彩色多普勒超声诊断肝动脉-门静脉瘘价值

目的：探讨肝动脉-门静脉瘘超声声像图特征,提高超声诊断肝动脉-门静脉瘘准确率。方法：回顾性分析5例肝动脉-门静脉瘘患者彩色多普勒超声声像图资料。结果：超声诊断肝动脉-门静脉瘘3例,误诊及漏诊各1例。肝动脉-门静脉瘘的超声声像图特征性表现为门静脉血流反向、频谱动脉化,肝动脉增宽、高速低阻。结论：彩色多普勒超声对肝动脉-门静脉瘘诊断有一定价值。     

肝内非新生血管畸形的超声影像学诊断

目的探讨肝内非新生血管畸形(NIVS)的超声影像学特征。方法回顾性分析19例经增强CT三维血管重建确诊的NIVS的超声影像学表现,总结其各类型的二维超声、彩色多普勒超声及超声造影特征。结果本组NIVS的主要类型有:肝动脉—肝静脉瘘4例、肝动脉—门静脉瘘3例、门静脉—肝静脉瘘12例。二维超声显示病灶均呈混合回声;彩色多普勒超声显示肝动脉—肝静脉瘘病灶引流的肝静脉分支内血流速度增高,出现"动脉样"频谱改变;门静脉—肝静脉瘘累及的肝静脉分支内三相波形消失,呈现"门静脉样"连续性血流频谱;肝动脉—门静脉瘘受累的门静脉分支内为离肝血流,频谱呈反向"动脉样"。进一步行超声造影检查显示出血流时相。结论科学分析NIVS的超声影像学特征性表现,可发现和正确判别NIVS类型,有助于该病的临床诊断及随访。     

颈动脉-海绵窦瘘的超声诊断

目的：总结颈动脉-海绵窦瘘的二维超声及彩色多普勒的诊断特征。方法：对1997年9月～2000年8月我院收治的15例(16只眼)颈动脉-海绵窦瘘患进行超声检查,观察二维声像图及血流特征。结果：16只眼均可见眼上静脉扩张及眼外肌增厚。5只眼显示视神经暗区增宽。彩色多普勒显示扩张的眼上静脉内呈现眼亮的搏动性红色血流(13例14只眼)或五彩镶嵌状的涡流(2例2只眼)。多普勒频谱相应的呈高速的动脉样血流频谱或双向性血流频谱。结论：超声检查尤其是彩色多普勒对颈动脉-海绵窦瘘的诊断及鉴别诊断具有重要价值。     

彩色多普勒超声对原发性肝癌肝动-静脉瘘诊断的临床应用

目的探讨原发性肝癌患者肝动-静脉瘘(HAVF)的超声图像特征,评价超声对该病的诊断价值,建立超声诊断HAVF标准值.方法二维及多普勒超声观察临床确诊的51例原发性肝癌患者的门静脉、肝静脉、肝动脉以及肝周、肿瘤周围及瘤体内部血管走行及血流形态,测定相关形态及血流动力学指标 .以数字减影血管造影(DSA)作为金标准,确定HAVF存在的真实性.结果本组51例原发性肝癌患者超声检出HAVF 15例,其中中央型肝动脉-门静脉瘘11例,周围型肝动脉-门静脉瘘3例,肝动脉-肝静脉瘘1例.中央型肝动脉-门静脉瘘超声表现为:(1)与本组36例无HAVF患者肝动脉比较,其内径增宽[(0.43±0.08)cm vs(0.36±0.08)cm,t=2.847,P＝0.006 4];(2)彩色多普勒超声见发生瘘的静脉内出现五彩镶嵌血流束;(3)脉冲多普勒于发生瘘的静脉内可测得"高速低阻"型反向脉动样血流频谱,Vmax为(94.67±34.40)cm/s;肝动脉阻力指数减低[(0.42±0.05) vs (0.77±0.07),t=17.544,P＝0.000],搏动指数明显减低[(0.59±0.10)vs(1.68±0.42),t=9.881,P＝0.000].结论 HAVF患者肝动脉的内径、发生瘘的静脉腔内彩色及频谱多普勒指标呈特征性变化,可作为超声检测原发性肝癌HAVF标准值,以便于该病的临床诊断、治疗及治疗后随访.     

