肝癌合并肝动-静脉瘘的多排螺旋CT表现与血管造影对照观察  

The comparative study of MSCT and arteriography on hepatocellular carcinoma with arteriovenous fistulae

作　　者：冉慕光[1] 刘林[1] 陈圣欢 雷苑麟[1] 

机构地区：[1]清远市人民医院放射科,广东511500

出　　处：《影像诊断与介入放射学》2009年第3期141-143,共3页Diagnostic Imaging & Interventional Radiology

摘　　要：目的对比分析肝癌合并动-静脉瘘(AVF)的多排CT和肝动脉血管造影的影像学表现,加深其对CT作用与限度的认识。方法回顾性分析42例肝癌病例的CT及肝动脉血管造影影像学资料,所有病例均经肝动脉造影证实合并有AVF,CT扫描为16排螺旋CT增强三期动态扫描。结果42例肝癌患者的CT表现:17例有肝动脉-门脉瘘(HAPVF)(40.5%)(其中中央型动-门静脉瘘10例(23.8%),动脉期门静脉主干或分支早期显影,肝实质强化;周围型动-门静脉瘘7例(16.7%),动脉期出现门静脉二级以上分支显影,有时可与动脉伴行呈"双轨征",肝实质楔形、三角形和不规则形强化);肝动-肝静脉瘘(HAHVF)5例(11.6%)(动脉期肝静脉主支显影);混合型肝动脉-门脉瘘合并肝动脉-肝静脉瘘3例(7.1%)(上述征象同时出现);17例CT未见AVF(40.5%)(在肝动脉造影证实存在动静脉瘘,CT检查中未见上述特征出现)。结论动脉期门静脉及肝静脉提前显示及相应肝实质异常强化是肝癌合并AVF的特征表现,也是诊断肝癌的重要参考依据之一。提高多排螺旋CT对肝癌患者的动脉期扫描时间分辨率,可降低其合并AVF显示的假阴性率。Objective To compare multi-silce CT （MSCT） and arteriographic imaging findings of hepatocellular carcinoma with arteriovenous fistula （AVF）, and to have a further understanding of the roles and limitation of CT. Methods The CT and arteriography imaging data of 42 cases of hepatocellular carcinoma with AVF were analyzed retrospectively. All cases had three-phase dynamic enhanced scanning by 16-slice spiral CT. Results CT positive findings were found in 25 of all 42 cases. 17 cases showed artery-portal vein fistulae （HAPVF） （40.5%） included 10 cases of centre type, which showed early visualization of the portal stem or more proximal portal branches in arterial phase and early enhancement of the hepatic parenchyma. And 7 cases of periphery type which showed early visualization of the segmental or more distal portal branches in arterial phase, occasionally appeared as ＂double-track＂ sign when accompanying with an artery and irregular abnormal enhancement of the adjacent hepatic parenchyma. 5 cases of artery-hepatic vein fistulae （HAHVF） （11.6%）, which meant early visualization of the liver vein branches or IVC in arterial phase. 3 cases appeared both HAPVF and HAHVF （7.1%）.17 cases with AVF proved by hepatic arteriography did not displayed by CT. Conduslon The characteristic CT findings of hepatocellular carcinoma with AVF are early visualization of the portal vein or/and hepatic vein in arterial phase combined with abnormal enhancement of the adjacent hepatic parenchyma, and it is also one of the important references to diagnosis hepatocellular carcinoma. With the improvement of the time resolution of hepatic artery phase scanning in MSCT, it is prospective to decrease the false negative of AVF in hepatocellular carcinoma on MSCT finding.

关 键 词：原发性肝细胞癌 动静脉瘘 螺旋CT 血管造影 

分 类 号：R735.7[医药卫生—肿瘤] R734.2[医药卫生—临床医学]