CT features of abdominal manifestations of primary antiphospholipid syndrome.

PURPOSE: The purpose of this work was to evaluate the CT features of the abdominal manifestations of primary antiphospholipid syndrome (PAPS). METHOD: Of the 32 patients who were confirmed to have PAPS among 751 patients with elevated antiphospholipid antibodies during a 2 year period, we retrospectively reviewed the 14 patients who underwent abdominal CT. The clinical indications for abdominal CT included abdominal pain, abdominal distension, or lower leg swelling. CT findings were analyzed with regard to the abdominal vascular system and abdominal organ involvement patterns as well as ancillary findings. RESULTS: Of the 14 patients with PAPS, 10 had involvement of the venous system (72%), 2 of the arterial system (14%), and 2 of both systems (14%). Of the 12 patients who had venous system involvement, 4 had thrombosis in the inferior vena cava (IVC), 2 in both the IVC and the hepatic vein, 1 in the IVC and splenic and portal veins, 1 in the IVC and hepatic and adrenal veins, 1 in the hepatic, portal, and renal veins, and 3 in the portal and superior mesenteric veins. Budd-Chiari syndrome developed in five of the nine patients who had thrombosis of the IVC or hepatic vein. Arterial thrombosis was noted in four patients, hepatic artery in two, aorta in one, renal artery in one, pancreatic arcade in one, and splenic artery in one, with infarct of multiple organs including the liver, jejunum, colon, kidney, and adrenal gland. Seven of the 14 patients (50%) manifested thrombosis or infarct of multiple extra-abdominal organs. CONCLUSION: PAPS should be included in the differential diagnosis when CT demonstrates infarcts in multiple organs or patients have recurrent episodes of venous or arterial thrombosis.     

Comparison of Ultrasound,CT, and MR Imaging in the Evaluation of Candidates for TIPS

To compare ultrasound (US), CT, and MRI in the evaluation of hepatic vascular anatomy, portal and splenic venous flow, and collateral pathways (varices and spontaneous shunts) in candidates for transjugular intrahepatic portosystemic shunting (TIPS), 17 patients with history of refractory variceal bleeding or intractable ascites underwent duplex US, contrast-enhanced CT, and MRI before TIPS. The appearance of portal and hepatic anatomy was graded from 1 (not visible) to 4 (excellent visualization) independently by four radiologists. Presence and direction of portal and splenic venous flow, and presence and location of varices and spontaneous portosystemic shunts were also assessed. Results and effects of interobserver variation were assessed for significance using Friedman's ANOVA and Wilcoxon's signed-rank test. MRI yielded higher scores than CT or US for hepatic veins (P <.0001) and inferior vena cava (P <.0001). MRI and CT scored better than US for portal vein branches (P =.012) and splenic vein (P =.0038). All tests demonstrated the main portal vein well, with no statistically significant difference. US and MRI were more sensitive than CT for detecting portal vein flow and direction (US 76%, CT 0%, MRI 82%). MRI was most sensitive for splenic vein flow and direction (US 41%, CT 0%. MRI 76%). CT and MRI were more sensitive than US in detecting varices (US 5%, CT 50%, MRI 58%) and spontaneous shunts (US 13%, CT 75%, MRI 75%). Interobserver variation did not influence results significantly P =.3691). MRI provides the most useful information and may be the preferred single imaging test prior to TIPS.     

Pancreatic portal cavernoma in patients with cavernous transformation of the portal vein: MR findings

The purpose of the article was to prospectively evaluate the MR findings of pancreatic portal cavernoma in a consecutive series of patients with cavernous transformation of the portal vein. This study was approved by the review board of our institution, and informed consent was obtained. The clinical and biological data and the MR imaging for 20 patients (11 female, 9 male; median age, 49 years) with cavernous transformation of the portal vein and no evidence of previous pancreatic disease were reviewed. The presence of pancreatic portal cavernoma (defined as intra- and/or peripancreatic portal cavernoma), morphological changes in the pancreas, biliary and ductal pancreatic abnormalities, and extension of the portal venous thrombosis were qualitatively assessed. Fifteen patients (75%) had pancreatic portal cavernoma with collateral formation in the pancreas and/or collaterals around the pancreas seen on dynamic contrast-enhanced MR sequences: three patients had both intra- and peripancreatic portal cavernoma, six had intrapancreatic portal cavernoma alone and six had peripancreatic portal cavernoma only. The presence of intra- or peripancreatic portal cavernoma was significantly associated with extension of the thrombosis to the splenic and superior mesenteric veins (p = 0.05). Morphological changes in the pancreas, heterogeneity on T2-weighted sequences and main ductal pancreatic abnormalities were seen in two, four and two patients, respectively. All these patients had intrapancreatic portal cavernoma. Bile duct dilatation was observed in 13 (65%) patients: among them three had extrahepatic dilatation only and these three patients had associated intrapancreatic portal cavernoma. In patients with cavernous transformation of the portal vein, intra- or peripancreatic portal cavernoma is common. In conclusion, intra- or peripancreatic portal cavernoma was only observed in patients with extension of the thrombosis to the splenic vein and/or the superior mesenteric vein.     