彩超对肝脏弥漫性病变肝静脉门静脉血流检测意义

目的：本通过对肝脏弥漫性病变患门静脉，肝静脉的超声多普勒频谱分析。以确定二之间的相关性，将其作为肝弥漫性病变的定量性检测指标，并对比分析肝脏血流多普勒检查对肝脏弥漫性损害程度的诊断意义。方法：运用彩色多普勒超声对116例肝弥漫性病变与33例正常人肝静脉和门静脉血流频谱的检测以分析其相关性。结果：正常人肝静脉呈双向三峰型，门静脉流速＜0．15cm/s，正向平直血流，急性肝炎组肝静脉与门静脉多普勒频谱与正常人无显性差异，脂肪肝，慢性肝炎与肝硬化组肝静脉血流波形分为三种双向三峰型，平直型，单向双峰或单向波峰减低型，门静脉频谱可分为正向流速正常，正向流速减慢，双向流速减慢，离肝负向减慢血流，肝静脉，门静脉频谱的变化与肝弥漫性病变分类间存在着明显的差异，结论：对肝静脉门静脉超声多普勒血流检测可以作为肝弥漫性为诊断的一项定量性检测手段。     

彩色多普勒超声对创伤性子宫动静脉瘘的诊断价值

目的：探讨创伤性子宫动静脉瘘（AVM）的灰阶超声、彩多普勒超声和盆血管造影的特征。方法：7例创伤性AVM患者均行检查血管造影。记录各病例的收缩期值血流速度（PSV）和阻力指数（RI）。结果：子宫动静脉瘘在二维声像图上没有特异性。彩色多普勒血流显像病灶显示特征性的丰富血流。多普勒频谱表现为高速低阻的特点；PSV36－102cm/s,RI0.30-0.43。盆腔血管造影可显示动静脉瘘形成处的血管。结论：彩多普勒超声是无创性诊断性AVM的可靠方法。     

多普勒超声对创伤性动静脉瘘的诊断及鉴别诊断

目的 探讨创伤性动静脉瘘的彩色及频谱多普勒特征及其鉴别诊断。方法 回顾性分析11例动静脉瘘患者，使用彩色超声诊断仪观察瘘口处血流情况，受累血管的内径、形态、血流性质及方向，对瘘口处及受累血管血流频谱进行分析，并与健侧对照。结果 8例可直接显示瘘口，显示受累血管管壁连续性中断，瘘口处五彩镶嵌样血流自动脉流向扩张的静脉腔，脉冲多普勒示瘘口处呈双期单向连续性频谱，血流速度300～390cm／s，受累动脉近心端血流为高速低阻型，受累静脉出现脉动样血流，近心端静脉呈高速低阻型频谱；4例患者远心端静脉内出现逆向离心性血流。结论 瘘口处双期单向分流，静脉出现高速、动脉样血流频谱是动静脉瘘的特征性表现，多普勒超声对创伤性动静脉瘘能够正确诊断及鉴别诊断。     

彩色多普勒超声对特发性门静脉高压症的诊断价值

目的探讨彩色多普勒超声对特发性门静脉高压症的诊断价值。方法应用彩色多普勒超声对15例特发性门静脉高压症患者进行检查,观察肝脏表面,内部回声,脾脏大小,肝门静脉及分支以及脾静脉等。结果二维灰阶超声显示15例特发性门静脉高压症中11例均出现不同程度的肝实质回声增粗,但均未见表面凹凸不平表现。15例(15/15)均见门静脉肝内分支管壁增厚、回声增强、管腔狭窄甚至闭塞呈条索状高回声。3例(3/15)伴有门静脉主干及脾静脉迂曲扩张,7例(7/15)伴有门静脉主干狭窄,显示门静脉主干管壁增厚、回声增强,管腔狭窄。彩色多普勒超声显示沿狭窄闭塞的肝内门静脉分支走行探及少许断续的点状血流。9例(9/15)出现门静脉海绵样变性。结论彩色多普勒超声显示肝内门静脉分支管壁增厚、管腔狭窄甚至闭塞的特征性改变及门静脉海绵样变性等,可提示为特发性门静脉高压症,彩色多普勒超声在特发性门静脉高压症诊断上有较高的临床应用价值。     

