胰源性区域性门静脉高压症的螺旋CT诊断——与门静脉高压 …

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１８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,胃冠状静脉,胃网膜静脉曲张或扩大的比例分别为１１％,７２％,９４％和１００％,１００％,２８％,２０％。结论 与ＰＨ相比,ＰＳＰ的胃周侧支循环开放具有特征性,这     

64层螺旋CT门静脉造影对门静脉高压侧支循环的研究

目的 评价64层螺旋CT门静脉造影对门静脉高压侧支循环的诊断价值.方法 正常者30例、肝硬化患者27例,行64层螺旋CT门静脉造影检查,容积数据采用最大强度投影法(MIP)、容积再现法(VR)及多平面重组法(MPR)三维重建,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;门静脉高压症组门静脉属支管径显著大于正常组(P=0.000);肝功能对于其管径改变无显著影响(P值分别为0.343,0.778、0.367、0.370);脾/胃肾静脉分流的存在对门静脉直径有影响(P=0.000);脾静脉与胃左静脉共同分担门静脉压力及参与胃脾区高压形成,两者直径呈正相关性(r=0.653,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(Kappa值为0.832).结论 64层螺旋CT门静脉造影能够多角度、立体观察侧支循环情况,对预测其并发症、于术方案的制定具有重要的指导意义.     

肝硬化CT门静脉血管成像中门静脉侧支血管的临床表现分析

分析肝硬化CT门静脉血管成像中门静脉侧支血管的临床表现,以期指导临床。收治的87例肝硬化伴门静脉高压患者实施肝脏CT检查,并对其CT影像重点实施门静脉血管成像,且实施门静脉侧支血管三维图像重建。结果呈胃左静脉曲张、食管下段曲张、胃短/胃后静脉曲张、食管旁静脉曲张、胃/脾-肾静脉分流、附脐静脉及腹壁静脉曲张影像学表现的例数分别为71、45、35、24、18及15例。肝硬化实施门静脉血管CT成像,对肝硬化合并的侧支血管门静脉高压可以得到极佳的影像学揭示效果,故其用于肝硬化及门静脉高压的诊断具有重要的临床价值。     

螺旋CT评价门静脉海绵样变性及其侧支循环的特点

目的探讨门静脉海绵样变性（CTPV）不同CT分型及门静脉病变范围的侧支循环特征。方法收集门静脉海绵样变性83例进行回顾性分析,所有病例均行标准化上腹部螺旋CT双期增强扫描,其中40例原始数据进行重建,分别行VR、MIP和MPR重组。Ⅰ型：门静脉原因不明的管腔狭窄或消失;Ⅱ型：门静脉管腔正常或增粗,内可见栓子形成;Ⅲ型：门静脉走行区病变推挤侵犯门静脉,门静脉管腔狭窄或闭塞。观察CTPV侧支血管的CT表现,对比分析不同CT分型的年龄及门静脉不同病变范围侧支血管的特点。结果Ⅰ型与Ⅱ型和Ⅲ型的年龄间统计学差异有显著性（P〈0.05）。与肝内门静脉病变比较,肝内外门静脉病变的胰十二指肠后上静脉的显示率高（P〈0.05）。CTPV中的胆支、胃支是参与门-门短路和门体分流的最常见的侧支血管,显示率分别为100%、81.9%。73.5%胆支、8.4%胃支、18.1%胆支和胃支共同参与门-门短路的侧支循环。结论不同CT分型的CTPV,Ⅰ型患者年龄小于Ⅱ型和Ⅲ型。门静脉病变范围广的CTPV中,胰十二指肠后上静脉的显示率高。胆支是构成CTPV门-门短路的主要侧支血管,部分胃支也形成侧支参与门-门短路侧支循环。     

Couinaud肝段在CT图像上的划分

为给肝内占位性病变的ＣＴ定位提供解剖学依据，利用２０例腹部连续横断层标本和１０例活体正常肝的ＣＴ图像，研究了Ｃｏｕｉｎａｕｄ肝段在ＣＴ图像上的划分。正中裂为下腔静脉左前壁至肝中静脉或胆囊的连线；左叶间裂的上部为左叶间静脉至下腔静脉左前壁的连线，门静脉左支脐部和肝圆韧带裂是其中、下部的天然标志；肝左静脉行于左段间裂内；右叶间裂为肝右静脉至下腔静脉左前壁的连线；肝门或门静脉右支是右段间裂的标志；背裂为下腔静脉右缘至静脉韧带裂右端或门静脉的连线。本文还探讨了易致错分肝段的一些因素。     