Splenic and portal venous thrombosis: a vascular complication of pancreatic disease demonstrated on computed tomography

Portal and splenic venous thrombosis is a rare but well recognised complication of pancreatic carcinoma and pancreatitis. We report a series of five patients with pancreatic disease in whom CT detected this complication. The appearances on CT are of an enlarged vein with a centre of lower attenuation which does not enhance following intravenous contrast injection, ring enhancement and opacification of collateral veins. Splenic vein thrombosis following pancreatitis should be considered in all patients with pancreatic disease as this complication is increasingly recognised as a cause of upper gastrointestinal haemorrhage from varices.     

CT criteria for venous invasion in patients with pancreatic head carcinoma

The purpose of the study was to evaluate CT criteria for venous invasion in patients with potentially resectable carcinoma of the pancreatic head, with surgical and histopathological correlation. In 113 patients evaluated with spiral CT for suspected pancreatic head carcinoma, several CT criteria for venous invasion were scored prospectively for the portal vein (PV) and the superior mesenteric vein (SMV): length of tumour contact with PV/SMV (0 mm, < 5 mm, > 5 mm); circumferential involvement of the vein (0 degree, 0-90 degrees, 90-180 degrees, > 180 degrees); degree of stenosis; irregularity of the vessel margin; and tumour convexity towards vessel. 65 patients underwent surgery. Pancreatic head carcinoma was proven and pathology of the vascular margin was obtained in 50 of these patients. CT findings for single and combined criteria were correlated with pathology in these 50 patients, 30 of whom showed venous ingrowth. Invasion was found in all cases with SMV narrowing (n = 7), PV contour involvement > 90 degrees (n = 6), PV narrowing (n = 5) and PV wall irregularity (n = 3). The vascular ingrowth rate was 88% (15/17) for tumour concavity towards the PV or SMV. Poor predictors of ingrowth were length of tumour contact with PV > 5 mm (78% ingrowth, 14/18) and contour involvement of the SMV > 90 degrees (83% ingrowth, 10/12). Absence of vascular ingrowth could not be predicted in 100%. In conclusion, CT criteria can predict a high risk of invasion in potentially resectable tumours. Narrowing of the SMV and the PV seems the most reliable criterion, as well as circumferential involvement of the PV > 90 degrees. The best combination of criteria was tumour concavity with circumferential involvement > 90 degrees (sensitivity 60% and positive predictive value 90%).     

The gastrocolic trunk and its tributaries: CT evaluation.

Dilatation or occlusion of the gastrocolic trunk (GT) may be a clue to a portal venous or pancreatic pathologic condition. To evaluate the normal and abnormal appearances of the GT and its tributaries at computed tomography (CT), the CT scans, angiograms, and surgical-pathologic records of 21 patients with cancer of the pancreas and 15 patients with chronic pancreatitis were reviewed retrospectively. The CT examinations of 30 patients with metastatic disease of the liver and no known pancreatic disease were studied for comparison. A normal GT (2.6-4.7-mm diameter) was identifiable in 48% of the control group in CT scans obtained with 10-mm-thick sections and in 90% of CT scans obtained with 5-mm-thick sections. The GT was dilated in five patients with isolated splenic vein occlusion and in five patients with occlusion or stenosis of the portal-superior mesenteric vein confluence (P-SMVC) above the level of the GT entry into the superior mesenteric vein. The GT was obliterated in eight patients and was associated with P-SMVC occlusion. Findings at surgery confirmed tumor extension into the root of the transverse mesocolon in three patients with cancer of the pancreas. Abnormal findings at CT, however, do not enable differentiation between benign and malignant pancreatic diseases.     

门静脉阻塞的CT诊断

目的提高门静脉阻塞的CT诊断水平.方法回顾性分析24例门静脉阻塞病人的CT检查.总结门静脉阻塞的CT表现.结果门静脉阻塞的CT表现1阻塞近侧门静脉扩张;2门静脉海绵状改变;3侧支途径形成;④门静脉腔内充盈缺损及管壁增强;⑤肝内异常密度改变;⑥脾脏增大.结论掌握门静脉阻塞的CT表现,可以对门静脉阻塞作出正确的CT诊断.     

