急性胰腺炎肝脏灌注异常现象的多层螺旋CT表现  

Multislice spiral CT manifestations of hepatic perfusion disorders in acute pancreatitis

作　　者：温大勇[1] 吴惠萍[2] 杨晔[1] 伍兴友[1] 

机构地区：[1]银川市第一人民医院放射科,宁夏银川750001 [2]宁夏医科大学

出　　处：《实用放射学杂志》2011年第12期1844-1847,共4页Journal of Practical Radiology

摘　　要：目的 探讨急性胰腺炎肝脏灌注异常现象（hepatic perfusion disorders,HPD）的CT表现及发生机制.方法 回顾性分析20例急性胰腺炎发生HPD的多层螺旋CT动态增强扫描各期图像,并对复查病例影像变化进行比较.结果 20例中HPD发生于单个肝叶（或段）者6例,同时发生于2个肝叶（或段）者12例,同时发生于3个肝叶（或段）者2例.CT表现为楔形、扇形或片状高密度影.20例中并发肝内、外多发门静脉系统血栓3例,脾静脉血栓2例,其中肝内门静脉血栓均位于肝右叶门静脉2级分支,相应肝段均发生HPD.13例复查病例中共24处HPD有18处消失,3处密度减低,2处无变化,1例出现1处新增HPD.5例门静脉系统血栓复查后4例消失,1例血栓明显缩小.20例中合并胰外积液18例、脂肪肝5例.结论 急性胰腺炎HPD发生环节涉及诸多生理、病理因素,其中门静脉血供减少,肝动脉供血代偿性增加是导致HPD的主要原因.Objective To approach multislice spiral CT（MSCT） manifestations and mechanism of hepatic perfusion disorder （HPD） in the patients with acute pancreatitis. Methods MSCT dynamic contrast-enhanced findings of HPD in 20 cases of acute pancreatitis were analyzed retrospectively. Results The HPD occurred single liver lobe or segment in 6 cases, simultaneously in two lobes in 12 cases and in three lobes in 2 cases. The lesions appeared as fan-shaped,wedge-shaped or patch hyperintense shadows. In 20 patients with HPD, complicated by multiple portal vein thrombosis in 3 cases, splenic vein thrombosis in 2 cases. Inhepatic portal vein thrombosis occurred at the right two branches of the portal vein, the corresponding hepatic perfusion abnormalties were presen- ted. There were 24 HPD areas in 13 reviewed patients, of them,18 HPDs were disappeared,the density in 3 HPDs were decreased, and a new HPD was showed in 1 case, and 2 HPDs unchanged. In 5 patients with portal vein thrombosis, the thrombus were disappeared in 4 and obviously reduced in one when reviewed. There were effusion around the pancreas in 18 and fatty liver in 5 cases. Conclusion The etiology of HPD involves a number of physiological and pathological factors,of which the reduction of the portal blood flow and hepatic arterial flow increase are the main causes.

关 键 词：胰腺炎 肝脏 灌注 体层摄影术 X线计算机 

分 类 号：R657.51[医药卫生—外科学] R814.42[医药卫生—临床医学]