螺旋CT门静脉成像评价门脉高压的价值

目的 评价螺旋CT门静脉成像（SCTP）显示门静脉高压的价值。材料与方法 51例患者分别进行了SCTP和常规门静脉造影,间隔时间0－3天。其中42例为肝癌患者伴或不伴门静脉高压,9例为单纯肝硬化伴门静脉高压患者。分析SCTP图像上门静脉主干及左、右分支的开放性;侧支循环发生的部位和分布范围,结果与常规门静脉造影（直接和间接法）相对照,评价两者的符合情况。结果 在51例患者共153支门静脉主干和左、右分支中,SCTP显示107支通畅中的104支,46支充盈缺损、闭塞中的44支,总符合率为96．7％（148／153）。除1例冠状静脉曲张及1例脐静脉开放未显示外,SCTP清楚显影其余侧支血管,总符合率为95．3％（41／43）。结论 SCTP与常规门静脉造影诊断符合率高,能准确显示门静脉开放性和门静脉高压侧支循环分布情况,基本能取代有创性的传统门静脉造影术。     

单次屏气三维对比增强磁共振门静脉造影

目的探讨中次收气三维对比增强门静脉造影（3DCEMRP）方法并初步评价其临床应用价值。方法39例病人接受3DCEMBP检查及三维时间飞越法（2DTOF）门静脉成像，其中无肝脏疾患者8例，肝硬化18例，肝癌12例，脾静脉血栓形成1例，Gd-DTPA用量为每公斤体重0.1～0.2mmol，用团注实验剂量确定门静脉峰值通过时间及扫描延迟时间，所有图像分别经最大信号强度投影（MIP）重建，评价门静脉成像质量、开放程度、侧支血管及从静脉曲张的情况。结果门静脉内造影剂峰值通过时间为17～45秒，所有病例3DCE哑MRP成像质量明显优于2DTOF门静脉成像。8例无肝脏疾病者，CEMRP均完整显示门静脉主干及肝内4级以上的分支；18例肝硬化中有17例显示门、脾静脉扩张迂曲，其中10例显示食管胃底静脉曲张，1例门静脉主干近段闭塞，12例肝癌中，5例门静脉主干和（或）其主分支闭塞，6例显示肝内门静脉分支受压、移位；1例脾静脉血栓形成，见脾静脉闭塞及广泛的侧支血管。结论3DCEMRP为一快速、有效评价门静脉系统的检查方法。     

超细针直接法CO2门静脉造影的临床应用价值

目的 评价经皮脾穿刺CO2门静脉造影（CO2-SP）的临床价值。方法 36例患者均接受了CO2-SP及三维MR增强门静脉血管成像（3D—CE—MRA），评价门静脉主干、肝内分支、门静脉开放性、侧支循环的显示情况，建立评分标准评价两者的优越性。结果 CO2-SP时19例患者（52．8％）出现腹部轻度不适感觉，1例出现脾包膜下血肿，经保守治疗后好转出院，16例无不适。CO2-SP对显示肝内门静脉分支优于3D-CE-MRA（总评分分别为232、198分，t=4．52，P〈0．01）；显示门静脉的侧支循环与3D—CE-MRA比较差异无统计学意义（总评分分别为14、16分，t=0．62，P〉0．05）。结论 超细针直接法CO2-SP具有微创、安全、动态等优点，对肝内门静脉细小分支显示效果较MRI更好。     

直接法CO2门静脉造影术对肝脏肿瘤的诊断价值

目的探讨经皮脾穿刺门静脉CO2鄄DSA造影效果及其对肝脏肿瘤侵犯门静脉的评估价值。方法21例患者,原发性肝癌15例,转移性肝癌6例。以26G超细针在B超引导或透视定位下经皮穿刺至脾内,行CO2鄄DSA。结果19例清晰显示门静脉4级以上分支,图像质量优,门静脉分流显示清晰。9例门静脉分支受压移位,2例门静脉主干阻塞,2例肝内门静脉左支主干阻塞,1例门静脉左支主干严重狭窄,3例胃底静脉曲张,1例失败。术中8例患者无任何不适,10例患者有轻度腹部不适,2例有恶心感,1例腹痛,B超示脾包膜下血肿。结论经皮细针穿刺脾实质CO2鄄DSA可以清晰地显示门静脉及分支结构,显示肿瘤对门静脉分支的压迫或门静脉内癌栓,手术简单、快捷、创伤小,熟练的操作可避免风险。     

