论文部分内容阅读
目的 探讨肝细胞癌 (HCC)合并近端肝动脉 门静脉分流 (arterioportalshunt,APS)的多层螺旋CT动态增强表现、形成机制 ,并与肝动脉数字减影血管造影 (DSA)比较 ,评价多层螺旋CT在诊断近端APS中的作用及临床价值。方法 16 8例HCC患者分别进行了肝脏多层螺旋CT动态增强扫描和DSA检查 ,间隔时间为 3～ 15d。其中 ,巨块型 37例 ,结节型 10 2例 ,弥漫型 2 9例。以DSA诊断近端APS为标准 ,对照分析多层螺旋CT诊断近端APS的能力及近端APS的CT表现特征。近端APS的诊断不包括肝段或亚段的外周APS。结果 16 8例HCC患者 ,42例 ( 2 5 0 %)DSA证实为合并近端APS ,此 42例均在CT增强动脉期发现与近端APS相关的阳性征象 ;另外 ,CT还发现 6例假阳性患者 ,其中 2例门静脉显影密度低于主动脉增强密度。CT诊断近端APS的敏感度、特异度、准确度、阳性和阴性预测值分别为 10 0 0 %、95 2 %、96 4%、87 5 %和 10 0 0 %。 42例近端APS患者中 ,CT与DSA显示APS范围 (门静脉主干、左右支、肠系膜上静脉、脾静脉及胃冠状静脉显影 )相符的患者有 35例( 83 3 %) ,对门静脉主干及左右支显影的符合率达 90 5 %。CT上近端APS的直接征象表现为肝动脉期门静脉主干和 (或 )左右支提早显影 ,其门静脉显影密度接近于主动脉增强密度
Objective To investigate the dynamic enhancement and formation mechanism of multi-slice spiral CT in hepatocellular carcinoma (HCC) with proximal arterioportal shunt (APS) and compare with DSA in hepatic artery to evaluate the effect of multi-slice spiral The role of CT in the diagnosis of proximal APS and its clinical value. Methods Totally 16 cases of HCC patients underwent multi-slice spiral CT dynamic contrast-enhanced scanning and DSA examination, the interval time was 3 ~ 15 days. Among them, 37 were bulky, 102 were nodular and 29 were diffuse. Using DSA to diagnose proximal APS as the standard, the ability of multi-slice spiral CT to diagnose proximal APS and the CT features of proximal APS were analyzed. Diagnosis of proximal APS does not include peripheral or sub-peripheral APS. Results In 16 of 16 patients with HCC, 42 (250%) DSA were confirmed as proximal APS. All of the 42 cases showed positive signs of proximal APS in CT enhanced arterial phase. In addition, 6 cases of false positive Patients, two cases of portal vein imaging density lower than the aortic density. The sensitivity, specificity, accuracy, positive and negative predictive value of CT in the diagnosis of proximal APS were 100%, 95%, 96%, 87% and 100% respectively. Of the 42 patients with proximal APS, 35 (83.3%) had CT and DSA findings in the APS range (main portal vein, left and right branch, superior mesenteric vein, splenic vein, and gastric venous perfusion) Branch of the line rate of 90 5%. The direct signs of proximal APS on CT showed early development of the main portal vein and / or left and right branches of the hepatic artery. The portal vein densities were close to those of the aorta