超声检查附脐静脉开放腹壁静脉曲张在门静脉高压临床分型的意义

目的应用彩色多普勒超声对门静脉高压附脐静脉开放和腹壁静脉曲张门腔之间侧支循环进行研究,确定门脉高压分型。方法超声检查86例肝硬化门静脉高压、13例布加综合征及6例门静脉主干、脾静脉血栓3组门静脉高压患者的腹壁静脉曲张门腔之间侧支循环吻合情况及血流方向。结果肝硬化门静脉高压组腹壁静脉曲张在脐以上血流流向头端,而脐以下血流流向腹端。布加综合征合并下腔静脉阻塞组,血流均流向上胸端。门静脉主干、脾静脉血栓未见脐静脉开放及腹壁静脉曲张。结论应用彩色多普勒超声判断附脐静脉开放和腹壁静脉曲张门腔之间侧支循环的情况,可明确血管阻塞部位、程度、范围,为肝前、肝内及肝后门静脉高压分型的诊断提供有效依据,对临床制定合理治疗方案具有指导意义。     

门静脉高压致食管静脉破裂出血的超声分析

目的：通过超声观察门静脉、脾静脉内径增宽与食管静脉曲张破裂出血关系。方法：超声测量和动态观察门静脉和脾静脉的内径；CDFI血流频谱以及侧支循环开放的情况。结果：认为肝门静脉内径＞13mm，脾静脉内径＞9mm，脾肋间厚＞40mm，有脾功能亢进者应考虑有门静脉高压；门静脉内径＞14mm，脾静脉内径＞10mm。有侧支循环开放时应考虑有食管静脉曲张；门静脉内径＞16mm，脾静脉内径＞llmm，作为破裂出血的危险指标。结论：超声是预测门静脉高压致食管静脉破裂出血的准确、安全、方便的首选检查方法之一。     

多层螺旋CT门静脉造影诊断肝硬化门静脉高压

目的评价门静脉CT血管造影对肝硬化门脉高压患者的诊断价值.方法对43例经临床、肝功能和影像学检查诊断的肝硬化门脉高压患者进行门静脉CT血管成像(CTPV),对门静脉主干、主要属支和侧支循环血管进行显示和测量.结果 43例患者均成功地实施了门静脉CTPV,门静脉主干显示率100%,胃左静脉97.6%,胃短静脉44.2%,食管胃底静脉曲张90.7%,脾/胃肾分流28.7%,脐静脉、腹壁静脉曲张分别为46.5%、44.4%.其中门静脉主干宽度为(13.94±2.47) mm,胃左静脉主干宽度为(5.62±2.40) mm.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,有助于对门脉高压合并消化道出血患者选择合理治疗方案及进行疗效随访.     

门静脉高压症脐静脉开放的超声表现

门静脉高压症是由于肝内外的多种病因导致门静脉血流受阻而引起的。长期而持久的门静脉高压势必将导致门静脉血液动力学的改变，其中之一就是侧支循环的建立。脐静脉重新开放是门静脉高压时建立的侧支循环通道之一。本文总站报告了6例门静脉高压症脐静肺开放的超声表现。     

动态增强门静脉成像在门静脉系统疾病诊断中的临床应用

目的探讨3D动态增强门静脉成像(3DDCEMRP)在门静脉系统疾病诊断中的临床应用价值。方法 应用GE公司1.5T超导磁共振机对53例疑有门静脉系统疾病的病人进行上腹部常规扫描后,进行3DDCEMRP,对感兴趣区血管的原始图像用最大强度投影法重建,分析门静脉及其分支显示情况和通畅性及有无侧支循环形成。结果 53例病人均获得较为清晰、立体的门静脉图像,图像质量达到诊断要求。门静脉主干及肝内3～4级分支、肠系膜上静脉、脾静脉显示清楚,合并有门静脉高压侧支循环形成的病例能较清楚显示侧支循环血管情况。结论 3DDCEMRP作为一种新的磁共振血管成像技术,安全、简便易行,是显示门静脉系统结构的可靠方法,可准确显示门静脉系统疾病的病理改变。     

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     

门静脉血栓的CT表现及鉴别诊断

目的探讨门静脉系统血栓的CT影像表现。方法对18例经临床及病理证实的门脉栓塞的患者进行螺旋CT扫描检查．分析门脉血栓影像特点。结果18例门脉血栓中，栓子发生于主干15例，右支10例，左支7例，脾静脉6例，肠系膜上静脉4例；栓子出现高密度5例，等密度8例，低密度2例；栓子为部分偏心栓塞13例，呈现小条状、柴捆状；出现受累管腔扩张2例，附栓管壁均连续光滑、无外突结节，无1例出现管壁强化；出现食管胃丛及脾丛侧支循环10例，胆管丛及胆囊丛侧支循环2例；无1例出现动-门脉瘘。结论门脉血栓在栓塞的位置、栓子的表现、附栓管腔的情况及肝外侧支循环等方面都有不同于癌栓的特征性表现，结合病史和CT表现可以对门脉栓塞的定性作出更准确的诊断。     

