVVel）、HARI、SpARI及肝脾动脉搏动指数（HAPI、SpARI）,并计算门脉高压指数（PHI）。门脉高压组门脉压力以术中胃网膜右静脉直接测压为准。结果对门脉高压组采用直接压力测定法测得门脉压力为（30.090±4.151）mmHg。门脉高压组HAPI、SpAPI及PHI高于正常对照组（P=0.012,P=0.034,P=0.026）,而PVVel、HARI及SpARI在两组之间差异无统计学意义。以HAPI=1.34诊断门脉高压的敏感性为73%、特异性80%、准确性74%。HARI、HAPI与门脉压力呈显著正相关（r=0.699,r=0.582,P均〈0.001）。门脉压力与肝功能Child-Pugh分级呈显著正相关（r=0.589,P=0.044）。结论HAPI在门脉高压组显著高于正常对照组,且与门脉压力呈显著正相关,因此HAPI可作为评价门脉高压的有效指标。     

Duplex assessment of the portal venous system.

The clinical applications of duplex ultrasound and color Doppler imaging in the evaluation of the portal venous system and hepatic vasculature are quite diverse and widespread. These include identification of portal vein thrombosis, portal venous hypertension, and hepatic veno-occlusive disease as well as a role in the preoperative and postoperative treatment of patients who are candidates for portosystemic shunts or for liver allografts. As technological improvements continue, the current applications will almost certainly be refined, with resultant improvements in sensitivity, specificities, and accuracy rates.     

64排螺旋CT血管造影评价肝硬化血管改变及侧支循环

目的 探讨MSCTA评价肝硬化肝脏血管的异常改变及侧支循环形成的价值。 方法 对168例肝硬化患者(肝硬化组)及120例无肝硬化的患者(对照组)行肝区三期MSCTA,应用MIP和VR进行重建,并对获得的图像进行对照分析。 结果 肝硬化组和对照组门静脉1级和肝静脉1级血管的显示差异无统计学意义(P分别为0.51、0.08),肝动脉、门静脉、肝静脉分级显示差异均有统计学意义(P<0.01)。肝硬化组肝动脉、门静脉起始部增粗85例,分支纤细、纡曲98例,门静脉癌栓形成9例,海绵变性8例,肝动脉持续显影55例、门静脉持续显影57例;对照组3例肝动脉、门静脉起始部增粗,2例分支纤细、纡曲,4例肝动脉持续显影,3例门静脉持续显影。肝硬化组交通支开放总数258支,其中食管胃底静脉曲张196例(196/258,75.97%),对照组仅2例见腹膜后分流。 结论 64排CT三期血管成像可准确、全面显示肝 硬化血管的异常改变及门体分流,尤其能较早、较全面地显示食管胃底静脉曲张,为临床提供更多可靠的诊断和治疗依据。     

Sonographic demonstration of portal venous system thromboses secondary to inflammatory diseases of the pancreas

Sonographic demonstration of abdominal venous thromboses subsequent to pancreatic benign inflammatory diseases has been seldom reported up to now. Seven cases of thromboses of the portal venous system associated with acute or chronic pancreatitis are reported. All cases were detected by sonography in patients without clinical manifestations of portal hypertension. Echogenic thrombus within the lumen of the vein was observed only in the short-term follow-up of acute pancreatitis. Cavernomatous transformation was observed in 6 patients with long-term calcifying pancreatitis. Extrinsic compression by pseudocyst of the pancreas was observed in only 1 case. In all the other cases, thromboses seems to be secondary to local inflammatory phenomena during previous episodes of acute pancreatitis.     

