肝癌伴门静脉癌栓血流动力学变化及CT表现的研究

目的：探讨肝癌门静脉癌栓时肝脏血流动力学改变及其影像特征，为肝癌的诊治和预后判断提供帮助。材料和方法：经临床证实并行全肝螺旋CT双期增强扫描的原发性肝癌伴门静脉癌栓32例，不伴门静脉癌栓54例，分别观察动脉期和门脉期癌旁与较远处肝实质及肝癌结节的密度变化。结果：18例肝癌伴门静脉分支癌栓，动脉期主要表现肝动脉血流高灌注，相应受累肝实质呈现斑片状、弧圈形或楔形高密度影，门脉期也见少许楔形高密度影；14例主门静脉主干癌栓和54例门静脉无癌栓，绝大多数全肝密度均匀一致；门静脉有无癌栓组间，灌注异常出现率不同；门静脉癌栓时肝癌的血供分型发生变化，门脉供血型和双重供血型明显减少。结论：肝癌伴门静脉癌栓可影响肝脏的血流动力学改变，引起肝癌结节和周围非癌肝实质的灌注异常，产生特征性的CT表现。

A Clinical Study on Haemodynamic Changes and Biphasic Helical CT Findings of Hepatic Carcinoma with Carcinomatous Embolus in Portal Vein

Objective:To investigate the haemodynamic changes and biphasic helical CT findings of hepatic catcinoma with carcinomatous embolus in portal vein.Materials and Methods:The biphasic helical CT scans of HCC patients,32 with and another 54 without portal carcinomatous emblus were observed for HCC attenuation changes and attenuation difference between the peripheral and the distant liver parenchyma.Results:liver parenchyma in 18 HCC with portal branch embolus presented high liver perfusion chiefly as irregular patchy,are or pyramid-shaped high density in arterial phase,and less in portal venous phase;The density of the liver parenchyma was homogenous in most of the 14 HCC with portal shaft embolus and the 54 HCC without portal embolus as well.The blood supply typing in HCC was changed with portal embolus,and the type of portal vein supply and the double blood supply were decreased.Conclusion:The carcinomatous embolus in portal vein could alter the hemodynamics of the liven resulting in abnomal perfusion of liver parenchyma and HCC.