MDCT血管成像对肝硬化门脉高压侧支血管分流途径的研究

目的 应用16层螺旋CT肝门静脉成像(CTPV)技术,探讨肝硬化门脉高压侧支血管分流途径及其临床意义.方法 收集并分析我院16层螺旋CT肝门静脉成像145例.进行常规平扫及三期增强扫描,三维重建方法采用MIP、VR、MPR.结果 仅向上腔静脉引流45例(31％);仅向下腔静脉引流11例(7.7％);分别向上、下腔静脉引流89例(61.3％).结论 CTPV可显示肝硬化门脉高压患者的门-体静脉之间各种侧支循环血管,有助于对门脉高压患者上消化道出血等合并症选择合理治疗方案及进行疗效随访.     

CT对肝硬化后期门静脉高压的诊断价值

目的:探讨螺旋CT血管造影对肝硬化后期门脉高压患者的诊断价值。方法:通过对33例肝硬化门脉高压患者进行门静脉CT血管成像(CTPV)增强检查。结果:33例患者均成功地实施了门静脉CTPV,所有患者全有门静脉主干曲张外,以脐周静脉、腹膜后静脉、食管周围静脉曲张和奇静脉扩大为主,部分有门静脉-肝动脉瘘和门静脉栓子形成。结论:CTPV可显示肝硬化门脉高压患者的门体静脉之间侧支循环血管曲张及早期诊断肝硬化的深远意义。     

多层螺旋CT门静脉成像评价门脉高压侧支循环研究进展

目的:门脉高压时,门体之间侧支血管扩张,形成多处门体循环;尤其是食管胃底静脉曲张,常导致上消化道出血,初次出血6周内病死率达50%,严重危及患者健康和生命,对其出血危险性的评估具有重要临床意义。近年来,随着多层螺旋CT技术的发展,多层螺旋CT门静脉成像可以清楚的显示门静脉及其侧支循环的部位、形态和程度,为其临床诊断、选择和优化治疗方案、预后的评估有重要价值。     

64层螺旋CT静脉成像在肝硬化门脉高压症早期诊断中的价值

目的 探讨64层螺旋CT在肝硬化门脉高压的早期诊断.方法 研究经病理和/或临床诊断的42例肝硬化早期、中晚期病人64层螺旋CT门静脉及肝静脉血管成像表现,测量42例患者及15例健康者门静脉和肝右静脉管径并分析64层螺旋CT门脉血管成像法在肝硬化门脉高压症的早期诊断价值.结果 所有病人的观察血管在显示较佳的基础上,测得门静脉宽度(PV)在正常对照组(＜12 mm)与其他2组比较有显著性差异,肝硬化代偿组与失代偿组之间差异无明显统计学意义;肝右静脉宽度(RHV)在代偿期内径明显增宽,＞10 mm,而失代偿期肝静脉明显变窄,血管强化密度减低;PV/RHV比值在失代偿期约1.77±0.06,正常对照组及肝硬化代偿组PV/RHV均＜1.5.利用后处理软件最大密度投影(MIP)观察门静脉及肝右静脉血管,代偿组可显示3级以上的门静脉及肝右静脉,失代偿组肝右静脉显示欠佳,最多显示1级,门静脉属支走行扭曲且最多显示3级.结论 64层螺旋CT肝、门静脉血管成像对临床肝硬化门脉高压的早期诊断有重要临床意义.     

MDCTP对肝硬化门脉高压侧支循环血管的显示价值

目的:评价16排螺旋CT门静脉血管成像(MDCTP)技术在显示肝硬化门脉高压侧支循环血管方面的应用价值。方法:对38例临床诊断肝硬化门脉高压的患者行上腹部MDCTP检查。采用MIP、MPR、VR等三维重组技术进行图像后处理,获得门静脉系统及侧支循环血管图像。结果:38例中显示食管胃底粘膜下静脉曲张31例,食管旁静脉曲张10例;胃左静脉曲张29例,胃短静脉曲张26例;脐静脉与腹壁静脉曲张7例;脾-肾或胃-肾分流6例;腹膜后分流2例。结论:MDCTP能显示肝硬化患者门-体侧支循环开放部位、范围及程度,有重要的临床应用价值。     