Portal hypertension exacerbates intrahepatic portosystemic venous shunt and further induces refractory hepatic encephalopathy: A case report

BACKGROUNDIntrahepatic portosystemic venous shunt (IPSVS) is a rare hepatic disease with different clinical manifestations. Most IPSVS patients with mild shunts are asymptomatic, while the patients with severe shunts present complications such as hepatic encephalopathy. For patients with portal hypertension accompanied by intrahepatic shunt, portal hypertension may lead to hemodynamic changes that may result in exacerbated portal shunt and increased shunt flow.CASE SUMMARYA 57-year-old man, with the medical history of chronic hepatitis B and liver cirrhosis, was admitted to our hospital with abnormal behavior for 10 mo. He had received the esophageal varices ligation and entecavir therapy 1 year ago. Comparing with former examination results, the degree of esophageal varices was significantly reduced, while the right branch of the portal vein was significantly expanded and tortuous. Meanwhile, abdominal ultrasound presented the right posterior branch of portal vein connected with the retrohepatic inferior vena cava. The imaging findings indicated the diagnosis of IPSVS and hepatic encephalopathy. Instead of radiologic interventions or surgical therapies, this patient had only accepted symptomatic treatment. No recurrence of hepatic encephalopathy was observed during 1-year follow-up.CONCLUSIONHemodynamic changes may exacerbate intrahepatic portosystemic shunt. The intervention or surgery should be carefully applied to patients with severe portal hypertension due to the risk of hemorrhage.     

Hepatic involvement in hypereosinophilic syndrome: value of portal venous phase imaging

US, portal venous phase CT, and MRI-CSE (MRI with conventional spin-echo sequence) findings in three cases of hepatic involvement in hypereosinophilic syndrome are presented. These showed varied imaging findings, but portal venous phase CT showed multiple, poorly marginated, and hypodense hepatic lesions in all three cases. The result suggested that portal venous phase CT is the optimal method for depicting hepatic involvement. Received: 16 January 1996/Accepted: 30 October 1996     

Utility and limitations of splanchnic venous ultrasonography in diagnosis of portal hypertension

The splanchnic venous system was examined by real-time ultrasonography in 46 patients with cirrhosis and documented portal hypertension and in 32 healthy subjects. Patients with portal hypertension had increased diameter of the splanchnic (portal, splenic, and superior mesenteric) veins (76% of patients), attenuation of the normal inspiratory increase in vein size (59%), and demonstrable portasystemic collateral vessels (umbilical or coronary veins or spontaneous splenorenal shunt) (44%). Splanchnic venous dimensions were significantly increased and changed less with respiration in patients with demonstrable portasystemic collaterals as compared to patients without these vessels. Portal pressure correlated only mildly with portal vein diameter (r = 0.30, p less than 0.05). Ultrasound abnormalities are present in a majority of patients with intrahepatic portal hypertension. However, because increased venous diameter and attenuated change in diameter with respiration are less frequent in patients lacking demonstrable portasystemic collaterals, the sensitivity of the test is least in those patients in whom its specificity is also limited.     

超声引导下经颈静脉肝内门体分流术

本文报道经颈静脉肝内门体分流术治疗２６例门脉高压症，术前由彩色多普勒超声检查．术中Ｂ超引导穿刺，并获成功，使门脉与肝静脉平均压力梯度从３．３３ｋＰａ下降到０．８２ｋＰａ。此手术安全、简便、定位准确，且穿刺成功率高。     

Clinical value of hepatic vein catheterization

Techniques of hepatic vein catheterization, hepatic venous pressure measurement, and occlusion phlebography using a balloon catheter are described.Hepatic venous pressure measurements (n=95) and hepatic occlusion phlebography were combined in 32 cases.In patients with liver cirrhosis (n-63) a significant elevation of hepatic venous pressure gradients was found. A decrease of the pressure gradient was seen after portacaval and splenorenal shunt operations.Hepatic occlusion phlebography showed alterations of hepatic veins only in patients with cirrhosis. A rough correlation between pressure gradients and the extent of changes in the liver veins was found. Hepatic occlusion phlebography, in patients who had undergone shunt procedure, demonstrated various collaterals.Combined hepatic vein pressure measurements and hepatic occlusion phlebography using a balloon catheter are proposed as a very suitable method for the evaluation of chronic liver disease and portal hypertension.     