彩色多普勒超声检测肝豆状核变性的肝脏改变

目的 通过分析肝豆状核变性(hepatolentieular degeneration HLD)的超声征象及其病理变化与临床表现提高对HLD病的认识及诊断的正确率。方法 全部36例均行彩色多普勒超声检查，回顾性分析其病理变化及临床表现。结果 彩色多普勒超声提示全部病例都有不同程度的肝损害图像及门静脉血流参数的改变．大致可分为四型：Ⅰ型．弥漫性点状增强型：16例表现肝区光点弥漫性点状增强回声：Ⅱ型．光点不均匀增粗型：12例呈肝光点不均匀增粗型硬化：Ⅲ型．小结节型：5例呈肝区光点呈小结节型硬化：Ⅳ型．大结节与小结节并存型：3例声像图表现为肝区大结节与小结节并存，间隔类似肝癌的团块状回声．根据超声不同的表现均有不同程度的门静脉血流动力学改变大结节型与小结节型的肝硬化门静脉血流明显降低。结论 肝豆状核性变声像图最多表现为肝区光点弥漫性点状增强及肝光点不均匀增粗型，特别是肝区弥漫性点状增强回声最具特征性．     

乳腺癌彩色多普勒超声的诊断及鉴别诊断

目的探讨彩色多普勒超声在乳腺癌诊断与鉴别诊断中的应用价值。方法回顾性分析经手术病理证实的68例乳腺癌患者与67例乳腺良性肿块患者声像图资料,对乳腺癌二维超声图像与彩色多普勒血流图像(CDFI)特点进行总结,并将超声与病理结果相对照。结果乳腺恶性肿块与乳腺良性肿块的二维声像图存在差别;彩色多普勒血流图检查恶性肿块血流显示率为96%,良性肿块血流显示率为48%;恶性肿块多表现为穿入性动脉血管(76%),并呈高阻血流信号(RI>0.7)。结论彩色多普勒血流的分布特点与频谱变化是反映乳腺新生血管的一个重要特征,二维超声与彩色多普勒血流图结合能进一步提高乳腺癌的诊断率。     

Doppler ultrasound evaluation of advanced portal vein pulsatility in patients with normal echocardiograms

The hypothesis tested that mechanisms other than retrograde transsinusoidal fluid wave transfer reported in patients with right heart failure are responsible for the ultrasonographic sign of advanced portal vein pulsatility (APP). Within a time-period of 3 years we have seen 13 patients with APP, defined as temporary portal flow reversal in the face of a normal echocardiogram. Nine of these patients had biopsy-proven liver cirrhosis and four with liver disease were without cirrhosis or cardiac pathology. A randomly selected control group of 18 healthy subjects was studied. Doppler ultrasound evaluation of the hepatic veins as well as the intra and extrahepatic portal vein territories was performed in both groups. Hepatopetal portal flow with APP reversed to hepatofugal flow in follow up studies in two patients. In another two hepatopetal flow with APP in the main portal vein and hepatofugal flow in the intrahepatic portal radicles was recorded during the same examination. The remaining group displayed APP in the intra and extrahepatic portal vein territories. None of the normal subjects presented with APP. Hepatic venous outflow obstruction associated with excessive arterioportal shunting is likely to account for APP of all of our patients. Based on a causal link between angiographic ‘to-and-fro’ flow pattern and the sonographic APP sign in patients with sinusoidal outflow obstruction we suggest, that APP expresses a short, transitional period of portal hypertension just before the occurence of flow reversal.     

彩色多普勒超声诊断累及肝脏的遗传性、出血性毛细血管扩张症

目的探讨遗传性、出血性毛细血管扩张症患者累及肝脏时的彩色多普勒超声表现.方法用二维及彩色多普勒超声观察6例经临床明确诊断的遗传性、出血性毛细血管扩张症患者的肝脏及肝内外血管的走行及分布.结果 6例患者均表现为肝固有动脉纡曲扩张伴血流速度增快,5例同时伴有肝内动脉纡曲扩张;2例发现肝内动脉-静脉瘘,3例发现肝内动脉-门脉瘘;2例合并有肝硬化,其中1例同时合并有血管瘤.结论肝内外动脉纡曲扩张伴血流速度增快为累及肝脏的遗传性、出血性毛细血管扩张症的主要超声特点,彩色多普勒超声在此病的筛查、诊断及追踪观察等方面具有重要作用.     