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。     

多层螺旋CT对肝移植受体手术前后评估

目的探讨多层螺旋CT血管造影（MSCTA）对原位肝移植受体手术前后的评估. 资料与方法对14例临床拟行肝移植受体进行MSCT多期增强扫描,并行2D、3D血管重建,观察肝脏、血管情况.5例行原位肝移植手术患者的MSCTA图像与手术对照分析. 结果 14例患者的肝脏病变及肝动脉和门静脉系血管结构清晰显示,其中肝硬化6例,肝硬化合并肝癌5例,Budd-Chiari综合征1例,Budd-Chiari综合征合并肝硬化1例,Budd-Chiari综合征合并小肝癌1例. 肝动脉解剖走行常见型11例,变异3例,腹腔干狭窄2例,肝动脉狭窄1例,脾动脉瘤1例.显示门静脉系血栓5例,门脉高压侧支循环形成6例;胆管结石3例.5例肝移植受体术前门脉癌栓1例,门脉高压侧支循环形成3例,术后未发现并发症. 结论 MSCTA对肝移植受体术前术后提供更多准确的信息,具有很好的应用前景.     

Budd-Chiari syndrome: CT observations

The authors describe four patients with Budd-Chiari syndrome in whom contrast material-enhanced computed tomographic (CT) scans demonstrated low-density venous thrombosis in three sites not, to our knowledge, previously described with this modality. Thrombosis was seen in the portal circulation, the hepatic veins, and the intrahepatic inferior vena cava. It is known that concomitant portal vein thrombosis may be seen in 20% of patients with Budd-Chiari syndrome. Three of the four patients in the current study had this finding, one with extensive thrombosis of portal, mesenteric, and splenic veins and the other two with portal vein branch involvement. In one patient hepatic vein thrombosis was demonstrated with CT, and in three inferior vena cava clot was demonstrated. All four patients had the distinctive hepatic parenchymal contrast enhancement pattern seen in this condition, which the authors think may be at least partially caused by associated portal thrombosis. The presence of portal venous thrombosis should prompt the observer to consider the diagnosis of Budd-Chiari syndrome. Detection of hepatic vein clot confirms the diagnosis and may be seen in this condition in association with inferior vena cava thrombus.     

Alterations in hepatic perfusion resulting from splanchnic venous luminal compromise caused by pancreatic carcinoma

OBJECTIVE: We determined whether alterations in hepatic enhancement exist on dual phase helical CT of the liver in patients with splanchnic venous luminal compromise resulting from pancreatic adenocarcinoma. SUBJECTS AND METHODS: We examined the extent of hepatic enhancement on dual phase helical CT in 22 patients with pancreatic adenocarcinoma. Eleven patients had splanchnic venous luminal narrowing (flattening along at least 120 degrees of the circumference) of the superior mesenteric vein with (n = 3) or without (n = 8) portal vein involvement caused by tumor. In the remaining patients, splanchnic vasculature appeared normal. An additional 16 patients without pancreatic or hepatic abnormality who underwent dual phase helical CT served as control subjects. We compared the extent of arterial phase and portal venous phase enhancement among the three groups. RESULTS: The group of patients with splanchnic venous luminal compromise had significantly higher hepatic enhancement during the arterial phase (p < 0.01) and lower enhancement during the portal venous phase (p < 0.05) compared with the other two groups of patients. No significant difference in hepatic enhancement during either phase was noted between the control subjects and the patients with normal vasculature. CONCLUSION: Because hepatic enhancement correlates with perfusion, splanchnic venous luminal compromise resulting from pancreatic adenocarcinoma likely causes decreased portal venous flow and compensatory increased hepatic arterial flow. This finding supports other evidence of a homeostatic mechanism that maintains hepatic perfusion.     