Hepatic vein involvement in hepatocellular carcinoma

A retrospective review of the dynamic computed tomography (CT) and ultrasound scans from examinations of 134 patients with hepatocellular carcinoma was undertaken with emphasis on evaluation of hepatic vein involvement. Hepatic veins were involved in 8 patients (5.9%). Portal vein obstruction was associated in 7 of these cases. Sonography demonstrated hepatic vein involvement in 6 cases was considered within normal limits in 1 and failed to display hepatic veins in another. Dynamic CT was superior in depicting venous obstruction in all the cases by different signs including (a) hypodensity and enlargement of the vessel, (b) perivenous arterial hypervascularization surrounding the hypodense intraluminal region, and (c) hemokinetic changes in relation to the outflow obstruction. The frequency and significance of these CT signs are discussed and correlated in 2 patients with magnetic resonance imaging (MRI) data.     

Color Doppler sonographic evaluation of spontaneous portosystemic shunts and inversion of portal venous flow in patients with cirrhosis

PURPOSE: The aim of the study was to evaluate the usefulness of color Doppler sonography in the detection of spontaneous portosystemic shunts and abnormal blood flow direction in the portal vein in patients with cirrhosis. METHODS: Patients were 67 men and 42 women (mean age, 53 +/- 14 years) with cirrhosis confirmed by liver biopsy. All patients underwent abdominal gray-scale and color Doppler sonographic evaluations to detect the presence of spontaneous portosystemic shunts and to analyze portal vein blood flow direction. RESULTS: Spontaneous portosystemic shunts were found in 41 patients (38%), most often as splenorenal shunts (21%) and patent umbilical veins (14%). Less frequent were gastric collaterals, gallbladder varices, collaterals to thrombotic portal veins, mesoiliac shunts, and portorenal shunts to the right kidney. The presence of shunts was associated with that of esophageal varices (p < 0.01), ascites (p < 0.01), and inversion of portal flow (p < 0. 001) but not with splenomegaly. The direction of portal venous flow was normal (hepatopetal) in 80 patients (73%), hepatofugal in 10 (9%), and bidirectional in 7 (6%); 12 patients (11%) had partial portal vein thrombosis. CONCLUSIONS: Portosystemic shunts and the direction of portal venous flow are important features in the sonographic diagnosis of portal hypertension.     

Vascular complications after liver transplantation: evaluation with Doppler US

Purpose To demonstrate the spectral and color Doppler ultrasonography (US) findings that would indicate vascular complications after liver transplantation and to report our single center results of vascular complications detected in liver transplant recipients. Materials and methods Our study was consisted of 326 patients who underwent liver transplantation procedures between November 1997 and May 2004. The records of all patients were reviewed retrospectively for the details of each patient’s post-transplant Doppler US examinations, visceral angiographic examinations, and/or surgical procedures. Doppler US findings were correlated with angiographic results or surgery. Sensitivity and specificity of Doppler US parameters for the diagnosis of vascular complications of the hepatic artery, portal vein, and hepatic veins were calculated. Results Vascular complications occurred in 47 patients (14%). Eight instances of vascular complications were detected intraoperatively by Doppler US at the time of transplantation. For hepatic artery complications, use of a Doppler US criteria resulted in a sensitivity and a specificity of 92% and 97%, respectively. Doppler US parameters also resulted in a sensitivity and a specificity of 100% in detecting portal vein complications, and resulted in a sensitivity of 99% and a specificity of 100% in detecting hepatic vein complications. Conclusion Although it is clear that Doppler US evaluation is an effective choice for diagnosing vascular complications after liver transplantation, we also observed that Doppler US examination plays an important role in detecting vascular complications intraoperatively and improving the patient’s chance for a successful outcome.     

CT灌注成像对门脉高压分流术后肝血流灌注改变的评价

目的应用多层螺旋CT观察肝硬变门脉高压患者门腔静脉分流后肝脏血流灌注的改变。方法肝硬变门静脉高压合并上消化道出血患者15例。肝功能Child分级A级13例、B级2例。在分流术的前后两周之内各进行一次CT血流灌注扫描。测量每一例患者的肝血流量(HBF)、肝血容量(HBV)、平均通过时间(MTT)、毛细血管通透性(PS)和肝动脉灌注指数(HPI)。所测参数与术中测量的分流前后门静脉压力作对照观察。结果门腔静脉分流前/后的各灌注参数为:HBF120.0/110.1ml/(min·100ml)(P>0.05)、HBV17.9/20.9ml/100ml(P>0.05)、MTT13.6/14.2s(P>0.05)、PS35.8/37.5ml/(min·100ml)(P>0.05)、HPI0.21/0.42(P<0.01)。门腔静脉分流前/后的门静脉压力为41.7/28.1cm水柱(P<0.001)。结论肝脏CT灌注成像显示肝硬变门脉高压患者的肝血流量下降,肝动脉指数在分流术后明显增高,提示门静脉灌注量降低。CT血流灌注扫描助于了解肝硬变门脉高压的血流动力学改变。     