Color Doppler sonographic signs of respiration-dependent hepatofugal portal flow

PURPOSE: The role of respiration in modulating blood flow in the portal vein is unclear. The aim of this study was to investigate the phenomenon of respiration-dependent periodic hepatofugal portal venous blood flow as detected on color Doppler sonography. METHODS: Within 1 year, we identified 13 patients with respiration-dependent reversal of blood flow in the portal vein that was diagnosed on color Doppler sonography. This phenomenon was investigated by color Doppler sonographic examination of the portal venous flow during both mid-inspiration breath-holding and a respiratory cycle including deep inspiration; evaluation of hepatic vein Doppler waveforms as normal (triphasic) or decreased (flattened); and echocardiographic examination to determine the presence or absence of tricuspid regurgitation. RESULTS: The patients' median age was 53 years (range, 26-87 years). Seven of the 13 patients had heart disease (tricuspid regurgitation) with or without liver disease, 3 had liver disease without heart disease, and 3 had other diseases with no evidence of heart or liver disease. On Doppler sonography, 10 of the 13 patients had increased portal venous pulsatility (7 of the 10 had tricuspid regurgitation; the other 3 did not); the remaining 3 patients had neither increased pulsatility nor tricuspid regurgitation. Sonographic follow-up within 4 weeks in 4 of the 13 patients revealed loss of the respiration-dependent hepatofugal portal flow. CONCLUSIONS: Respiration-dependent hepatofugal portal flow is a rare finding associated with periodic portal hypertension in patients with right heart insufficiency and liver disease. Its clinical significance is unclear. Among our patients, its occurrence was predominantly associated with an increased venous pulsatility index due to tricuspid regurgitation or venous outflow obstruction. Further study is needed to investigate whether periodic respiration-dependent hepatofugal portal flow is predictive of the occurrence of continuous flow reversal.     

Splenic vascular malformations and portal hypertension in hereditary hemorrhagic telangiectasia: sonographic findings

Hereditary hemorrhagic telangiectasia, or Osler-Rendu-Weber disease, is an autosomal dominant disorder in which a variety of vascular dysplasias occur throughout the organ systems. We report the gray-scale and color Doppler sonographic findings in a case of hereditary hemorrhagic telangiectasia. Gray-scale sonographic examination revealed massive splenomegaly, multiple dilated intrasplenic vascular structures (some with adjacent punctate calcifications), an aneurysmal dilatation of the splenic vein, dilated intrahepatic portal branches, and marked atrophy of the right hepatic lobe. Color Doppler sonography showed dilatation of the truncus coeliacus and high-velocity flow in the splenic artery. There were significant aliasing in the splenic hilum and an abnormal, arterialized flow in intrasplenic branches of the splenic vein. The splenic vein was massively enlarged with increased flow velocity and contained an isolated aneurysmal dilatation in the hilum. There were multiple serpiginous retroperitoneal collateral vessels, and the left gastric vein was dilated with hepatofugal flow. The patient had portal hypertension that developed secondary to the increased portal flow.     

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.     

Clinical utility of pulsed Doppler in the detection of arterioportal shunting in patients with hepatocellular carcinoma.

Ninety-seven patients with hepatocellular carcinoma had duplex scanning from the patent or residual portal lumen and comparative angiography. Duplex ultrasonography identified five of nine patients with angiographic evidence of arterioportal shunting. Furthermore, Doppler results indicated the presence of the shunt in one patient without angiographic evidence. Duplex scanning from the portal lumen may be useful in the detection of arterioportal shunting. This procedure can be used to evaluate the hemodynamic change of the recipient portal vein under natural physiologic conditions. However, small shunts without hepatofugal portal blood cannot be detected by this procedure.     