门静脉系统血栓的64层螺旋CT诊断价值

目的 探讨门静脉系统血栓(portal vein thrombosis,PVT)的64层螺旋CT表现特征.资料与方法 15例PVT行64层螺旋CT平扫和双期增强扫描,采用最大密度投影(MIP)、容积再现(VR)及多平面重组(MPR)观察其影像学特征.结果 15例中,血栓发生于门静脉(PV)主干13例,右支6例,左支7例,脾静脉(SV)3例,肠系膜上静脉(SMV)9例,其中血栓同时累及PV主干和SMV 8例,同时累及PV左右支、主干和SMV 4例,累及PV主干和右支6例,累及PV主干和左支6例,累及SV和SMV 2例,PV主干、SV、SMV三岔口处血栓1例.Yerdel分级:Ⅰ级1例,Ⅱ级10例,Ⅲ级3例,Ⅳ级1例;血栓呈高密度10例,等密度2例,低密度3例;血栓为部分偏心性栓塞12例,呈小条状、"柴捆"状;附栓管壁均连续光滑、无外突结节,局部PV管壁呈典型的线样"强化征"或"轨道征";出现食管胃丛及脾丛侧支循环12例,胆管丛及胆囊丛侧支循环4例,无一例出现肝动脉.门静脉瘘.结论 64层螺旋CT能够清晰、立体地显示PVT的部位、累及范围,具有特征性,是PVT重要的检查方法.     

Use of Ga-68 DOTATATE PET/CT to confirm portal vein tumor thrombosis in a patient with pancreatic neuroendocrine tumor

A 37-year-old man complained of increasing severity and frequency of abdominal pain over a 2-year period. Initial contrast-enhanced computed tomography of the abdomen demonstrated diffuse enlargement of the pancreas associated with a filling defect in the portal vein, splenomegaly with wedge-shaped peripheral splenic hypodensities and multiple hepatic hypodensities. Findings were suggestive of a pancreatic malignancy complicated by hepatic metastases, splenic infarcts, and portal vein thrombosis. We describe the use of gallium-68 DOTA-DPhe1, Tyr3-octreotate positron emission tomography/computed tomography (Ga-68 DOTATATE PET/CT) in confirming the diagnosis of a pancreatic neuroendocrine tumor with portal vein tumor thrombosis.     

3D CE-MRA在评价腹部静脉系统中的应用

目的探讨三维增强磁共振血管成像（3DCE—MRA）技术在腹部静脉系统中的应用价值。方法收集具有完整资料的16例病例，先行常规MRI检查，随后经静脉注射Gd—DTPA20—30mL后连续三次行3DCE—MRA采集数据，对静脉系统原始图像进行MIP重建。主要观察指标为下腔静脉、脾静脉、肝静脉、肠系膜上静脉、门静脉形态变化。结果16例患者中，门腔静脉正常者9例，3DCE—MRA清晰显示下腔静脉、肝静脉、脾静脉、肠系膜上静脉、门静脉结构；门静脉高压3例，示脾静脉增宽迂曲，门静脉主干增宽及明显侧支循环形成；2例布加氏综合征；1例下腔静脉血栓形成；1例门静脉海绵样改变。结论3DCE—MRA是一种安全、敏感性高的血管造影技术，可提高腹部静脉系统疾病的术前诊断。     

胰腺癌血管侵犯的不同CT诊断标准的研究

目的:研究胰腺癌血管侵犯的不同CT诊断标准的优劣。材料和方法:回顾性收集我院经多层螺旋CT三期动态增强扫描并经手术病理证实为胰腺导管细胞癌的36例患者。CT轴位图像结合CTA(以MIP和VR方法重建)以及多平面重建(MPR)分别对这些血管以Loyer和Lu血管分级CT标准进行分级,并和手术结果进行对照,分别作出受试者工作特性曲线(ROC),比较曲线下面积的差异。另外,运用Lu的CT诊断标准分别评价胰周动脉和静脉受侵的准确性、灵敏度、特异度、阳性预测值、阴性预测值、Youden指数,研究Lu的CT诊断标准对动静脉分级的差异。结果:Loyer和Lu的CT诊断标准所得的灵敏度、特异度分别为84.5%、86.0%、81.4%、91.8%,两个诊断标准的ROC曲线下面积分别为0.886、0.912,经统计学检验无明显差异。应用Lu的CT诊断标准,胰周动静脉受侵的阳性预测值分别为57.1%和71.0%。结论:分别以Loyer和Lu血管分级CT标准对胰腺癌胰周血管侵犯进行分级,两者的诊断价值相同,Lu的CT诊断标准的最佳诊断分界点应在90°-180°之间,此外,它对胰周动脉的价值要比静脉差。     

Calcifications in the portal venous system: comparison of plain films, sonography, and CT.