超声成像在经颈内静脉肝内门体分流术的应用进展

经颈静脉肝内门体分流术（TIPS）能够缓解肝硬化门静脉高压引起的难治性并发症。影像学方法在TIPS围手术期评估、术中引导以及术后随访中具有重要价值。本文对超声成像技术在TIPS术前、术中以及术后的应用进展进行综述。     

彩色多普勒超声研究肝移植后门静脉血流动力学变化

目的探讨肝移植术后的门静脉血流动力学变化规律。方法应用灰阶和彩色多普勒超声检测了15例正常人和22例原位肝移植患者术后的肝脏。总结14例无明显并发症原位肝移植患者的门静脉时间平均血流速度（TAV）变化规律和5例肝动脉血栓形成患者及3例门静脉并发症患者的门静脉血流动力学变化。结果①肝移植术后无并发症的患者早期门静脉TAV显著高于对照组，但呈下降趋势，至手术3个月后与对照组差异无显著性意义。②5例肝动脉血栓形成患者的门静脉TAV高于肝移植后同期无并发症的患者。③3例门静脉并发症患者的门静脉血流紊乱。结论肝移植后门静脉TAV逐渐下降，至手术3个月后恢复正常；门静脉血流动力学变化对肝移植后并发症的协助诊断有重要意义。     

Role of contrast-enhanced 3D magnetic resonance portography in evaluating portal venous system compared with color Doppler ultrasonography

Aim The purpose of this study was to evaluate the capability of contrast-enhanced three-dimensional (3D) MR portography in detecting abnormal findings associated with the portal venous system compared with the results of color Doppler ultrasonography (CDUS). Materials and methods MR portography findings were retrospectively compared with the results of CDUS examinations in 161 patients, who were suspected of having portal venous system abnormalities. Portal venous vessels were divided into main 5 groups including the main portal vein, its left and right intrahepatic branches, splenic vein and superior mesenteric vein. Imaging findings were classified as normal, occluded, or partially thrombosed. Results of clinical and imaging follow-up examinations including CDUS, MR portography or angiography, if available, were used as a proof of final diagnosis. The potential sites of varicose veins and collateral vessels were also examined by both imaging methods. Results Vascular abnormalities were identified in 79 of 161 patients. There was a statistically significant agreement between the results of MR portography and CDUS in evaluating portal venous system (κ = 0.871, P < 0.05). The sensitivity of MR portography was slightly superior to CDUS in detecting partially thrombosis and occlusion in the main portal venous vessels. In addition, MR portograms were superior to CDUS in the management of patients with portal hypertension by identifying portosystemic collaterals more adequately, and clearly demonstrated portal venous vessels that cannot be visualized at CDUS. Conclusion Results of present study indicates that contrast-enhanced 3D MR portography is well suited and superior to CDUS in the management of patients with portal hypertension.     

肝门静脉积气的超声表现及临床意义

目的探讨肝门静脉积气的超声表现及临床意义.方法回顾性分析我科4年来超声发现肝门静脉积气的5例患者,分析肝门静脉积气的超声特点及其对临床治疗和预后的影响.结果 5例门静脉积气的患者均由超声首先发现,其共同的超声表现为门静脉内随血液流动的气泡样或点状强回声以及肝实质内边界不清的条片状强回声区.5例患者的原发病分别为腹腔脓肿、坏死性小肠结肠炎、肝移植手术和闭合性腹部外伤,根据原发病的不同,其中3例门静脉积气患者进行了手术治疗并痊愈,另2例经保守治疗后出院.结论多种病因可导致肝门静脉积气,超声诊断具有早期、敏感、特异的特点.肝门静脉积气的临床处理根据原发病的不同而不同.     