间接门静脉造影在儿童门静脉海绵样变中的诊断价值

目的 探讨儿童门静脉海绵样变(CTPV)的间接门脉造影诊断价值。方法 回顾性分析了3例门静脉海绵样变患儿的间接门脉血管造影图像,观察其特征性的血管造影表现,同时与门脉多普勒超声及CT检查相对照。结果 3例CTPV间接门静脉造影能清楚显示门脉主干近肝门处阻断,代之以瘤样纡曲扩张的侧支静脉,并向肝内延伸,以及离肝性侧支循环静脉。结论 儿童CTPV具有特征性的血管造影表现,间接门脉造影对CTPV的诊断有重要价值。与门脉多普勒超声及CT检查相对照,间接门静脉造影仍不失为CTPV的诊断金标准。     

经颈静脉肝内-门体静脉分流术后肝内门脉分支血流方向改变的意义

目的探讨经颈静脉肝内-门体静脉分流(TIPSS)术后肝内门脉分支血流方向改变的意义。方法应用彩色多普勒超声动态观测55例肝硬化患者TIPSS手术前后门脉血流方向的变化,并结合门脉造影结果分析术后肝内门脉分支血流方向变化的意义。结果15例TIPSS术前门脉主干及分支为离肝血流(或双向血流)患者术后各时相点包括支架管功能障碍(狭窄或闭塞)时门脉血流方向没有改变。而40例TIPSS术前门脉主干及分支为入肝血流者术后即有26例门脉左、右支变为离肝血流,2年内26例中有14例发生支架管狭窄或闭塞,而此时这14例患者门脉左、右支血流均又变为入肝血流。结论TIPSS术前门脉为入肝血流患者术后肝内门脉分支出现离肝血流是支架管通畅的可靠间接证据,若随访中肝内门脉分支离肝血流再次变为入肝血流,则提示支架管功能障碍。动态观测TIPSS手术前后门脉分支血流方向变化对评定部分患者支架管功能有重要价值。     

Portal hypertension in children and young adults: sonographic and color Doppler findings

Portal hypertension is a relatively uncommon pathologic condition in children and young adults in contrast with older adults. The aim of this study is to evaluate the utility of sonography and color Doppler sonography in the diagnosis of portal hypertension in children and young patients and to evaluate the sonographic pattern of each disease. We reviewed 25 such patients who were younger than 30 years old and obtained the following sonographic findings: (1) liver cirrhosis: (a) multiple intrahepatic venovenous shunts in patients with primary Budd-Chiari syndrome and (b) intrahepatic vascular narrowing and nodular coarse parenchymal texture, with multiple very-high-echo spots along the portal vein in patients with Wilson disease; (2) congenital hepatic fibrosis: marked and developed collaterals, wide periportal echogenic band, and a heterogeneous parenchymal texture comprised of multiple high echoes but without portal thrombus; and (3) extrahepatic portal thrombosis: invisible portal lumen except as an echogenic band. Sonography and color Doppler sonography are very useful in diagnosing these portal hypertensive diseases. However, there are no specific sonographic findings, and the role of sonography is limited to follow-up observation of associated secondary hepatobiliary changes in patients with congenital biliary atresia. Received: 1 May 1995/Accepted: 24 June 1995     

A comparison of duplex Doppler sonography of the ligamentum teres and portal vein with endoscopic demonstration of gastroesophageal varices in patients with chronic liver disease or portal hypertension, or both.

The ability of duplex Doppler sonography of the ligamentum teres and portal vein to detect specific signs of portal hypertension was compared with the ability of endoscopy to demonstrate gastroesophageal varices in consecutive patients. Among 90 patients with parenchymal liver disease and a high probability of portal hypertension, 70 had varices, 72 had specific sonographic signs, and four had neither. Ultrasonography was comparable to endoscopy irrespective of the clinical severity of the underlying liver disease. Eleven patients had vascular occlusive diseases; nine had varices; and all had at least one sonographic sign. Duplex Doppler ultrasonography may have a clinical role in noninvasive detection of portal hypertension. Further studies correlating the findings with those of portal pressure are needed to define the place of duplex Doppler ultrasonography as a predictor of the presence of portal hypertension.