多层螺旋CT及其门静脉造影在TIPS联合胃冠状静脉栓塞术前应用价值

目的：探讨多层螺旋CT（MSCT）及多层螺旋CT门静脉造影（MSCTP）在经颈静脉肝内门体分流（TIPS）联合胃冠状静脉栓塞（GCVE）术前应用的价值。方法对126例肝硬化门静脉高压伴发食管胃底静脉曲张破裂出血或顽固性腹水拟行TIPS联合GCVE患者,术前行MSCT及MSCTP检查。采用最大密度投影（MIP）、多平面重组（MPR）、遮蔽表面显示（SSD）和容积再现（VR）等后处理技术全面了解肝脏情况。结果 MSCT及MSCTP能清晰显示肝硬化肝脏形态变化、肝静脉与门静脉空间位置关系、门静脉侧支循环开放程度和范围以及腹水等情况,为TIPS联合GCVE术前评估提供了重要的解剖信息。结论 MSCT 及MSCTP 是无创性检查并明确诊断肝硬化门脉高压症的可靠方法,对 TIPS 联合GCVE术中准确引导门静脉穿刺及曲张静脉栓塞治疗具有重要指导意义。     

64层螺旋CT门静脉三维重组对门静脉高压侧支循环的研究及临床应用

目的：评价64层螺旋CT门静脉三维重组对门静脉高压侧支循环的诊断价值及临床应用。方法：正常者20例,肝硬化患者39例,行64层螺旋CT门静脉造影,容积数据采用最大密度投影（MIP）、容积再现法（VR）、表面遮盖法（SSD）、多平面重组（MPR）三维重组,观察门静脉高压肝内门静脉、属支及侧支循环的影像学特征。结果：64层螺旋CT门静脉三维重组能准确显示侧支循环分布范围、初步评估病变程度,门静脉高压症组门静脉属支管径显著大于正常组（P=0.000）,64层螺旋CT诊断食管胃底静脉曲张与胃镜诊断有高度一致性。结论：64层螺旋CT门静脉三维重组能够多角度、立体观察侧支循环情况,对预测其并发症、手术方案的制定具有重要的指导意义。     

64层螺旋CT门静脉造影在显示肝硬化门静脉高压侧支循环中的价值

目的：评价64层螺旋CT门静脉造影对肝硬化门静脉高压侧支循环显示的价值.材料和方法：肝硬化患者28例,采用64层螺旋CT行动脉期、门脉期及平衡期扫描后,运用容积重建法（VR）、多层面重建法（MPR）和最大密度投影法（MIP）对门静脉及其分支进行重建,观察门静脉高压肝内门静脉、属支及侧支循环的影像学特征.结果：64层螺旋CT门静脉造影能准确显示侧支循环分布范围,初步评估病变程度;门静脉高压时,门静脉属支管径显著扩张（门静脉主干、脾静脉、肠系膜上静脉、胃冠状静脉）.胃冠状静脉曲张24例、食管胃底静脉曲张21例、食管周围静脉曲张17例、胃短静脉曲张10例、脾/胃-肾分流6例、脐静脉和腹壁静脉曲张5例、腹膜后静脉曲张2例和直肠上静脉曲张2例,门静脉海绵状变性1例.结论：64层螺旋CT门静脉造影能够多角度、准确地显示门静脉高压时侧支循环开放的情况,对判断病变程度、预测其并发症、选择治疗方案具有重要意义.     

双源CT在TIPS评价中的应用价值

目的 :探讨双源CT在经颈内静脉肝内门体静脉分流术(transjugular intrahepatic portosystemic stent shunt,TIPS)术前、术后影像学评价中的价值。方法:收集肝硬化门静脉高压患者36例,在TIPS术前及术后复查均行CT增强扫描及三维后处理成像。将CT与DSA中门静脉分支、侧支血管及肝内分流道狭窄程度的显示情况进行比较。结果:双源CT和DSA 2种方法对36例肝硬化门静脉高压患者门静脉属支、侧支血管开放情况和支架狭窄程度的判别上分别呈现为较高度一致性、中度一致性、较高度一致性。结论:双源CT可清晰显示门静脉高压患者门静脉属支、侧支血管及肝内分流道狭窄程度,是TIPS影像学评估的重要手段。     

