肝脏灌注异常的多层螺旋CT研究

目的　用多层螺旋CT评价各类肝脏灌注异常 ,强调认识肝脏灌注异常的重要意义。方法　回顾性分析 1年中接受上腹部螺旋CT检查的 15 68例病人的CT资料 ,对各种类型的肝脏灌注异常病例的CT表现、病因和发生机制进行探讨。结果　共发现各类肝脏灌注异常 10 3例 ,其中与肿瘤相关者 69例 ,非肿瘤相关者 3 4例。按其发生原因可分为 :( 1)肝动脉门静脉瘘 ( 4 1.7% ) ;( 2 )门静脉阻塞 ( 2 3 .3 % ) ;( 3 )炎症性充血 ( 17.5 % ) ;( 4 )富血供肿瘤的盗血现象 ( 6.8% ) ;( 5 )肝静脉阻塞 ( 4 .9% ) ;( 6)肝脏迷走血供 ( 3 .9% ) ;( 7)病因不明 ( 1.9% )。灌注异常的CT形态与其产生原因有明显的关系。结论　多层螺旋CT是评价各类肝脏灌注异常的有效方法。熟悉肝脏灌注异常的CT表现有助于对其所反映的病理生理状况作出准确推断

The Study of Hepatic Perfusion Disorders with Multi-Slice Spiral CT

Objective To evaluate the various patterns of hepatic perfusion disorders with multi-slice spiral CT and to emphasize the significance of recognition for them . Methods In a period of 1 year, the all CT images of 1568 patients received multi-slice spiral CT examination of upper abdomen were analyzed retrospectively. The CT findings, etiologies and mechanisms of different pattens of hepatic perfusion disorders were investigated. Results 103 cases were demonstrated to have hepatic perfusion disorders. 69 cases were associated with tumors and the other 34 cases were non-tumor associated. The etiologies of various hepatic perfusion disorders were classified as (1)arterioportal fistulae(41.7%), (2) portal venous inflow obstruction(23.3%), (3) inflammartory hyperemic changes(17.5%), (4) steal phenomenon by hypervascular tumors(6.8%), (5) hepatic venous outflow obstruction(4.9%), (6) aberrant hepatic blood supply (3.9%) and (7) uncertain causes(1.9%). There was significant correlation between the CT images of perfusion disorders in shape and distribution and the causes of them. Conclusion Multi-slice spiral CT provides a new effective technique for demonstrating and understanding various hepatic perfusion disorders. Familiarity with the spiral CT appearances of these perfusion disorders will result in more accurate evaluation for various pathologic or physiologic states reflected by them.