多层螺旋CT门静脉成像对门脉高压侧支循环血管的研究

目的:评价多层螺旋CT门静脉成像(MDCTP)在门脉高压侧支循环血管显示中的价值。方法:31例经临床检查确诊的门静脉高压患者行MDCTP检查,采用MIP、MPR、VR等重建技术进行图像后处理,获得门静脉系统及侧支血管图像,两名医师分别判断侧支血管显示情况。结果:MDCTP不仅显示肝内门静脉3~4级分支,还显示了整个门脉侧支血管系统。31例患者中,胃左静脉曲张28例,食管或食管旁静脉曲张27例,脾静脉曲张21例,胃短/胃后静脉曲张7例,脾-肾分流血管1例,脐静脉曲张伴腹壁静脉曲张2例,门静脉栓塞4例,肠系膜上静脉血管闭塞2例。结论:MDCTP能显示门静脉高压侧支血管开放的部位、范围及程度,有助于对门脉高压患者治疗方案的选择,是一种有重要临床价值的无创性门脉检查方法。

Evaluation of portal system and its collaterals in portal hypertension using multi-detector row spiral CT portography

Objective:To evaluate the value of multi-detector row spiral CT portography(MDCTP) in demonstrating portal system and its collaterals in portal hypertension.Methods:MDCTP was performed in 31 patients with documented portal hypertension in clinics,image post-processing techniques such as MIP,MPR and VR were applied to display the portosystemic collaterals of portal venous system.Results:MDCTP simultaneously depicted third or fourth branches of the intrahepatic portal veins and provided images of entire portosystemic collaterals,on MDCTP images,left gastric varices were seen in 28 patients,esophageal and paraesophageal varices in 27,splenic varices in 21,short gatric veins or posterior gastric veins in 7,splenorenal shunts in 1,abdominal wall and paraumblical varices in 2,portal venous thrombosis in 4,SMV thrombosis in 2.Conclusion:As a non-invasive and valuable portography method,MDCTP provide the accurate information of the collateral circulation in patients with portal hypertension.