多层螺旋CT对门静脉海绵样变的诊断价值

目的:分析门静脉海绵样变(CTPV)的多层螺旋CT(MSCT)表现和特征,探讨MSCT对该病的诊断价值.方法:使用16排MSCT对30例CTPV患者,行上腹部CT平扫、动态增强扫描,采用多平面重组(MPR)、最大密度投影(MIP)、容积再现 (VR)等图像后处理技术显示异常的门静脉及侧枝血管情况.结果:CTPV的MSCT平扫示门静脉结构不清,肝门区可见多发的结节状软组织影.增强扫描示动脉期10例有肝实质灌注异常;门静脉期18例患者门静脉主干和(或)左右分支增粗,内可见充盈缺损,4例门静脉显示不清;8例门静脉主干和(或)左右分支在正常范围内;1例门静脉主干变细.胆管周围静脉丛(100%)、胆囊静脉(60%)及胃左静脉(23.3%)呈点状、簇状扩张.MPR、MIP、VR可直观地显示各曲张血管的走行及曲张程度.结论:MSCT及图像后处理系统对CTPV诊断具有重要价值,门静脉栓塞及其周围纡曲扩张的侧枝静脉为其特征性表现.

Diagnostic Value of Multi-slice CT in Cavernous Transformation of Portal Vein

Objective:To study the diagnostic role and CT features of cavernous transformation of portal vein(CTPV)with multi-slice CT(MSCT).Methods:A 16-detector-row spiral CT scanner was used to perform plain and multi-phase contrast enhanced abdominal scanning in 30 patients with CTPV.Image post-processing techniques,including MPR,MIP and VR,were applied to depict the cavernous transformed portal vein and its collaterals.Results:On plain MSCT,the portal vein was not clearly seen,while multiple soft tissue nodules were found in the porta hepatis region.On dynamic enhanced scans,abnormal hepatic perfusion during arterial phase in 10 cases was demonstrated.On portal vein phase images the main trunk of portal vein and/or its left and right branches were dilated with filling defects in 18 cases.Inconspicuous portal veins were shown in 4 cases.Normal main portal veins and/or left and right branches of portal vein in 8 cases were demonstrated.The main trunk of portal vein looked thin in 1 case.Pericholedochal venous plexus(100%),cystic(60%)and left gastric veins(23.3%)were dilated and varicose,looking like clusters of spots.The courses and extents of the varicose vessels were directly demonstrated with MPR,MIP and VR techniques.Conclusion:MSCT and relative image post-processing techniques were of great value in the diagnosis of CTPV.Thrombosed portal vein and its adjacent varices as well as dilated collaterals might be served as the primary features of CTPV.