探讨MSCT对肝细胞癌合并动静脉分流的诊断价值  

Diagnostic Value of Multi Slice CT for Arterio-venous Shunt with Hepatocellular carcinoma

作　　者：刘汉菊[1] 孙亚臣[1] 

机构地区：[1]北华大学附属医院,吉林吉林132011

出　　处：《北华大学学报（自然科学版）》2007年第2期137-141,共5页Journal of Beihua University（Natural Science）

摘　　要：目的探讨肝细胞癌合并AVS（包括HAPVS和HAHVS）的MSCT影像学表现，评价MSCT在AVS诊断中的价值．方法回顾性分析298例HCC患者中的68例合并AVS患者的MSCT表现．所有患者采用Siemens Sensation16层螺旋CT行动态增强扫描，动脉期延迟20～25S，静脉期延迟55～60S，将采集的薄层图像传到Wizard工作站进行血管重建，部分病例采用SSD，VRT，MIP技术，部分采用MPR技术．结果门静脉主干和／或1级分支提早显影，或显影密度大于肠系膜上动脉／脾动脉者，属于中央型（n=15）；门静脉2级和／或以下分支提早显影，或显影密度大于上1级分支者，属于周围型-Ⅰ型（n=18）；一过性肝实质强化者，属于周围型-Ⅱ型（n=32）；4例HAHVS HCC病灶内粗大迂曲引流静脉汇集至肝静脉，肝静脉提早增强、浓密显影．SSD，VRT和MIP对中央型AVS显示率达100％，在显示能力上无统计学意义；在周围型-Ⅰ型上，SSD的显示能力不及VRT和MIP，VRT和MIP在统计学上无差异；对于周围型-Ⅱ型，3种技术显示均较低，无法用来评估，补充采用MPR，MPR对THPE的显示能力达100％．结论HCC合并AVS具有多种复杂的表现形式，CTA可以弥补CT横轴位的不足，二者结合，明显提高了AVS的诊断和鉴别诊断能力．Objective To investigate Multi slice CT （MSCT） appearances of arterio-venous shunt （hepatic artery-portal venous shunt and hepatic artery-hepatic venous shunt） with hepatocellular carcinoma （HCC）, and to evaluate the value of their appearances in diagnosis. Methods MSCT appearances of 298 patients with HCC were retrospectively analyzed and 68 patients of AVS with HCC were found. All patients were performed by Sienmens Sensation 16 Multi slice CT. Delayed time was 20～25 s for arterial phase, 55～60 s for portal venous phase. Collected thin-slice pictures were converged on Wizard and finished volume rendering reformation. Partly cases applied on SSD, VRT and MIP, partly cases applied on MPR. Results MSCT revealed earlier enhancement of the main portal trunks and/or the first order branches, or stronger opacification of main portal trunks and/or the first order branches than that of superior mesenteric veins or splenic veins, which belonged to central type（ n = 15） ; earlier enhancement of the second order and/or smaller branches, or stronger opacification of the second order and/or smaller branches than that of superior branches, which belonged to peripheral type-type Ⅰ （ n = 18） ; Transient hepatic parenchymal enhancement belonged to peripheral type-type Ⅱ （ n = 32） ; As for 4 HAHVS, thick and tortuous drainage veins within HCC loci were converged into hepatic veins, which had earlier enhancement and stronger opacification. Central type AVS was completely showed by SSD, VRT, MIP and no statistic significance; The showing power of SSD was worse than that of MIP and VRT,MIP and VRT had no difference to show peripheral type-type Ⅰ , SSD, VRT, MIP could not evaluate for peripheral type-type Ⅱ due to badly show, but MPR was the best for showing power of peripheral type-type Ⅱ. Conclusion There were kinds of complex appearances of AVS with HCC. CTA could be complemental to CT horizontal plane. They might raise AVS, diagnostic and differential diagnostic ability.

关 键 词：肝细胞癌 肝动静脉分流 多层螺旋CT 

分 类 号：R73[医药卫生—肿瘤]