门静脉癌栓导致肝血异常的CT研究

目的:总结肝细胞癌合并门静脉癌栓所致肝血异常CT表现,探讨其血流动力改变的机理及临床意义。方法:在2004年7月至2011年6月于我院CT检查诊断为肝细胞癌病例中,对存在肝血异常病例作为研究对象。全部病例均常规进行肝动脉期、门静脉期、平衡期增强扫描。结果:具有肝血异常CT表现者120例,全部病例见原发性肝细胞癌灶和肯定的门静脉癌栓,癌灶外肝血异常的增强扫描表现可分为三种:肝实质局部早期强化,门静脉提前显影,门静脉海绵样变。在同一病例中,可单独以一种表现,也可同时以两种表现(双重表现)或三种表现(三重表现)。结论:肝细胞癌肝血异常由门静脉癌栓引起,其发生机理为肝动脉或门静脉对肝脏的灌注异常,肝静脉或下腔静脉的引流异常,肝动脉-门静脉异常分流,侧支循环的建立等。

CT Study of Abnormal Hepatic Blood Due to Portal Vein Thrombosis

Objective: To summarize the CT appearance of abnormal hepatic blood due to hepatocellular carcinoma associated with portal vein thrombosis,to investigate the mechanism and clinical significance of its hemodynamic change. Methods: From July 2004 to June 2011,the cases of hepatocellular carcinoma were diagnosed by CT scan in our hospital.The objects of study included the cases of abnormal hepatic blood within them.All patients were routinely performed contrast enhanced CT scan with the arterial phase,portal vein phase and balance phase.Result: There were 120 cases of CT appearance with abnormal hepatic blood and all cases of primary hepatocellular carcinoma lesion and definite portal vein thrombosis.The appearance of contrast enhanced CT scan with abnormal hepatic blood outside the tumor lesion were divided into three types: early enhancement of local hepatic parenchyma,early display of portal vein,cavernous transformation of portal vein.In the same case,only one type of performance occurred,or two types(dual performance) and three types(triple performance) occurred simultaneously.Conclusion: Abnormal hepatic blood of hepatic carcinoma is caused by portal vein thrombosis,its mechanism include abnormal hepatic perfusion through hepatic artery and portal vein,abnormal drainage through hepatic vein and inferior vena cava,abnormal hepatic artery-portal vein shunt,establishment of collateral circulation,etc.