肝硬化肝内外门-体循环交通的CT表现

目的探讨肝硬化门静脉高压肝内外门-体循环交通的发生率及CT表现特点。方法回顾性分析80例肝硬化门脉高压患者的肝内外门-体交通的螺旋CT三期扫描表现。结果肝外型门-体循环交通见于79例（98．75％），其中，食管下段黏膜下及食管周围静脉曲张48例（60％），奇静脉和半奇静脉扩张28例（35％），小网膜静脉曲张46例（57．5％），副脐静脉肝外型再通20例（25％），脾肾静脉和胃肾静脉分流10例（12．5％），腹膜后椎旁静脉曲张14例（17．5％）；肝内型门-体循环交通6例（7．5％），其中，5例为门静脉左支与副脐静脉交通型（6．25％），1例为门静脉右后支与下腔静脉交通型（1．13％）。结论螺旋CT三期扫描对肝硬化门静脉高压侧支循环的显示有独特的价值，不仅能显示侧支循环的部位、范围和曲张的程度，而且可以追踪血流异常途径。认识侧支循环的CT表现特点，有助于肝内外疾病的鉴别诊断。     

门静脉CTA在门静脉高压门体分流侧支血管显示中的应用

目的 研究多层螺旋CT血管成像(CTA)在门静脉高压患者上腹部分流侧支血管显示中的作用. 资料与方法 对126例门静脉高压患者行门静脉系统及侧支血管的CTA检查. 结果 126例中,CTA提示各类食管静脉曲张108例(85.7%),胃底静脉曲张117例(92.9%),单纯食管静脉曲张8例(6.3%),食管静脉曲张合并胃体部静脉曲张1例(0.8%),食管静脉曲张合并胃底静脉曲张99例(78.6%),单纯胃底静脉曲张18例(14.3%).胃左静脉显示120例(95.2%),附脐静脉显示26例(20.6%),胃网膜静脉显示10例(7.9%).发现脾肾分流道4例(3.2%),胃左肾分流道35例(27.8%). 结论 门静脉CTA可以清晰显示门静脉高压患者食管、胃底静脉曲张及主要侧支血管的走行、分布,为临床治疗方案的选择和疗效的观察评估提供有价值的影像学依据.     

Adrenal pseudotumors on CT due to dilated portosystemic veins

The adrenal and periadrenal venous systems are part of the portosystemic collateral pathways that may enlarge in portal hypertension. The cross-sectional image of the resulting enlarged venous channels may simulate an adrenal mass. Three examples of such computed tomographic (CT) scans are presented with selective venographic correlation. Patients with portal hypertension and suspected adrenal pathology may require enhanced or dynamic CT scans.     

Portosystemic collaterals in portal hypertension: visualization by using blood-pool SPECT imaging

Single-photon emission CT (SPECT) was performed with technetium-99m autologous RBCs in 11 patients with chronic hepatitis and in 46 cirrhotic patients with portal hypertension to determine the value of the procedure for identifying portosystemic collateral blood flow. Twenty millicuries (740 MBq) of 99mTc-RBCs, labeled by an in vivo technique, were given IV, and tomographic imaging of the intraabdominal vascular blood pool was performed. Fourteen patients with cirrhosis also had arterial portography, and 37 had scintiphotosplenoportography. In 38 of 46 patients with cirrhosis, SPECT images showed portosystemic collaterals. The coronary vein was seen in 52% of the patients, the short gastric vein in 11%, the gastrorenal or splenorenal shunt in 24%, the umbilical vein in 11%, and the anterior abdominal wall vein in 17%. Portosystemic collaterals were not shown in any of the patients with chronic hepatitis. Collaterals were identified on SPECT images in 10 of 11 patients in whom collaterals were documented by arterial portography and in all 28 patients in whom collaterals were shown by scintiphotosplenoportography. Furthermore, SPECT clearly showed a patent portal vein in three patients and the coronary vein in two patients, when these veins were not identified by means of scintiphotosplenoportography. This experience suggests that SPECT is useful for the noninvasive identification of portosystemic collaterals in patients with portal hypertension.     

Post mortem CT demonstration of hemoperitoneum caused by rupture of a paraumbilical vein into a paraumbilical hernia in a man with liver cirrhosis and portal hypertension

In patients with liver cirrhosis and portal hypertension collateral circulation can develop to direct blood from portal to systemic veins allowing decompression of the portal system. A potential complication of portal hypertension is rupture of collateral vessels with subsequent fatal hemorrhage, occurring most commonly in the esophagus. The paraumbilical vein is a recognized collateral pathway in patients with portal hypertension however cases of rupture have been rarely documented. The authors report a case of hemoperitoneum caused by rupture of a paraumbilical vein into a paraumbilical hernia in a man with liver cirrhosis and portal hypertension. Post mortem CT imaging was valuable in localizing the source of hemorrhage in this case.     

