下腔静脉病变的螺旋CT诊断  

Helical CT Diagnosis of Inferior Vena Cava Abnormalities

作　　者：郑金龙[1] 韩萍[1] 柳曦[1] 周承凯[1] 蒋南川[1] 陈艳[1] 雷子乔[1] 于群[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院放射科,武汉430022

出　　处：《临床放射学杂志》2006年第9期838-842,共5页Journal of Clinical Radiology

摘　　要：目的探讨下腔静脉病变的螺旋CT及下腔静脉CT血管造影(CTP)的影像特点。资料与方法40例肿瘤侵犯下腔静脉及下腔静脉病变,采用螺旋CT平扫、增强扫描及下腔静脉CTP检查,分析不同扫描模式及后处理图像所示病变的部位、范围、密度变化特点及侧支循环形成。结果19例肝癌沿肝静脉侵犯下腔静脉,癌栓位于下腔静脉肝段及肝上段;邻近下腔静脉肝段的肝癌直接侵犯下腔静脉;6例轻度强化,未见明显侧支循环形成。9例肾癌沿肾静脉侵犯下腔静脉,癌栓位于肾上段,无强化,见肾包膜静脉侧支形成及性腺静脉增粗。5例下腔静脉血栓管腔狭窄或闭塞,呈节段性,壁不光整,可见条状或斑点状钙化,CTP后延迟扫描,病变段无明显强化,见明显的侧支循环。3例下腔静脉内血管平滑肌瘤病,起自子宫,沿卵巢静脉及髂静脉上行,经下腔静脉侵入右心房,病变密度较均匀,无钙化及坏死囊变,强化较明显,病变段附近见大量侧支循环形成。发育异常所致布-加综合征(Budd-Chiarisyndrome)3例,表现为肝上段节段性狭窄,周围见大量的侧支循环形成。下腔静脉内平滑肌肉瘤1例,病变位于肝下段下腔静脉,呈节段性增粗,边缘不光整,密度不均,延迟CT扫描后不均匀强化,邻近见大量侧支循环形成。结论下腔静脉病变的CT表现以充盈缺损、无或轻-中度强化、管腔狭窄及侧支血管形成为特征,下腔静脉CTP的三维重建能立体显示管腔狭窄和侧支血管,合理的CT扫描模式有利于病变的诊断和确定手术方案。Objective To investigate imaging features of Helical CT （HCT） and Helical CT phlebography （HCTP） of the inferior vena cava （IVC） in the inferior vena cava abnormalities. Materials and Methods HCT and HCTP were performed in 40 patients with IVC abnormalities, The location, scope, density features and collateral pathway of IVC abnormalities by different scan mode and three dimensional reconstruction were analyzed. Results Tumor thrombuses in intrahepatic IVC and superior intrahepatic IVC were seen in 19 patients with liver cancer. 6 cases were mild enhancement. No collateral pathway of IVC was seen in all cases. Renal carcinomas in 9 patients intruded into renal vein and IVC. The augments of renal capsule vein and sex gland were found in 4 cases. Stenosis and occlusion of IVC were depicted in 5 patients with the thrombus of IVC with strip or spot calcification, nonenhancement and with rich collateral pathway. Intravenous leiomyomatosises in 3 patients originated at uterine and extended into ovary vein, ilium vein, IVC and the right atrium, equality density, evidence enhancement and rich collateral pathway were shown. Budd Chiari syndromes in 3 patients were appeared segmental stenosis located at suprahepatic segment of IVC with rich collateral pathway. Intraverous leiomyosarcoma in 1 patient located in subhepatic IVC. Segmental tumor, asymmetric enhancement and rich collateral pathway were found. Conclusion CT features of IVC abnormalities are filling defect, no or mild moderate enhancement, stenosis of IVC and collateral pathway. HCTP is an ideal method of showing stenosis and collateral pathway. Rational scan mode is useful to diagnose the IVC abnormalities and determine the plan before surgery.

关 键 词：下腔静脉病变 螺旋CT 

分 类 号：R816.2[医药卫生—放射医学]