多层螺旋CT在评价门脉海绵样变侧支血管中的应用

目的利用64层螺旋CT增强扫描和血管重建对门脉海绵样变的解剖关系及侧支血管的形成情况进行评价。方法对我院2004年8月-2005年5月期间收集的18例门脉海绵样变资料进行分析。结果在门脉闭塞后,引起相应血管的纡曲扩张及侧支血管的形成,其中有门脉周围形成门门侧支循环,胆囊壁静脉的曲张,胃网膜静脉的增粗纡曲,胆管壁静脉的纡曲扩张,腹膜后椎体旁侧支血管的开放,脾肾静脉短路的开放,胃底食管静脉的曲张。结论多层螺旋CT血管重建在诊断门脉海绵样变方面有重要的临床意义。     

多层螺旋CT血管成像诊断胰源性与肝硬化门脉高压不同侧支循环的价值

目的探讨多层螺旋CT血管成像(MSCTA)评价肝硬化性及胰源性门脉高压不同侧支循环开放的价值.方法胰源性和肝硬化所引起的门脉高压患者各19例,均进行MSCT检查,并经后处理重建显示二者侧支循环.结果胰源性门脉高压常引起胃网膜右静脉(18/19)和胃冠状静脉曲张(15/19),较少有食管下段静脉曲张(2/19),无脐静脉开放;而肝硬化门脉高压较常见胃冠状静脉(19/19)、食管下段静脉曲张(15/19)和脐静脉开放(9/19),无胃网膜右静脉曲张.结论 MSCTA在诊断及鉴别诊断胰源性和肝硬化所引起的门脉高压不同侧支循环具有重要临床价值.     

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.     

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     

原发性肝癌门脉癌栓的双期增强CT表现

目的：探讨原发性肝癌门静脉癌栓螺旋CT双期增强扫描表现。材料与方法：对36例门静脉癌栓患者行螺旋CT双期增强扫描,观察门静脉癌栓在CT上的表现。结果：36例TIPV患者在螺旋CT动态增强扫描时均显示出门静脉内癌栓及相关的阳性征象,表现为门静脉扩张、门静脉腔内充盈缺损及“门静脉铸型”,门静脉周围可见网状供血动脉。36例中,门静脉主干合并右支癌栓12例,门静脉主干合并左支癌栓8例,主干和左右支均有癌栓者9例,单纯右支癌栓4例,单纯左支癌栓3例。结论：螺旋CT双期增强扫描是诊断门静脉癌栓的有效方法,可以完整地提供门静脉癌栓的全部资料。     

Altered flow dynamics of intravascular contrast material to the liver in superior vena cava syndrome: CT findings

Background: To evaluate the findings of altered flow dynamics in the livers of patients with obstruction of superior vena cava (SVC) on helical computed tomography (CT). Methods: In six patients (age range = 28–80 years) with SVC obstruction, CT findings were retrospectively reviewed to identify the abnormal enhancement patterns of the liver and the relation with the extrahepatic collateral vessels and hepatic vessels. Results: Abnormal hepatic enhancement was observed in the following four (A–D) portions: (A) anterior portion of segment IV (n = 5), (B) subdiaphragmatic portion of the liver (n = 4), (C) posterior portion of the right lobe (bare area; n = 1), and (D) lateral segment of the left lobe (n = 2). Two major collateral pathways to the liver were demonstrated as follows: A and D → from the umbilical vein to the left portal vein, and B and C → from the subcapsular vein to the bare area of the liver or to the hepatic veins. On helical CT, these collateral pathways were also clearly visualized. Conclusion: When these abnormal enhancements of the liver on CT are recognized within the liver, these findings indicate diversion of contrast material into collateral pathways to the liver with SVC obstruction. Received: 31 March 1999/Revision accepted: 25 June 1999     

Cavernous transformation of the portal vein: three-dimensional dynamic contrast-enhanced MR angiography

BACKGROUND: To investigate characteristic features of three-dimensional dynamic contrast-enhanced MR angiography (3D DCE-MRA) and validate its clinical significance for the diagnosis of cavernous transformation of the portal vein (CTPV). METHODS: 3D DCE-MRA, along with subsequent data processing using three-dimensional reconstruction, was performed in 33 CTPV patients. We observed 33 emboli in the portal vein, 29 in the left and/or right portal branches, 18 in the superior mesenteric vein, and nine emboli in the splenic vein. RESULTS: The main presentation of CTPV on 3D DCE-MRA was the replacement of the normal configuration of the portal vein by numerous distorted hepatopetal collateral vessels, the presence of arterio-portal venous shunts, and the appearance of hepatofugal collateral vessels in the abdominal cavity and wall. CONCLUSION: 3D DCE-MRA can be used to simultaneously characterize the portal system and collateral vessels, and can improve the diagnosis and clinical treatment of CTPV.     

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。