64排螺旋CT血管造影评价肝硬化血管改变及侧支循环

目的 探讨MSCTA评价肝硬化肝脏血管的异常改变及侧支循环形成的价值。 方法 对168例肝硬化患者(肝硬化组)及120例无肝硬化的患者(对照组)行肝区三期MSCTA,应用MIP和VR进行重建,并对获得的图像进行对照分析。 结果 肝硬化组和对照组门静脉1级和肝静脉1级血管的显示差异无统计学意义(P分别为0.51、0.08),肝动脉、门静脉、肝静脉分级显示差异均有统计学意义(P<0.01)。肝硬化组肝动脉、门静脉起始部增粗85例,分支纤细、纡曲98例,门静脉癌栓形成9例,海绵变性8例,肝动脉持续显影55例、门静脉持续显影57例;对照组3例肝动脉、门静脉起始部增粗,2例分支纤细、纡曲,4例肝动脉持续显影,3例门静脉持续显影。肝硬化组交通支开放总数258支,其中食管胃底静脉曲张196例(196/258,75.97%),对照组仅2例见腹膜后分流。 结论 64排CT三期血管成像可准确、全面显示肝 硬化血管的异常改变及门体分流,尤其能较早、较全面地显示食管胃底静脉曲张,为临床提供更多可靠的诊断和治疗依据。

64-slice spiral CTA in evaluation on the changes of hepatic vessels and the portosystemic collateral circulation in liver cirrhosis

Objective To investigate the changes of hepatic vessels and the portosystemic collateral circulation in patients with liver cirrhosis with 64-slices spiral CTA. Methods Tri-phase enhanced CT scan of whole hepatic region were performed in 168 patients with liver cirrhosis (liver cirrhosis group) and 120 patients without liver cirrhosis (control group). All images were post processed with MIP and VR, and were compared between the two groups. Results The difference between the two groups were statistically significant (P<0.01) in showing hepatic artery, portal vein and hepatic vein of different grades, except in showing 1st grade of portal vein and hepatic vein (P=0.51, 0.08). In liver cirrhosis group, dilated trunk of hepatic artery and portal vein were observed in 85 patients, narrowing and tortuosity of vessels were observed in 98 patients, carcinoma thrombus formation and spongy degeneration in portal vein were detected in 9 and 8 patients, respectively, while continuous enhancement of hepatic artery and portal vein were noticed in 55 and 57 patients, respectively. In the control group, dilated trunk of hepatic artery and portal vein were observed in 3 patients, narrowing and tortuosity of vessels were observed in 2 patients, continuous enhancement of hepatic artery and portal vein were noticed in 4 and 3 patients, respectively. Totally 258 portosystemic collateral circulations were found in liver cirrhosis group, including 196 esophagogastric varices (196/258, 75.97%), whereas only 2 retroperitoneal shunts were found in control group. Conclusion 64- slices spiral CT tri-phase angiography is a safe, convenient and reliable method to display the changes of hepatic vessels and the form of portosystemic collateral circulation, especially esophagogastric varices in patients with liver cirrhosis.