MSCT诊断肝癌并门静脉癌栓及其在介入治疗中的价值

目的探讨256层螺旋CT在原发性肝癌并门静脉癌栓中的诊断价值及其在介入治疗中的临床应用价值。方法采用256层螺旋CT对我院68例肝癌合并门静脉癌栓患者行肝脏多期增强扫描，三维后处理方法包括最大密度投影、多平面重建及容积再现等技术。其中29例患者于检查后96h内接受数字减影血管造影并行肝动脉化疗栓塞术，将螺旋CT影像表现与DSA做对照观察。结果门静脉癌栓主要影像表现为门静脉主干或分支扩张、门静脉腔内充盈缺损，增强扫描可见其不同程度强化，其中门静脉海绵样变（CTPV）17例、肝实质异常灌注21例及肝动脉门静脉瘘（APS）25例。在29例行DSA检查及介入治疗的肝癌患者中，多层螺旋CT多期增强扫描在肿瘤供血动脉、血管变异及门静脉癌栓等病变的显示上与DSA一致。结论256层螺旋CT可以准确诊断、评价肝癌并门静脉癌栓及其血流动力学变化，并对介入治疗具有重要临床价值。

The valuation of multi-slice spiral CT in diagnosis of hepatocellular carcinoma with portal vein tumor thrombus and interventional treatment

Objective To explored the 256-slice spiral CT in the diagnosis of hepatocellular carcinoma with portal vein tumor thrombus（PVTT） and its clinical valuation of the interventional treatment. Methods 68 inpatients of hepatocellular carcinoma with portal vein tumor thrombus were examined by 256-slice spiral CT liver multi-phase enhanced scanning. Post-processing methods includes maximum intensity projection（MIP）, multi-planar reconstruction（MPR） and volume rendering（VR）. 29 cases accepted digital subtraction angiography and hepatic artery chemotherapy embolization. Observed the 128-sliee spiral CT imaging and DSA. Results PVTT imaging fingdings of the trunk or branch expansion of the portal vein, portal vein intra luminal defect, enhanced scanning showed varying degree strengthen, including CTPV 17 cases, abnormal liver parenchyma perfusion 21 cases and APS 25 cases. The 29 cases accepted DSA examination and TACE showed that the tumor feeding artery, abnormal blood vessels and PVTT lesions consistent with DSA. Conclusion 256-slice spiral CT liver multi-phase enhanced scanning can accurately diagnose the evaluation of hepatocellular carcinoma with PVTT, hemodynamic changes, and it has important clinical value to the interventional treatment.