We describe 10 patients with long-standing portal hypertension and calcifications in the splenoportal and mesenteric venous systems or collateral vessels. The patients were examined with abdominal plain films (n = 10), sonography (n = 10), and CT (n = 9). Calcium was seen on CT scans in nine cases, on sonograms in seven, and on abdominal plain films in five. Calcifications appeared to be located in the wall of the vein in all cases. Sites of detection included the main portal, splenic, superior mesenteric, coronary, and peripancreatic veins. CT was more sensitive than sonography, and both were more sensitive than plain films, in showing portal venous calcification. Detection of such calcifications may influence surgical or percutaneous therapy of portal hypertension.     

Portal venous stent placement in patients with pancreatic and biliary neoplasms invading portal veins and causing portal hypertension: initial experience.

PURPOSE: To evaluate the clinical usefulness of portal venous stent placement in patients with pancreatic or biliary neoplasms invading portal veins and causing portal hypertension. MATERIALS AND METHODS: Thirteen patients underwent portal venous stent placement because of gastrointestinal bleeding (n = 8), risk of gastroesophageal varix rupture (n = 4), ascites (n = 4), thrombocytopenia (n = 3), and/or portal venous thrombosis (n = 3). The main portal vein or both the intrahepatic and main portal veins were invaded in six patients (group A). The main portal vein and splanchnic veins were involved in seven patients (group B). Stents were placed across the stenotic (n = 8) or occluded (n = 5) lesions after percutaneous transhepatic portography. Changes in portal venous pressure, stent patency, and survival were evaluated. RESULTS: Mean portal venous pressure decreased significantly immediately after stent placement, from 24.9 mm Hg +/- 5.9 (SD) to 15.8 mm Hg +/- 4.6 (P <.001). In group A, blood flow through the stent was maintained and the symptoms had subsided at follow-up (mean, 12.5 months). In group B, symptoms were improved in five patients, but the stents were occluded in all but one patient at a mean follow-up of 1.5 months. There was a significant difference in stent patency between the patients with (14%) and those without (100%) splanchnic venous involvement (P <.01). CONCLUSION: Stent placement helped to relieve portal hypertension symptoms. Splanchnic venous involvement was associated with worse stent patency.     

门静脉高压静脉曲张的螺旋CT表现

目的评价门静脉高压静脉曲张的螺旋CT表现.材料和方法回顾性分析47例经螺旋CT平扫及双期增强扫描诊断为门静脉高压静脉曲张的CT表现,并对其发生部位作了统计.结果增强扫描门静脉期扭曲扩张的静脉表现为曲线条、团块状或结节状高密度影.其中食管下端粘膜下及食管旁静脉曲张最常见(发生率为61.7%),以下依次为胃周静脉曲张(36.2%),脾门附近静脉曲张(23.4%),脐旁静脉曲张(21.3%),肾及肾上腺静脉曲张(12.8%),腹膜后一椎旁静脉曲张(4.3%),门静脉海绵状变性(4.3%).结论螺旋CT增强扫描门静脉期静脉曲张一目了然,结合其特定的解剖部位,CT能作出定性诊断并判断其程度.     

多层螺旋CT对胰源性门静脉高压的诊断价值

目的探讨多层螺旋CT腹部增强扫描在诊断胰源性门静脉高压(PSPH)中的价值。方法对15例临床疑诊胰腺体尾部病变累及门静脉系统的患者的增强CT资料进行回顾性研究,观察门静脉系统形态改变,并测量胃冠状静脉、门静脉、脾静脉、肠系膜上静脉内径。结果急慢性胰腺炎及胰腺癌侵犯或压迫脾静脉,血液向门静脉回流受阻,致其远端显影不佳,近端血管扩张以及侧支循环形成最终导致胰源性门静脉高压症。结论多排螺旋CT可连续观察侧支循环走行,清晰显示病变与邻近结构关系,为胰源性门脉高压患者提供血管形态、病因诊断等多方面有价值信息,并为临床诊断和治疗提供客观的影像学依据。     

Mesenteric vein thrombosis: CT identification

Superior mesenteric vein thrombosis was identified on computed tomographic scans in six patients. In each case, contrast-enhanced scans showed a high-density superior mesenteric vein wall surrounding a central filing defect. Four of the six patients had isolated superior mesenteric vein thrombosis. A fifth patient had associated portal vein and splenic vein thrombosis, and the sixth patient had associated portal vein and inferior vena cava thrombosis. The diagnosis of superior mesenteric vein thrombosis was confirmed by angiography in two patients and by surgery in a third. One of the six patients had acute ischemic bowel disease. The other five patients did not have acute ischemic bowel symptoms associated with their venous occlusion. This study defines the computed tomographic appearance of mesenteric vein thrombosis. A dense venous wall surrounding a central lucency representing blood clot was present in all six cases.