肝脏增强三维磁共振血管成像双期扫描的价值

目的：与常规血管造影对照,评价肝脏增强三维磁共振血管成像（three-dimensional contrast-enhancedMRA,3DCEMRA)双期扫描显示肝动脉和门脉系统的价值。材料和方法：共有２２例患者做了肝脏３ＤＣＥ ＭＲＡ双期扫描,分别获得肝动脉和门脉ＭＲＡ图像,分析３ＤＣＥMRA上肝动脉的解剖和变异、肝动脉有无肿瘤经及、门脉主干和肝内门脉左右分支的开放性以及侧支循环发生的部位和严重程度。3D CE MRA的显示结果与常规血管造影术（包括腹腔动脉造影和直接或间接门脉造影术）相对照。评价两者的符合情况以获得3D CE MRA的诊断准确性。结果：3DＣＥＭＲＡ与腹腔动脉造影两种方法对肝动脉系统,包括腹腔干、肝总、肝固有、肝右和肝左动脉显示符合率为９７％,３ＤCE MRA准确示22例中4例肝动脉解剖变异并可检出肝动脉受肿瘤经及。22例患者66支门脉主干和左右分支中,有65支两种检查方法显示门脉的开放性的结果相同,符合率为98%。22例中有15例存在侧支循环,3DCEMRA准确显示其中的14例,与门脉造影符合率为93%。结论：肝脏3D CE MRA双期扫描能较准确地显示肝动脉和门脉系统的主干和二级分支,对肝脏血供提供了有用信息。     

三维动态增强磁共振门静脉造影对门静脉癌栓的诊断价值

目的 :探讨三维动态增强磁共振门静脉造影 ( 3DDCE MRP)对门静脉癌栓的诊断价值。方法 :对 2 6例门静脉癌栓患者行 3DDCE MRP检查 ,观察其门静脉癌栓在 3DDCE MRP上的表现 ,并与常规MRI表现进行比较。结果 :所有 2 6例门静脉显示满意。 3DDCE MRP均显示了癌栓所致相应部位门脉阻塞征象 ,2 1例示肝门部侧支血管 ,形成门静脉海绵样变性。结论 :3DDCE MRP是诊断门静脉癌栓的有效方法 ,尤其在显示由此引起的侧支循环方面有很大优越性。不足在于不能显示癌栓近侧端的范围     

动态增强磁共振门静脉成像及临床应用

目的　探讨动态增强磁共振门静脉成像 (DCE -MRP)技术要点及临床应用优势。方法　 3 1例进行腹部常规扫描时疑有门静脉异常的患者接受了动态增强磁共振门静脉成像扫描 ,其中正常 8例 ,异常 2 3例。使用高压注射器将Gd -DTPA造影剂经手背静脉注入血管 ,应用透视触发造影技术确定扫描延迟时间 ,所有图像分别进行数字减影、最大信号强度投影 (MIP)重建。结果　3 1例患者均获得了清晰、立体的门静脉图像。 8例无肝脏疾患者 ,DCE -MRP均能完整显示门静脉主干及肝内 5级以上的分支。 2 3例异常 ,其中肝硬化门静脉高压 13例 ,均显示门静脉扩张迂曲 ,2例显示门静脉主干闭塞 ;肝癌 9例 ,其中门静脉主干和 (或 )其主分支闭塞 3例 ;肝右叶巨大血管瘤 1例。结论　动态增强磁共振门静脉成像为新的磁共振血管成像技术 ,成像效果与传统的血管造影相仿 ,具有明显的临床应用优势     

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.     

