Color Doppler sonography of portocaval shunts

Nine patients who had undergone end-to-side portocaval shunts were assessed using a sector real-time color Doppler sonography system. Shunt patency was demonstrated in 8 of 9 patients by detection of color-coded flow within the portal vein, in the anastomotic region, and in the inferior vena cava adjacent to the shunt. Color flow could not be detected in 1 patient. This patient had no evidence of shunt compromise. Spectral Doppler studies were also performed in these patients and flow was demonstrated in all 8. In these instances, information available with color Doppler imaging allowed visualization of the shunt even when it had not been apparent on preliminary real-time grey-scale imaging. This study, which does not assess accuracy, nevertheless suggests that color flow Doppler sonography may prove useful in assessing patients with portocaval shunts.     

Portosystemic collateral shunts originating from the left portal veins in portal hypertension: demonstration by color Doppler flow imaging.

Color Doppler flow imaging was performed in 121 patients with portal hypertension. Portosystemic collateral shunts originating from the left portal veins were seen in 41 of the patients. A single collateral shunt was seen in 27 of these, and multiple collateral shunts were seen in the other 14. Collateral shunts running in the ligamentum teres were seen in 26 of the 41 patients; the veins ran through the liver parenchyma in 25 of these. B-mode ultrasound imaging could not clearly demonstrate vascular structures in 55% of the collateral shunts. Color Doppler flow imaging provided a clear picture of the course of the portosystemic collateral shunts originating from the left portal vein.     

Intrahepatic venous and portal venous aneurysms examined by color Doppler flow imaging.

Thirteen cases with liver cystic lesions, which were suspected to communicate with intrahepatic vessels on the basis of ordinary sonography, were examined by color Doppler flow imaging. By this method, blood flow within the cystic lesion was detected in 5 of these cases, and the communication to the intrahepatic vessel confirmed. Information about the hemodynamics of aneurysms was obtained. Two of these lesions were diagnosed as an aneurysmal porta-hepatic venous fistula, another 2 as a portal venous aneurysm, and the remaining 1 as a hepatic venous aneurysm.     

门脉高压症经颈内静脉肝内门体分流术前后彩色多普勒超声与X线门静脉造影比较

我院1993年8月至1995年11月对142例门脉高压症患者在经颈内静脉肝内门体分流术（TransjugularIntrahepaticPortosystemicShuntTIPSS）前后行彩色多普勒超声检查，并与门静脉X线造影比较，结果表明彩色多普勒与门静脉造影在TIPSS术前后的运用各具优点，两种方法互补最为有益。     

彩超诊断门脉癌栓

目的　观察肝癌门脉癌栓的超声影像特征。方法　应用彩色多普勒超声对 44例肝癌合并门脉癌栓的患者进行二维及彩色多普勒图像观察。结果　门脉癌栓好发于门脉主干、主干及右支 ,主干及左右支 ;弥漫型、巨块型肝癌多见 ,其中 11例门脉癌栓呈海绵样变。肝动脉扩张明显。结论　二维超声及彩色多普勒超声不但有利于门脉癌栓的检出 ,还有利于弥漫型肝癌的诊断     

彩色多普勒超声观察门静脉海绵样变性

应用彩色多普勒超声观察门静脉海绵样变性病人12例,将其病变部位声像分为3种类型.B超可以发现Ⅰ、Ⅱ型病变,CDFI有确诊意义.Ⅲ型只能用CDFI发现和诊断.超声观察门静脉海绵样变性的类型对判断病情有参考意义.     

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。     

二维和彩色多普勒超声诊断门静脉海绵样变性的价值与体会

目的探讨门静脉海绵样变性的二维彩色多普勒超声的声像图特征及诊断价值。 方法回顾性分析52例门静脉海绵样变性患者使用彩色多普勒超声诊断仪观察门静脉的血流情况，受累静脉的形态、血流性质和方向。 结果门静脉海绵样变性的二维超声具有特征性声像，结合彩色多普勒超声可以更加明确诊断。 结论二维和彩色多普勒超声是诊断门静脉海绵样变性的首选的无创检查手段，具有十分重要的临床应用价值。     

Incidence and clinical significance of spontaneous intrahepatic portosystemic venous shunts detected by sonography in adults without potential cause

