门静脉海绵样变的MRI表现

目的探讨门静脉海绵样变(CTPV)的MRI表现,评价MRI诊断CTPV的临床价值及意义.方法分析38例经手术病理或DSA证实的CTPV患者的MRI平扫、动态增强及动态对比增强磁共振血管成像(DCE-MRA)表现.结果CTPV的MRI平扫,所有病例门静脉主干或分支闭塞,周围可见由侧支静脉形成的团块状、网状异常软组织信号影;动态增强MRI,动脉期17例出现肝实质灌注异常,门静脉期全部病例见异常侧支静脉强化;DCE-MRA能直观显示上述改变.结论MRI平扫、动态增强及DCE-MRA检查对CTPV诊断具有重要价值,门静脉闭塞及其周围海绵样侧支静脉扩张为其特征性征象.     

B-TFE与3D DCE-MRA联合应用在布加综合征诊断中的价值

目的探讨B-TFE与3D DCE-MRA联合应用在布加综合征（BCS）诊断中的价值。材料与方法搜集经DSA证实的布加综合征患者32例,其中8例为单纯下腔静脉阻塞,2例为单纯肝静脉阻塞,22例为下腔静脉阻塞伴肝静脉阻塞。32例患者均行B-TFE和3D DCE-MRA检查,分析两种方法及联合应用时对BCS及其侧支循环的显示情况。结果 B-TFE正确诊断8例下腔静脉阻塞、18例下腔静脉阻塞伴肝静脉阻塞和2例肝静脉阻塞,总检出率为87.5%（28/32）;3D DCE-MRA正确诊断8例下腔静脉阻塞、19例下腔静脉阻塞伴肝静脉阻塞和1例肝静脉阻塞,总检出率为93.8%（30/32）。B-TFE共显示个193侧支循环,3DDCE-MRA则显示248个侧支循环。两者结合准确诊断全部BCS及其肝内外侧支循环。结论联合应用B-TFE和3DDCE-MRA是诊断BCS的理想方法。I     

Cavernous transformation of the portal vein secondary to tumor thrombosis of hepatocellular carcinoma: spiral CT visualization of the collateral vessels

Background: We investigated the constituting collateral vessels in cavernous transformation of the portal vein (CTPV) caused by tumor thrombosis of hepatocellular carcinoma (HCC) by using contrast-enhanced spiral computed tomographic (CT) examination. Methods: Fifty-four histopathologically proven HCC patients with tumor thrombosis-induced CTPV were retrospectively included and assigned to cirrhosis negative (n= 31) and positive (n= 23) groups. Another 15 cirrhotic patients with portal hypertension but no HCC and CTPV were used for comparison. Standardized dual-phase contrast-enhanced spiral CT was performed for all patients. CT appearances of the collateral vessels of CTPV were observed, and their visualization rates were analyzed. Results: Biliary (cystic and paracholedochal veins) and gastric (left and right gastric veins) branches of the portal vein were the most frequently visualized collateral vessels of CTPV. There was a marked difference in CT visualization rates for biliary branches between patients with and without CTPV (83–94% vs. 0). No difference existed in visualization rates for gastric branches across the three groups (77–87% for left gastric, 58–61% for right gastric vein). Conclusions: Biliary and gastric branches of the portal vein are the major collateral vessels of CTPV. The intergroup differences in CT visualization rates may provide clues to the roles that they might play in the hemodynamic adaptation process of CTPV. Received: 13 October 1999/Accepted: 12 January 2000     

门脉海绵样变的彩色多普勒超声诊断

目的：研究彩色多普勒在门脉海绵样变诊断中的应用,提高诊断的正确性。方法：对35例门静脉海绵燕变进行了彩色多普勒检查,先用两维图像显示肝门部结构、门脉主干及分支,以及周围侧枝血管回声,再用彩色多普勒显示血流方向、颜色。结果：根据形态学及超声表现可将门脉海绵样变分为三型：I型为肝外型;Ⅱ型为肝内型;Ⅲ型为肝内肝外型。门脉海绵样变的二维超声主要表现为：肝内外门静脉分支及主干狭窄或部分狭窄、闭塞,在其周围形成蜂窝状无回声区,门脉管壁回声增强,增厚,彩色多普勒超声显示血流呈红蓝相间,频谱多普勒显示门静脉血流呈毛刺状,为低速、平坦的血流流速曲线。结论：彩色多普勒血流显像对门脉海绵样变的诊断具有很高的准确性,是诊断门脉海绵样变的重要手段。     