肝移植术后肝实质缺血性损伤的多层CT诊断及病因学分析

目的探讨移植术后肝实质缺血性损伤的多层CT表现及CT诊断价值。方法多层CT检查发现43例肝动脉或门静脉狭窄或血栓,其中23例接受血管造影（DSA）检查,17例经病理组织学或随访复查诊断肝实质缺血或梗死。分析肝实质缺血或梗死的CT表现;并以DSA为对照分析CTA的病因学诊断价值。结果所有肝实质缺血或梗死区位于肝包膜下,平扫呈片状或楔形低密度灶,增强后缺血区强化减低,梗死区不强化,相应部位肝动脉或门静脉分支稀少、纤细或不强化。所有肝实质缺血或梗死患者CTA均发现不同程度血管病变,其中肝动脉病变占70.59%,门静脉病变5.88%,肝动脉合并门静脉病变23.53%,缺血性损伤分布与血管病变部位有关。以DSA为对照,CTA诊断肝动脉主干及门静脉狭窄和血栓的敏感性、特异性、阳性预测值及阴性预测值均为100%;诊断肝动脉分支病变上述值分别为100%、80.00%、72.73%、100%。结论多层CT动态增强结合CTA不仅能正确诊断移植肝缺血性损伤,还能准确评价导致移植肝缺血的血管病变,肝动脉病变为移植肝缺血性损伤的主要原因。     

肝硬化患者血浆血管紧张素Ⅱ与门脉高压的关系及意义

【目的】探讨肝硬化患者血浆血管紧张素Ⅱ（AT-Ⅱ）水平变化与门脉高压的关系。【方法】用时间分辨荧光免疫分析法测定54例肝硬化患者（其中30例合并腹水）和25例正常人的血浆AT-Ⅱ水平。同时,B超测门静脉宽度,胃镜测食管静脉宽度。【结果】肝硬化患者血浆AT-Ⅱ水平比对照组明显增高,合并腹水患者比无腹水患者增高明显。门静脉和食管静脉宽度随与AT-Ⅱ呈正相关。【结论】肝硬化患者血浆AT-Ⅱ可能在门脉高压形成中起重要作用,AT-Ⅱ与食管静脉曲张的形成有密切关系。     

肝窦阻塞综合征的超声影像学特征分析

目的描述肝窦阻塞综合征（HSOS）的多模态超声表现，并探讨超声在HSOS诊断中的应用价值。 方法回顾性分析2014年9月至2018年6月在复旦大学附属中山医院就诊的33例HSOS患者的临床特征和超声影像学特征，其中5例行超声造影和剪切波弹性成像检查，观察肝脏大小、肝区回声、肝静脉、门静脉、下腔静脉、胆囊、脾、体腔积液、肝弹性模量等情况；并用Cochran-Armitage趋势检验分析不同严重程度患者的超声征象阳性率。 结果患者中25例（75.8%）有土三七服药史，临床症状主要以腹胀、肝区痛、腹水和肝功能明显异常就诊。灰阶超声特征为16例（48.5%）肝肿大，10例（30.3%）肝区回声增强增粗，11例（33.3%）胆囊壁增厚，14例（42.4%）脾大，31例（93.9%）腹水，9例（27.3%）胸水，7例（21.2%）盆腔积液；彩色多普勒表现为20例（60.6%）肝静脉细窄，18例（54.5%）肝静脉频谱异常，5例（15.2%）门静脉细窄，门静脉平均流速（0.14±0.03）m/s，6例（18.2%）出现门静脉反流；超声造影表现为5例（100.0%）动脉期呈"花斑样"不均匀增强，肝动脉-肝静脉渡越时间和门静脉-肝静脉渡越时间分别为（22.3±3.3）s和（13.0±2.2）s；三维超声造影显示：肝动、静脉、门静脉充盈缓慢及节段性充盈缺损；肝弹性模量（54.0±10.1）kPa。肝肿大、肝静脉细窄和肝静脉频谱异常的阳性率与病情严重程度存在相关性（Z=2.830、2.171、2.840，P均<0.05）。 结论HSOS与服用中药土三七密切相关，超声造影及剪切波弹性成像对HSOS的诊断具有潜在的应用价值。