Dynamic CT and MRA findings of a case of portopulmonary venous anastomosis (PPVA) in a patient with portal hypertension: a case report and review of the literature

Portopulmonary venous anastomosis (PPVA), which has been rarely reported in conventional CT and MR studies, is an unusual collateral pathway in patients with portal hypertension. It has clinical implications related to right-to-left shunt that are different from the clinical implications related to other more usual portosystemic shunts in portal hypertensive patients. Here, we report the dynamic CT and MRA findings of a case of PPVA in a patient with portal hypertension, directly demonstrating the shunt flow from the paraesophageal varix to the left atrium via the right inferior pulmonary vein.     

门静脉高压镰状韧带内门体侧支循环在三维动态增强MR血管成像上的表现

目的 探讨门静脉高压镰状韧带内门体侧支循环在三维动态增强MRA(3D DCEMRA)的表现及临床意义.方法 回顾性分析53例镰状韧带内门体侧支循环形成的门静脉高压患者影像资料,分析其3D DCE MRA图像,总结曲张静脉卣径、数目、走行的位置以及引流静脉的变化情况.结果镰状韧带内门体侧支循环均起自门静脉左支,直径0.4～2.6 cm,数目1～3支,分为上下2组,镰状韧带下组静脉即脐静脉或附脐静脉,共47例,向脐水平以上引流16例,7例经腹壁上静脉、9例经胸腹壁静脉向上引流;向脐水平以下引流40例,7例经腹壁下静脉,33例经腹壁浅静脉向下引流;其中向上向下引流并存9例.镰状韧带上组静脉直接经胸廓内静脉向上引流6例.结论门静脉高压镰状韧带内门体侧支循环分为上下2组,3D DCE MRA可全面评价其开放情况以及引流静脉的走行和起止位置.     

Intrahepatic portosystemic venous shunt: occurrence in patients with and without liver cirrhosis

Portosystemic venous shunt within the hepatic parenchyma is rare, and its cause is disputed. Only 12 cases have been reported in the literature. Four new patients are presented here, all of whom had cerebral manifestations due to elevated blood-ammonia levels. One patient, initially misdiagnosed as having a psychiatric disorder, had multiple small portohepatic venous shunts in the peripheral hepatic parenchyma that were believed to be congenital in origin. The other three patients with clinical evidence of cirrhosis and portal hypertension had large tubular shunts between the posterior branch of the portal vein and the inferior vena cava. Shunts of this type were considered to be the collateral pathways developed in the hepatic parenchyma as a result of portal hypertension. The diagnosis of intrahepatic portosystemic venous shunts was established by angiography in all four patients. Sonography and CT failed to show the multiple small shunts, but did provide diagnostic information concerning the large tubular shunts. Intrahepatic portosystemic venous shunt can be the cause of hepatic encephalopathy. One should be familiar with the typical radiographic manifestations of this condition to prevent misdiagnosis as a psychiatric or neurologic disorder.     

Imaging findings of pulmonary vascular disorders in portal hypertension

PURPOSE: The purpose of this study was to demonstrate and compare the imaging findings of hepatopulmonary syndrome and portopulmonary hypertension. MATERIALS AND METHODS: We retrospectively reviewed the imaging findings of five patients with hepatopulmonary syndrome and four patients with portopulmonary hypertension. We evaluated chest radiographs, chest and abdominal computed tomography (CT) scans, 99mTc-macroaggregated albumin (MAA) lung perfusion scans, and pulmonary angiograms. RESULTS: In patients with hepatopulmonary syndrome, the presence of peripheral pulmonary vascular dilatation was detected by chest radiograph, chest CT scan, and pulmonary angiogram, especially the basilar segment. 99mTc-MAA lung perfusion scan showed extrapulmonary tracer distribution (brain, thyroid, and kidney), which revealed pulmonary R-L shunting. In patients with portopulmonary hypertension, chest radiographs and chest CT scans showed the classic findings of primary pulmonary hypertension. In patients with both disorders, extrahepatic features of portal hypertension including ascites, splenomegaly, and portosystemic collateral vessels were seen on abdominal CT. CONCLUSION: In conclusion, chest radiographs and CT in hepatopulmonary syndrome usually showed peripheral pulmonary vascular dilatation, whereas those in portopulmonary hypertension showed central pulmonary artery dilatation. The extrahepatic features of portal hypertension might be helpful for the diagnosis of both disorders.