门静脉海绵样变性的多层螺旋CT血管成像与原位肝移植手术程序的相关性研究

目的探讨CT显示门静脉海绵样变性(CTPV)的严重程度与原位肝移植(OLT)手术程序之间的相关性。方法包括24例CTPV病例。评价门静脉栓塞的部位及范围,记录每例形成的侧支循环并进行评分。复习21例拟行OLT者的病例资料。结果MIP、VR与SSD均可用于显示病变后形成的侧支循环,以MIP显示优良。24例中,拟行OLT者21例,其中13例行供体门静脉与受体门静脉端端吻合,2例处于待肝状态,6例吻合方式改变或放弃手术。结论多层螺旋CT血管成像可无创性诊断CTPV,可为临床提供重要相关信息,有助于原位肝移植术前决策。     

儿童原发性门静脉海绵样变性的64层螺旋CT分型初探及临床意义

[摘 要] 目的 研究64层螺旋CT在儿童原发性门静脉海绵样变性（cavernous transformation of portal vein,CTPV）中的应用价值,并初探其分型的临床意义。方法 回顾性分析37例经手术证实为原发性CTPV患儿的临床及64层螺旋CT资料,研究其特征性血管表现,根据病变累及范围及部位进行分型,对比各型的手术治疗方式并探讨其相应临床意义。 结果 37例原发性CTPV患儿通过64层螺旋CT检查均能发现特征性的门脉主干或其分支结构发育异常血管表现,以迂曲、狭窄、缺如或血管瘤样改变伴不同程度的门-门及门-体侧支血管形成为主。CTPV可分为三型：I型（8例）,海绵样变仅发生于肝内门静脉左和（或）右分支,肝移植是该型首选手术方式;II型（18例）,表现为I型合并门静脉主干狭窄或消失,代之为分布于肝门部和胆囊床部簇状或蚯蚓状(迂曲)血管,分流术及脾切除、贲门周围血管离断术是该型主要手术方式;III型（11例）,海绵样变在II型的基础上存在进一步累及肠系膜上静脉及脾静脉表现,门、肠、脾静脉广泛迂曲呈网状,该型难以实行分流术,仅可行脾切除和贲门周围血管离断术。结论 64层螺旋CT在诊断儿童原发性CTPV中具有重要应用价值,分型对CTPV的手术治疗方式选择、预后判断有重要指导意义。     

64层螺旋CT门静脉成像诊断门静脉海绵样变性

目的 探讨64层螺旋CT门静脉成像在门静脉海绵样变性(CTPV)诊断中的价值. 方法 收集并分析42例经证实的CTPV患者的64层螺旋CT门静脉成像资料. 结果 全部病例门静脉主干和(或)其分支闭塞和(或)狭窄.本组门静脉异常表现为门静脉主干和(或)其分支因栓子闭塞和(或)狭窄34例;门静脉受侵闭塞和(或)狭窄5例;门静脉原因不明的狭窄或闭锁3例.门静脉周围形成增粗、扭曲的侧支血管即门-门侧支血管:胆管周围静脉丛曲张39例;胆囊静脉丛曲张31例,有分支向肝内门静脉左支供血的胃左静脉曲张6例;并清楚显示多种门-体侧支血管;肝脏灌注异常18例;胆囊、胆管壁增厚28例. 结论 64层螺旋CT门静脉成像能很好地显示CTPV的特征,是很有效的诊断方法 .     