PURPOSE: B-mode and color Doppler sonography were used to assess the incidence and clinical significance of spontaneous intrahepatic portosystemic venous shunt in adults without detectable cause. METHODS: A total of 25,579 adults without potential cause of intrahepatic portosystemic venous shunt were screened using B-mode sonography. Suspicion of shunt was confirmed by color Doppler sonography. Patients with shunt were followed up with sonography at 6- to 12-month intervals and received dietary education to prevent the ingestion of extra-large amounts of protein. During each sonography session, the patients were asked to report any experience of consciousness disturbance. RESULTS: Six patients (0.0235%) showed evidence of shunt on color Doppler sonography. Direct communication between a right portal branch and the inferior vena cava was found in 3 patients; a small aneurysm connecting a peripheral portal branch to the hepatic vein was found in the remaining 3 patients. Five patients were followed up (range, 12-60 months) and showed no change in the size of the shunt. None of the patients with shunt reported an experience of consciousness disturbance. CONCLUSIONS: The incidence of spontaneous intrahepatic portosystemic venous shunt is extremely low in asymptomatic adult patients. Follow-up and dietary control seen to be suitable for their management.     

门静脉彩色多普勒超声诊断肝硬化的意义

目的：总结门静脉（PV）彩色多普勒（CDFI）超声对诊断肝硬化的意义。方法：运用CDFI超声检查了30例肝硬化患者的PV,并按Puph肝功能分级法进行统计学处理,与正常组30例进行对比分析。结果：PV内CDFI可显示本色、红色、混色或充盈缺损。PW可显示血流速度正常,减低或双向血流。血流速度、血流量随着Puph肝功能分级程度严重而下降,与正常组比较有显著差异（P＜0．05）。脾静脉（SV）内探及类动脉频谱,增厚的阳囊壁内可显示胆囊壁静脉。结论：CDFI检测门静脉不仅能诊断肝硬化,而且能判断肝硬化损害的程度。     

彩色多普勒对人肝血管餐前、后血流动力学的研究

目的观测正常成人入肝血管(肝动脉、门静脉)餐前、后血流动力学改变,探讨其相互关系及其临床意义。方法应用彩色多普勒超声分别测量50例正常成人餐前、后入肝血管的血流参数,包括门静脉主干的直径(D),最大血流速度(Vmax),血流量(Q),肝右动脉的收缩期峰值速度(Vmax),舒张末期峰值速度(Vmin),时间平均速度(Vmean),阻力指数(RI),搏动指数(PI)等,探讨其相互关系。结果餐前肝右动脉和门静脉各主要血流参数分别为肝右动脉RI0.65±0.04,PI1.20±0.17,门静脉主干最高血流速度为(17.80±2.14)cm/s,血流量为(905.55±162.50)ml/min;餐后肝右动脉和门静脉各主要血流参数分别为肝右动脉RI0.73±0.04,PI1.74±0.51,门静脉主干最高血流速度为(22.40±3.25)cm/s,血流量为(1279.24±239.84)ml/min。结论餐前、后肝右动脉和门静脉各血流参数间存在显著差异(P＜0.05),肝动脉和门静脉血流量存在彼消此长的关系,以维持入肝血流的相对衡定。     

彩色多普勒流速剖面技术对肝硬化程度评价的探讨

目的应用彩色多普勒流速剖面技术检测门静脉右支流速和血流量,以探讨其在评价肝硬化程度中的临床价值。方法56例乙型病毒性肝炎后肝硬化患者,分为肝硬化代偿组(31例)和肝硬化失代偿组(25例)。非肝硬化患者52例作为对照组。其中36例肝硬化患者经超声引导下穿刺活检病理证实。应用彩色多普勒流速剖面技术检测门静脉右支平均流速、最高流速和血流量,分别比较各参数之间差异。结果肝硬化组门静脉右支平均流速、最高流速以及血流量分别为(11.56±0.94)cm/s,(14.70±1.27)cm/s和(387.61±30.51)ml/min,较非肝硬化对照组的(14.32±0.81)cm/s,(17.94±1.02)cm/s和(499.05±25.44)ml/min明显降低(P值均<0.01),且肝硬化失代偿组门静脉右支平均流速、最高流速以及血流量分别为(9.08±0.31)cm/s,(11.91±0.45)cm/s和(262.3±12.18)ml/min,较肝硬化代偿组的(12.11±0.52)cm/s,(15.27±0.74)cm/s和(566.49±15.22)ml/min明显降低(P值均<0.01)。结论通过彩色多普勒流速剖面技术检测的门静脉右支平均流速、最高流速和血流量,能较好地反映肝硬化代偿期和失代偿期门静脉血流动力学变化情况,对于评价肝硬化程度具有较高的临床价值。     

