多层螺旋CT门静脉血管成像在胰源性门脉高压症诊断中的应用  

The application of multi-slice spiral CT portography in pancreatic portal hypertension disease

作　　者：靳勇[1] 林晓珠[1] 吴云林[2] 朱晖[1] 吴志远[1] 瞿晴[2] 徐学勤[1] 陈克敏[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院放射科,200025 [2]上海交通大学医学院附属瑞金医院消化科,200025

出　　处：《中华消化杂志》2008年第9期580-584,共5页Chinese Journal of Digestion

摘　　要：目的研究多层螺旋CT门静脉血管成像在胰源性门静脉高压患者诊断中的应用。方法应用16排多层螺旋CT门静脉血管成像，对47例临床怀疑胰腺体尾部病变的患者的门静脉系统形态改变与126例肝源性门脉高压患者和47例正常对照组进行形态学对比观察，并测量胃冠状静脉、门静脉、脾静脉、肠系膜上静脉内径、门静脉期肝实质和门静脉主干CT值，对比肝脏、脾脏体积。结果在47例胰腺体尾部病变中发现有脾静脉狭窄、闭塞者38例，其中胰腺肿瘤患者27例（71．1％），急慢性胰腺炎患者11例（28．9％）。38例胰源性门脉高压患者中，发现食管静脉曲张5例（13．2％），胃底静脉曲张25例（65．8％），胃体静脉曲张22例（57．9％），胃短-胃后静脉显示26例（68．4％），胃冠状静脉显示26例（68．4％），发现胃网膜静脉曲张24例（63．2％），肠系膜静脉曲张1例。脾静脉闭塞14例（36．8％），脾静脉狭窄23例（63．2％）。结论胰源性门脉高压在影像学上表现为脾静脉栓塞，脾脏增大，脾门处大量曲张静脉，胃后-胃短静脉及胃网膜静脉增粗迂曲，胃底和胃体静脉曲张，较少合并食管静脉曲张，肝脏形态大小亦无异常。多层螺旋CT门静脉血管成像检查可为胰源性门脉高压患者提供血管形态、病因诊断等多方面有价值信息，为临床诊断和治疗提供客观的影像学依据。Objective To study the application of multi-slice spiral CT（MSCT） portography in diagnonsis of pancreatic portal hypertension. Methods Forty-seven patients with lesion in body or tail of pancrease ,47 normal subjects and 126 patients with portal hypertension underwent MSCT portography with LightSpeed 16 CT scanner. The inner diameter of portal system and the main collateral veins were measured in maximun intensity projection （MIP） image. The volume of liver and spleen were also measured in volume rendering （VR） image. The liver parenchyma and main portal vein enhancement in portal vein phase were also taken. The endoscopy examination was made in 57 patiens with portal hypertension. Results In 47 patiens with lesion in body or tail of pancreas , stenosis or occlusion of spleen vein were found in 38 patients（pancreatic portal hypertension in 27 patients, chronic and acute pancreatitis in 11 patients）. In 38 patients with pancreatic portal hypertension , esophageal varices was found in 5 patients（ 13. 2%）, gastric fundus varix in 25 patients （65. 8%）, gastric body variees in 22 patients （57.9 % ）, short-gastric vein/post-gastric vein（SGV/PGV） in 26 patients （68.4 % ）, coronal gastric vein in 26 patients （ 68.4 % ）, dilated gasto-omenta vein in 24 patients （ 63.2 % ）, mesenterica varicesin 1 patient, splenic vein occlusion in 14 patients （36.8 % ）, splenic vein stenosis in 23 patinets（63.2 % ） . Conclusions The patients with pancreatic portal hypertension were demonstrate characteristic changes in MSCT portograpby. The MSCT portography is helpful in etiological diagnosis of pancreatic portal hypertension by supplying images in vessel morphology.

关 键 词：高血压 门静脉 体层摄影术 螺旋计算机 门静脉造影术 

分 类 号：R686[医药卫生—骨科学]