Cavernous transformation of portal vein: 16-slice CT portography and correlation with surgical procedure of orthotopic liver transplantation

OBJECTIVE: To evaluate 16-slice CT portography technique and appearances of cavernous transformation of portal vein (CTPV) and the correlation with surgical procedure of orthotopic liver transplantation (OLT). MATERIAL AND METHODS: Twenty-four patients with CTPV underwent triphase scanning using a 16-slice CT scanner. Twenty-one of the 24 patients were OLT candidates. After plain scan, enhanced CT scan was performed. The parameters were as follows: thickness of 2.5 mm, reconstruction interval of 1.3 mm, flow rate of 3-4 mL/s, contrast agent of 100 mL, delayed time of 20, 50, and 70 s, respectively. Imaging reformation, including MIP, VR, and SSD, were performed by one radiologist. Two radiologists assessed the thrombosis location and degree, collateral vessels, and superior mesenteric vein (SMV) or splenic vein (SV). The details of collateral vessels, thrombosis location were graded and recorded. One score was partial thrombosis of the main PV; 2 score, complete thrombosis of the main PV; 3 score, complete thrombosis of the main PV plus thrombosis of proximal SV or SMV, and the normal diameter of remaining veins; 4 score, complete thrombosis of the main PV plus thrombosis of more than a half of SV or SMV, and thin diameter of remaining veins; 5 score, complete nonvisualization of the main PV, one or both of SV and SMV, and thin diameter of remaining veins. Thirteen patients thereafter underwent OLT. Operation record was reviewed case by case. RESULTS: All cases obtained MIP images, 16 patients got VR images, and five cases had SSD images. These images can display thrombosis location, degree, and collateral vessels. All patients had hepatopetal collateral vessels. Eleven of the 21 OLT candidates had 1 score, two patients 2 score, four patients 3 score, one patient 4 score, and three patients had 5 score. Fourteen of the 21 candidates were performed end-to-end anastomosis between the donor's and recipient's portal veins, in which 11 patients had 1 score, two patients had 2 score, and two patients 3 score. Both patients with 3 score had normal SV; end-to-end anastomoses were performed between the donor portal vein and recipient SV. Two patients are waiting for donors. OLT was canceled or changed in the six patients with 4 score or 5 score. Correlation coefficient between the score of portal vein and surgical decision was 0.813 (P-value less than 0.001, nonparametric correlation). CONCLUSIONS: Using 16-slice CT portography can noninvasively diagnose CTPV. The appearances of CTPV on the 16-slice CT portography can provide helpful information for surgeons to make an accurate preoperative decision. MIP is the optimal technique for displaying CTPV.     

二维和彩色多普勒超声对门静脉海绵样变性的诊断

目的探讨二维和彩色多普勒超声对门静脉海绵样变性（CTPV）的价值及临床意义。方法回顾性分析18例经手术或血管造影证实的CTPV的超声表现及特征。结果二维超声可见门静脉闭塞，腔内栓子，闭塞门静脉周围侧支呈条状或蜂窝状无回声区。彩色多普勒超声显示闭塞门静脉内无或仅边缘部见少量血流信号，蜂窝状无回声区见少量暗淡血流信号。结论门静脉海绵样变性（cTPV）的二维及彩色多普勒超声具有特征性声像图表现，对CTPV的诊断及鉴别诊断具有重要价值，对临床制定治疗方案具有实用意义。     

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.     

单次屏气三维动态增强磁共振门静脉成像技术及初步应用体会

目的 探讨单次屏气三维动态增强磁共振门静脉成像(3D DCE MRP)技术的可靠性及临床应用价值。方法 对40例受检行常规轴位T1W，T2W成像后，进行冠状位3D DCE MRP，连续扫描3组数据，对感兴趣区血管的原始图像用最大强度投影法重建。评价图像质量，分析门静脉、脾静脉、肠系膜上静脉显示情况和有无侧支循环形成。扫描前经静脉快速注射钆喷酸葡胺20—30ml。结果 39例门静脉图像质量达到诊断要求，1例血管图像模糊。20例无门静脉高压症患的肠系膜上静脉、脾静脉、门静脉主干及其肝内3—5级分支均显示良好，门静脉高压症可出现肠系膜上静脉及门静脉增宽、门静脉栓塞、肝内门静脉分支级数减少、脾静脉迂曲增粗以及侧支血管形成。结论 3D DCE MRP是了解门静脉系统结构的可靠方法，可用于肝脏多种疾病的诊断和疗效评价。     