Magnetic resonance imaging of macroscopic intrahepatic portal-hepatic venous shunts

Direct communication between portal branches and the hepatic vein [macroscopic intrahepatic portal-hepatic venous shunt (IPHVS)] is a rare entity. We have recently studied five patients with this condition. Magnetic resonance imaging (MRI) clearly demonstrated in each case the portal-hepatic venous shunt due to flow void. Multiple diffuse shunts were present in one case and a solitary shunt was demonstrated in the others. The solitary shunt was either tubular, focally dilated or racemose in configuration. The MRI findings and clinical significance of this rare entity are discussed.     

门静脉高压脐静脉再通的超声检测及其临床意义

目的探讨彩色多普勒超声诊断技术对脐静脉开放的价值以及脐静脉与腹壁静脉侧支、附脐静脉的关系。方法对57例门脉高压脐静脉再通患者行超声多普勒超声检查,同时与门静脉高压脐静脉未开放组比较腹水征、上消化道出血、肝昏迷发生率和肝功能改变。结果单支细管状扩张扭曲25例;单支粗管状扭曲扩张11例;多支细管状扩张扭曲12例,多支粗管状扩张扭曲9例,在超声切面图像上表现为在圆韧带内见单个或多个或无回声团块。在脐孔上方穿过腹壁肌层与上腹部腹壁浅静脉相延续18例;与脐部周围血管相延续39例。脐静脉开放组与对照组比较其门静脉高压的并发症无明显差异。结论门脉高压时与门脉左支相连的侧支静脉为脐静脉,彩色多普勒超声可以显示脐静脉及附脐静脉的解剖学特点和血流特征。     

Color Doppler sonography in acute epididymitis and orchitis

Clinical diagnosis of patients with acute scrotal pain is frequently imperfect. Imaging, using nuclear medicine scintigraphy and hand-held continuous-wave Doppler ultrasound devices, has been used in these patients. We retrospectively analyzed 28 consecutive patients referred for scrotal sonography, all of whom had been imaged using color Doppler sonography. Of 22 patients with confirmed diagnoses, 11 had acute epididymitis/orchitis and 11 had another diagnosis. Ten of 11 patients with acute epididymitis/orchitis had increased epididymal flow. Eight also had increased testicular flow. None of the 11 patients without acute epididymitis/orchitis had increased flow. Our data suggest that color Doppler sonography may be useful in establishing the diagnosis of acute epididymitis/orchitis. This might decrease the need for scrotal exploration. No distinction could be made among scrotal lesions in the nonacute epididymitis/orchitis group. Sensitivity was inadequate to reliably detect flow in normal testicles, a prerequisite to accurately diagnose torsion. Newly improved sensitivity may enhance the utility of color Doppler sonography in assessing patients with acute scrotal pathology.     

Color Doppler sonography in the diagnosis of neonatal intrahepatic portosystemic shunts

Intrahepatic portosystemic shunts are infrequent in children. We report 3 cases of neonates who presented with jaundice during the first month of life. Color Doppler sonography in the first 2 cases showed direct communication between the right portal and hepatic veins. Both infants were asymptomatic, and the shunts disappeared spontaneously. The third case involved several shunts and an aberrant medial portal vein. This patient developed heart failure and died after surgery. Color Doppler sonography was useful in the diagnosis and follow-up of the shunts in all 3 cases.     

彩色多普勒能量图在检测肝血管瘤中的应用

应用彩色多普勒能量图（ＣＤＥ）和彩色多普勒血流图（ＣＤＦＩ），并结合脉冲多普勒对１０６个肝血管瘤血流情况进行观察。结果显示：１０６个肝血管瘤的血流检出率分别为ＣＤＥ９４．３％，ＣＤＦＩ５８．５％，两者差异极显著（Ｐ＜０．０１）。并认为“病灶染色”是肝血管瘤的ＣＤＥ特征。作者认为ＣＤＥ在肝血管瘤诊断与鉴别诊断上有较大的应用价值