彩色多普勒血流显像及超声造影鉴别诊断门静脉良恶性栓子

目的 探讨CDFI及CEUS鉴别诊断门静脉良恶性栓子的价值.方法 回顾性分析33例门静脉栓塞患者门静脉栓子的CDFI及CEUS灌注表现,包括门静脉癌栓23例,血栓10例.结果 23例癌栓中,完全填充17例,部分填充6例;10例血栓中,完全填充3例,部分填充7例.癌栓完全填充率高于血栓完全填充率(P=0.026),表明门静脉癌栓以完全填充为主,血栓以部分填充为主.CDFI显示癌栓自肝内向肝外生长多见,回声较强且不均匀;血栓则相反,且多见于脾切除后、肝硬化等患者.CEUS示门静脉癌栓均呈“快进快出”表现,而血栓内始终未见造影剂填充.结论 CDFI对定性诊断门静脉栓子具有一定价值;CEUS对鉴别门静脉血栓及癌栓有较高价值.

CDFI and CEUS in identification of benign or malignant portal vein thrombosis

Objective: To observe the value of CDFI and CEUS in identification of benign or malignant portal vein thrombosis. Methods: The images of CDFI and CEUS of 33 patients with portal vein thrombosis (PVT) were retrospectively analyzed. There were 23 cases of portal vein tumor thrombosis and 10 cases of portal vein blood thrombosis. Results: In 23 portal vein tumor thrombosis, there were 17 complete embolization and 6 partial embolization. In 10 portal vein blood thrombosis, there were 3 complete embolization and 7 partial embolization. The rate of the complete embolization in the portal vein tumor thrombosis was higher than that in the portal vein blood thrombosis (P=0.026), indicating that complete embolization was more usual in the tumor thrombosis, while partial embolization happened more often in the blood thrombosis. Moreover, CDFI showed that more tumor thrombosis located in the branches of portal vein with higher and heterogeneous echo, while blood thrombosis was opposite and might occur secondary to splenectomy and liver cirrhosis. CEUS mainly showed the fast "wash-in" and fast "wash-out" in tumor thrombosis, but no enhancement of blood thrombosis. Conclusion: CDFI helps to identify the nature of PVTs. CEUS is of significant value in differential diagnosis of tumor thrombosis and blood thrombosis.