胰源性门静脉高压症的多排螺旋CT表现

目的 应用多排螺旋CT门静脉成像技术研究胰源性门静脉高压症的侧支循环特点.方法 回顾性分析72例胰源性门静脉高压症的多排螺旋CT门静脉成像图像,研究其胃静脉曲张的部位、形态及侧支循环特点.结果 胰源性门静脉高压症胃静脉曲张以孤立型胃静脉曲张多见(88.89%),形态为多纡曲状(88.89%),胃周静脉以胃网膜静脉曲张为特征(100%).结论 胰源性门静脉高压症在多排螺旋CT门静脉成像上可表现出相应的特征,具有很好的诊断和鉴别诊断价值.     

三维动态增强磁共振血管造影在儿童大血管畸形应用中的技术探讨

目的探讨运用三维动态增强磁共振血管造影(3D DCE-MRA)技术在儿童大血管畸形检查中的技术参数优化和特殊技术选用.方法对7例大血管畸形患儿进行三维动态增强扫描并行三维重建.结果7例中发现主动脉缩窄2例,主动脉离断1例,肺静脉异位引流3例,肾动脉狭窄1例,均经手术或血管造影证实.结论通过优化技术参数及特殊技术的选用,3D DCE-MRA所得图像能够为儿科临床诊断及手术治疗提供重要的影像参考.     

Diagnosis of Budd-Chiari syndrome: three-dimensional dynamic contrast enhanced magnetic resonance angiography

Objective

To investigate the characteristics and diagnostic value of three-dimensional contrast-enhanced magnetic resonance angiography (3D CE-MRA) in the diagnosis of Budd?CChiari syndrome (BCS).

Methods

One hundred thirty-three BCS patients underwent 3D CE-MRA, 64 patients had primary BCS, and 69 had secondary BCS.

Results

Fifty five cases (41.4%) showed a segmental stenosis of the inferior vena cava, 9 cases (6.8%) a membranous obstruction of the inferior vena cava, 5 cases (3.8%) an unobstructed inferior vena cava and hepatic veno-occlusive condition, 16 cases (12.0%) an inferior vena cava stenosis and hepatic veno-occlusive disease, and 48 cases (36.1%) an intraluminal filling defect in the inferior vena cava. In 52 cases (39.1%), collateral blood vessels were formed, with deep, medium, and shallow portal veins and intrahepatic collateral veins in 88 groups. Among these, 41 (46.6%) had deep venous collateral channels, 24 (27.3%) had medium venous collateral channels, 9 (10.2%) had superficial venous collateral channels, 5 (5.7%) had portal vein collateral channels, and 9 (10.2%) had intrahepatic venous collateral channels.

Conclusion

3D CE-MRA is important in the clinical diagnosis and treatment planning of BCS and displays hepatic veins, the inferior vena cava system, and collateral vessels.     

64层螺旋CT血管造影三维重建在肺栓塞检查中的临床应用

目的评价肺血管成像在肺栓塞中的临床应用价值。方法19例拟诊肺栓塞、4例拟诊冠心病患者行64层螺旋CT肺动脉造影,在工作站上对原始薄层图像进行后处理观察肺动脉栓子分布情况,其中5例同时行DSA检查,并与64层螺旋CT检查结果进行比较。结果全部病例三维肺血管图像均能充分显示肺动、静脉的空间关系与解剖细节,不但能准确、直观地观察肺血管,而且能明确诊断肺动脉栓塞及有无侧支循环形成。23例患者中检出肺动脉栓塞16例,共发现肺动脉栓子264处,其中段及段以上栓子149处,亚段及以下5~6级分支115处,血栓栓塞血管直径最小者1mm。1例上肢和胸侧壁因锁骨下静脉血栓明显侧支循环形成,1例左上肺静脉左房入口和左心耳内附壁血栓形成。5例同时行DSA检查,对肺段及段以下肺动脉栓子检出率,64层CT和DSA相比,均具有统计学差异。结论64层CT肺动脉造影对肺动脉主干、亚段及以下5~6级分支肺栓塞具有很好的应用价值,为肺部血管性疾病诊断与治疗提供重要依据。     