经埋置式给药装置肝肿瘤门静脉造影的价值

目的 探讨总结经埋置式给药装置肝脏肿瘤门静脉造影的影像学特征。方法 ５１例肝肿瘤患者,术中行门静脉插管,并将埋置式给药装置（ＩＤＤＳ）埋置于腹壁皮下,术后经ＩＤＤＳ进行直接门静脉造影及摄片,分析总结其影像学特点。结果 门静脉系统显影均良好,门静脉造影主要影像学表现有肿瘤染色,肝内门静脉主支附近的细小分支异常增多呈“树叶征”样改变、门静脉分支伸入肿瘤内参与其血液供应（４例）,门静脉主干被癌栓部分或完     

儿童门静脉海绵样变的血管造影诊断及其临床意义

目的 探讨儿童门静脉海绵样变（ＣＴＰＶ）的间接门脉造影诊断及其临床意义。方法 回顾性分析了６例经超声诊断及手术证实的门静脉海绵样变患儿的间接门脉造影血管造影图像,观察其特性的血管造影表现,并对其指导临床治疗意义进行了评价。结果 ６例中５例清楚显示门脉主干近肝门处阻断,代之以肿块样迂曲血管并在其周围形成特征性向肝内放射状的侧支血管影像,以及离肝性侧支循环静脉。６例血管造影均能对与分流或断流手术有关的     

3D contrast-enhanced MR portography and direct X-ray portography: a correlation study

Our objective was to compare 3D contrast-enhanced MR portography (3D CE MRP) on a 1.5-T MR imager with direct X-ray portography. Twenty-six consecutive patients underwent 3D CE MRP with in-plane resolution of 1.4 or 1.8 mm, and direct X-ray portography. The findings of these two methods were evaluated and compared. The main portal vein (PV), right PV with its anterior and posterior segmental branches, and left PV including its sagittal segment were shown clearly without diagnostic problem in all cases on MRP. The main PV appearance was accordant with MRP and X-ray. For intrahepatic PVs, the results agreed in 21 patients but disagreed in 5 patients. In 1 patient with a huge tumor in right liver, the right posterior PV was classified as occluded at MRP, but diffusely narrowed at X-ray. The findings of left intrahepatic PV were discordant in 3 patients with hepatocelluar carcinoma in the left lobe. The MRP demonstrated complete occlusion of the left PVs, whereas X-ray showed proximal narrowing and distal occlusion. In another patient with hepatocelluar carcinoma, a small non-occlusive thrombus involving the sagittal segment of the left PV was seen on MRP but not on X-ray. With demonstration of varices and portosystemic shunts, MRP showed results similar to those of X-ray, except one recanalized para-umbilical vein was excluded from the field of view at MRP due to the patient's limited ability of breathholding. The 3D CE MRP correlated well with direct X-ray portography in most cases, it was limited in distinguishing narrowing of an intrahepatic PV from occlusion, but it showed advantage in demonstrating small thrombus within PV. Electronic Publication     

门静脉3D DCE MRA成像的价值与常规门静脉造影对照研究

与常规门静脉造影对照,评价门静脉三维动态态增磁共振血管成像（３－ｄｉｍｅｎｓｉｏｎａｌｄｙｎａｍｉｃｃｏｎｔｒａｓｔｅｎｈａｎｅｄＭＲＡ,３ＤＤＣＥＭＲＡ）显示门静脉开放性及侧支循环的能力。材料与方法：共有２０例患者做了门静脉ＤＤＣＥＭＲＡ成像,分析门静脉３ＤＤＣＥＭＲＡ上门脉主干,肝内门脉     

Three-dimensional portography using multislice helical CT is clinically useful for management of gastric fundic varices

