肝癌伴门静脉癌栓血流动力学变化的CT表现

目的:探讨肝癌合并门静脉癌栓的血流动力学变化及其CT表现,为肝癌的诊治及预后提供帮助。方法:经临床证实的原发性肝癌合并门静脉癌栓患者34例为研究组,不伴门静脉癌栓的25 例为对照组。所有病例均行螺旋CT三期增强扫描。结果:研究组34例中24例出现动脉期高灌注,9 例出现门脉期低灌注,研究组与对照组间肝实质灌注异常的差异具有显著性意义;研究组肝动静脉瘘发生率明显增加;门静脉主干癌栓常并发门静脉海绵样变性、胆囊静脉曲张及胆旁静脉丛扩张;CT可显示门脉高压的侧支循环。结论:原发性肝癌门静脉癌栓可引起肝脏血流动力学变化,正确认识其CT表现对指导临床具有重要意义。

The Hemodynamic Changes and CT Findings of Hepatocellular Carcinoma with Tumor Thrombosis in Portal Vein

Objective:To investigate the hemodynamic changes and CT findings of hepatocellular carcinoma (HCC) with tumor thrombosis in portal vein (PVT).Methods:34 clinically proven HCC patients with tumor thrombosis in portal vein were studied.Another 25 HCC patients without tumor thrombosis in portal vein were included for comparison.Stan- dardized three-phase contrast enhanced spiral CT was performed for all patients.Results:24 of 34 HCC patients with PVT presented high perfusion in arterial phase and 9 cases presented low perfusion in portal phase.There was a marked difference between the two groups in perfusion.And the occurrence of hepatic A-V-fistula increased in HCC patients with PVT.Cavernous transformation of portal vein often occurred in patients with main portal thrombosis,in which gallbladder varices and ectatic paracholedochal venous plexus often existed.Conclusion:The tumor thrombosis in portal vein of HCC could alter the hemodynamics of the liver.It is important to know those CT findings in clinical diagnosis and treatment.