彩色多普勒超声结合三维动态增强磁共振血管造影诊断下肢动脉硬化闭塞症

目的探讨彩色多普勒超声结合动态增强MRA对下肢动脉硬化闭塞症的诊断价值.方法23例下肢动脉硬化闭塞症患者经彩色多普勒超声及三维动态增强磁共振血管造影(3D DCE-MRA)检查,与数字减影血管造影检查(DSA)和/或手术结果相对照.结果83个可比节段中,超声检查符合率为72.29%,3D DCE-MRA符合率为53.01%,而超声结合MRA符合率达到84.34%.结论彩色多普勒超声结合3D DCE-MRA能提高下肢动脉硬化闭塞症诊断的准确率.     

Cavernous transformation of the portal vein (CTPV): role of color Doppler sonography in the diagnosis

Objective: The aim of this study was to investigate the hemodynamics of cavernous transformation of the portal vein (CTPV) using color Doppler sonography and to correlate it with sonographic findings and clinical manifestations. Methods: Using color Doppler sonography, we studied 25 patients who satisfied the sonographic diagnostic triad of CTPV and compared clinical, sonographic, and color Doppler findings. We also compared the hemodynamics of the liver vasculature in a group of CTPV patients with that in a group of normal subjects. Results: We could differentiate five cases of dilated hepatic artery without formation of CTPV from 20 cases of CTPV. In 13 cases of CTPV, the cause of the portal vein thrombosis prior to CTPV could be determined. Two types of CTPV were distinguished: linear type (small diameter without tortuosity) and tortuous type (large diameter with tortuosity). There were no particular tendencies in the cause or distribution between the two groups, but the flow velocity was significantly higher in the tortuous type than in the linear type. Slow continuous flow with little or no respiratory variations was observed in CTPV by color Doppler sonography in agreement with previous reports, and the velocity of CTPV was slower than that of the portal flow in normal subjects. The flow velocity was not related to the cause or the presence of developed collaterals, and the flow direction was always hepatopetal. Conclusion: Color Doppler sonography was considered to be the most useful modality for the diagnosis and comprehension of the hemodynamics of CTPV.     

Cavernous vessels around a patent portal trunk in the liver hilum

Objectives  

Cavernous transformation of the portal vein (CTPV) is considered a sequel to extrahepatic portal vein obstruction. However, we have observed an unusual finding of cavernous vessels around a patent portal trunk in the liver hilum. The aim of our study is to describe the imaging features, clinical profiles, management, and outcome of these patients.     

门静脉海绵样变性的二维超声彩色多普勒血流显像的诊断

本文应用二维超声、彩色多普勒血流显像诊断的１７例门静脉海绵样变性，其中７例为先天性，肝脏损害轻微，１０例继发性，肝脏损害严重。手术证实５例，ＣＴ及ＤＳＡ各证实５例。门静脉海绵样变性二维超声显像肝门区结构紊乱，呈蜂窝或盘曲管状液性暗区；ＣＤＦＩ呈红蓝相间彩色血流图像；脉冲多普勒在蜂窝状或盘曲的管状暗区内显示平坦的连续带状门静脉频谱；ＰＤＩ在病变区以星点状、短线状彩色血流信号充填，血管网络连续性好。本文认为，二维超声、ＣＤＦＩ、脉冲多普勒及ＰＤＩ可以准确地为门静脉海绵样变性做出诊断。     

胰源性区域性门静脉高压症的螺旋CT 诊断 ———与门静脉高压的对照研究

目的　探讨胰源性区域性门静脉高压 (PSPH)的CT表现及其鉴别诊断。方法　回顾性分析 1 8例PSPH的螺旋CT表现 ,并以 30例肝炎后门静脉高压 (PH)作为对照 ,着重观察胃周侧支静脉开放情况。结果　在PSPH和PH中 ,食管下端静脉、胃冠状静脉、胃短静脉、胃网膜静脉曲张或扩大的比例分别为 1 1 %、72 %、94%、94%和 1 0 0 %、1 0 0 %、2 8%、2 0 %。结论　与PH相比 ,PSPH的胃周侧支循环开放具有特征性 ,这对于PSPH的诊断和临床治疗具有指导意义