OBJECTIVE: This study seeks to evaluate three-dimensional (3D) helical CT portography as a tool for examining patients with gastric fundic varices. SUBJECTS AND METHODS: We compared 3D helical CT portography and conventional angiographic portography in 30 consecutive patients with gastric fundic varices. We assessed whether 3D helical CT portography is useful in selecting patients and in evaluating the results of balloon-occluded retrograde transvenous obliteration. RESULTS: Three-dimensional helical CT portography simultaneously depicted second or third branches of the intrahepatic portal vein and provided images of entire portosystemic collaterals. On 3D helical CT portography, gastric fundic varices were seen in 30 patients (100%), left gastric veins in 19 (63%), posterior gastric veins or short gastric veins in 28 (93%), gastrorenal shunts in 27 (90%), paraumbilical veins in three (10%), and inferior phrenic veins in two patients (7%). Findings of 3D helical CT portography and conventional angiographic portography were in close agreement. However, in four patients, posterior gastric veins or short gastric veins were not seen on conventional angiographic portography images of the spleen, but they were clearly revealed on 3D helical CT portography. Treatment was successful in all patients except one. Three-dimensional helical CT portography could easily evaluate therapeutic results. CONCLUSION: Three-dimensional helical CT portography proved so effective that it can be considered a less invasive alternative than conventional angiographic portography in assessing portosystemic collaterals. CT portography is useful in selecting candidates from patients with gastric fundic varices for retrograde transvenous obliteration and also in evaluating therapeutic results.     

三维对比剂增强MR血管成像诊断布加综合征的价值

目的观察三维对比剂增强MR血管成像（3DCEMRA）上布加综合征（BCS）的各种表现,并初步评价该项新技术的价值。方法33例BCS患者行3DCEMRA检查。23例为继发性BCS,分别继发于肝细胞癌（21例）、右肾上腺癌（1例）或血栓性静脉炎（1例）。10例为原发性BCS。观察肝静脉、下腔静脉（IVC）和门静脉的开放性,观察有无肝内外侧支、肝实质病变和门静脉一体静脉间曲张静脉。10例患者行下腔静脉造影术,2例行肝右静脉穿刺造影术,把3DCEMRA所获的诊断结果与造影相对照。结果3DCEMRA可显示BCS的各种表现。肝静脉表现包括：癌栓形成（19例）、肿瘤压迫（2例）、肝静脉未显示（4例）和局限性狭窄（4例）。IVC表现为严重狭窄或闭塞（10例）、肿瘤直接侵犯（2例）、癌栓形成（3例）、血栓性静脉炎（1例）和隔膜形成（3例）。9例显示肝内侧支形成,其中2例显示“蜘蛛网”征象。所见的肝外侧支包括扩张的奇静脉和半奇静脉（13例）,以及左肾一膈下一心包膈静脉侧支（2例）形成。2例患者发现门静脉左支闭塞,10例患者发生门静脉．体静脉间静脉曲张。3DCEMRA发现的肝实质病变有：尾叶增大（7例）、不均匀强化（18例）和并发肿瘤（18例）。12例3DCEMRA诊断结果均与造影结果一致。结论3DCEMRA能显示BCS的各种征象,并能帮助提供正确诊断。     

动态增强磁共振门静脉造影在门脉高压症诊断中的价值

目的:探讨动态增强磁共振门静脉造影(DCE MRP)在门脉高压症诊断中的价值。方法:对门脉高压症组23例和正常对照组15例行DCE MRP检查。观察23例门静脉高压症在DCE MRP上的表现。结果:对照组15例均清楚显示门静脉。门脉高压症表现为门静脉增粗(21例)、脾静脉迂曲扩张(23例);门静脉分支级数减少(18例);门静脉延迟显影(7例);显示侧枝循环静脉(6例);门静脉血栓形成(3例)。结论:DCE MRP是评价门静脉的一项快速无创的技术,可准确显示门静脉高压症门静脉系统的病理改变。     

Intrahepatic portal venous variations: demonstration by helical CT during arterial portography

PURPOSE: We assessed the prevalence and types of intrahepatic portal venous variations by helical computed tomography performed with arterial portography (CTAP). METHODS: In 192 patients without evidence of vascular invasion or distortion, CTAP images were reviewed retrospectively to identify portal venous variations. RESULTS: Of the 192 patients examined, 10 (5.2%) had trifurcation, 5 (2.6%) had a right posterior segmental branch arising from the main portal vein, 5 (2.6%) had an absence of the horizontal segment of the left portal vein, and 1 (0.5%) had an absence of the left lateral segmental portal branch. Of the patients without a horizontal segment, two had a right-sided ligamentum teres associated with malposition of the gallbladder, while another had complete ramification of intrahepatic portal branches from an umbilical vein-like segment. In the patient missing the left lateral segmental branches, the right portal vein segments were subcapsularly located. CONCLUSION: Variations of the intrahepatic portal veins can be recognized on CTAP imaging. tomography-Portal vein, computed tomography.     

