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目的探讨256层螺旋CT在原发性肝癌并门静脉癌栓中的诊断价值及其在介入治疗中的临床应用价值。方法采用256层螺旋CT对我院68例肝癌合并门静脉癌栓患者行肝脏多期增强扫描,三维后处理方法包括最大密度投影、多平面重建及容积再现等技术。其中29例患者于检查后96h内接受数字减影血管造影并行肝动脉化疗栓塞术,将螺旋CT影像表现与DSA做对照观察。结果门静脉癌栓主要影像表现为门静脉主干或分支扩张、门静脉腔内充盈缺损,增强扫描可见其不同程度强化,其中门静脉海绵样变(CTPV)17例、肝实质异常灌注21例及肝动脉门静脉瘘(APS)25例。在29例行DSA检查及介入治疗的肝癌患者中,多层螺旋CT多期增强扫描在肿瘤供血动脉、血管变异及门静脉癌栓等病变的显示上与DSA一致。结论 256层螺旋CT可以准确诊断、评价肝癌并门静脉癌栓及其血流动力学变化,并对介入治疗具有重要临床价值。
Objective To investigate the diagnostic value of 256-slice spiral CT in the diagnosis of primary hepatic carcinoma with portal vein tumor thrombus and its clinical value in interventional therapy. Methods Sixty-six spiral CT was performed in 68 patients with hepatocellular carcinoma and portal vein tumor thrombus in our hospital. The three-dimensional post-processing method included maximum density projection, multiplanar reconstruction and volume rendering. Among them, 29 patients underwent digital subtraction angiography and transcatheter arterial chemoembolization within 96 hours after the examination. Spiral CT imaging was compared with DSA. Results The main manifestations of portal vein tumor thrombus were the dilatation of the main branches or branches of the portal vein and the filling of the portal venous cavity. The enhanced portal vein embolization (CTPV) in 17 cases, abnormal hepatic parenchymal perfusion in 21 cases and hepatic arterial portal vein fistula (APS) in 25 cases. In 29 patients with hepatocellular carcinoma who underwent DSA examination and interventional therapy, MSCT was consistent with DSA in the display of tumor-supplying artery, vascular variation and portal vein tumor thrombus. Conclusion 256-slice spiral CT can accurately diagnose and evaluate the tumor thrombus and its hemodynamic changes in patients with hepatocellular carcinoma and has important clinical value for interventional therapy.