成人肝海绵状血管瘤并发动静脉短路的DSA检查和诊断

目的：纠正成人肝海绵状血管瘤（ＣＨＬ）罕见并发动静脉短路（ＡＶＳ）的传统认识，提高其ＤＳＡ诊断率。方法回顾性分析确诊为ＣＨＬ且不伴有其他肝脏疾患和肝损伤的３０例成人患者的ＤＳＡ图像，并与其他中并发ＶＡＳ的２１例行经导管动脉碘油栓塞术（Ｌ－ＴＡＥ）后的即时Ｘ线片进行对比，通过观察碘油的沉积分布状况再次验证ＤＳＡ显示的ＡＶＳ。结果３０例中２２例（７３％）获得ＤＳＡ明确诊断的ＡＶＳ，皆出现于瘤周肝组织，

DSA examination and diagnosis of arteriovenous shunts in hepatic cavernous hemangiomas of adults

Objective To correct the misunderstanding that arteriovenous shunts (AVS) are rarely found in adult cavernous hemangiomas of the liver(CHL) and to increase its diagnosis rate by DSA. Methods DSA examination and DSA images of thirty adults with definitely diagnostic CHL and without evidence of other hepatic diseases and hepatic injury were analyzed retrospectively. X ray films of 21 cases with AVS taken immediately after transcatheter arterial embolization using lipiodol (L TAE) were compared with the corresponding DSA images to check up those AVS opacified in DSA by observing sediment and distribution of iodized oil injected. Results Definite diagnosis of AVS by DSA were obtained in 22 cases of this series(73%). All the AVS were located in the peritumoral parenchyma and appeared as parellel track sign, and early opacification of small draining veins,etc.during arterial phase of DSA. X ray films taken immediately after L TAE in 21 of 22 cases with AVS showed that few portal radicles or draining veins were refilled by iodized oil through incompletely occluded shunts in 11 cases, and no any vein was refilled by iodized oil resulted from complete occlusion of the present AVS in 10. No definite AVS was found in the other 8 cases of this series, and in 6 of them improper imaging factors of DSA were used. Conclusion This study serves to emphasize that AVS is not a diagnosis of hepatic malignancy, but is frequently seen in the commonly benign CHL of adults. Proper imaging factors of DSA and superior images can be helpful to opacify small AVS of CHL. The formation of AVS in CHL may be closely related to the pathological changes of peritumoral parenchyma, however, its mechanism must be further studied.