Gadolinium-enhanced phase-contrast magnetic resonance portography.

PURPOSE: The purpose of this study was to investigate the effect and usefulness of gadolinium-chelated contrast medium in phase-contrast magnetic resonance (MR) portography. METHODS: Twenty-six patients (21 men, 5 women; aged 34 to 79 years, mean 62 years) underwent respiratory-triggered 3-dimensional phase-contrast portography before and after administration of gadolinium in a 1.5T MR unit. Coronal maximum intensity projection (MIP) images of the portal vein were reconstructed and compared to conventional arterial portograms regarding visualization. Signal-to-noise ratio (SNR) and portal vein-to-liver contrast-to-noise ratios (CNR) of main, right, right anterior, right posterior, left portal veins, and umbilical portion were measured on both non-enhanced and gadolinium-enhanced images and compared. RESULTS: Portal veins and branches were more clearly visualized on the gadolinium-enhanced than on the non-enhanced images. Compared to arterial portography, gadolinium-enhanced portography showed similar performances in visualization, except in the right posterior branch and left portal vein. No severe image degradation from respiration was experienced. SNR was significantly higher on the gadolinium-enhanced than on non-enhanced images except in the right anterior branch. CNR was significantly higher on the gadolinium-enhanced than on the non-enhanced images at all measured locations. CONCLUSIONS: Administration of gadolinium improves the SNR and CNR of phase-contrast portography and visualization of the portal vein. The phase-contrast technique with gadolinium enhancement can be used to evaluate the portal vein as a supplemental technique.     

多层螺旋CT门静脉成像对门脉高压侧支循环血管的研究

目的:评价多层螺旋CT门静脉成像(MDCTP)在门脉高压侧支循环血管显示中的价值。方法:31例经临床检查确诊的门静脉高压患者行MDCTP检查,采用MIP、MPR、VR等重建技术进行图像后处理,获得门静脉系统及侧支血管图像,两名医师分别判断侧支血管显示情况。结果:MDCTP不仅显示肝内门静脉3~4级分支,还显示了整个门脉侧支血管系统。31例患者中,胃左静脉曲张28例,食管或食管旁静脉曲张27例,脾静脉曲张21例,胃短/胃后静脉曲张7例,脾-肾分流血管1例,脐静脉曲张伴腹壁静脉曲张2例,门静脉栓塞4例,肠系膜上静脉血管闭塞2例。结论:MDCTP能显示门静脉高压侧支血管开放的部位、范围及程度,有助于对门脉高压患者治疗方案的选择,是一种有重要临床价值的无创性门脉检查方法。     

Contrast-enhanced three-dimensional MR portography.

Three-dimensional (3D) magnetic resonance (MR) portography with contrast material enhancement is a fast means of evaluating the portal venous system that has some advantages over currently used modalities, such as digital subtraction angiography, helical computed tomography, ultrasonography, and nonenhanced MR angiography with time-of-flight and phase-contrast techniques. With contrast-enhanced 3D MR portography, a first-pass study of the mesenteric vasculature is performed after rapid bolus injection of gadopentetate dimeglumine; a 3D fast field echo sequence is used, which can demonstrate the intrahepatic and extrahepatic portal venous system clearly. Repeated sequences after administration of gadopentetate dimeglumine allow separate demonstration of the splanchnic arteries and portomesenteric veins. The images are reconstructed by means of maximum-intensity projection postprocessing, and a subtraction technique can be used to eliminate arterial enhancement and demonstrate portosystemic shunts. The coronal source images simultaneously demonstrate parenchymal lesions of the liver, pancreas, biliary tract, and spleen. This technique is clinically indicated in portosystemic shunt, portal vein thrombosis, hepatocellular carcinoma, pancreatobiliary tumor, hepatic vein obstruction, differentiation of splanchnic arterial from portal venous disease, and gastrointestinal hemorrhage. Its limitations include allergic reactions to contrast media, inappropriate positioning of the 3D acquisition slab, respiratory motion artifacts, and pseudodissection.