肝海绵状血管瘤并发动静脉短路的螺旋CT研究  

Arterial-portal Shunt Associated with Cavernous Hemangioma of the Liver: A Clinical Study with Spiral CT

作　　者：欧阳墉[1] 于明[1] 欧阳雪晖[1] 吴日图[1] 

机构地区：[1]内蒙古自治区医院介入放射科,呼和浩特010017

出　　处：《临床放射学杂志》2002年第3期205-209,共5页Journal of Clinical Radiology

摘　　要：目的　探讨成人肝海绵状血管瘤 (CHL)并发肝动脉 门静脉短路 (APVS)在螺旋CT动态增强扫描(DCESCT)中出现的瘤周楔形强化区 (PWSEA)的表现和形成机制 ,以及其出现频率与瘤体强化速率、瘤体大小的关系。资料与方法　对确诊的 10 8例CHL 2 4 9个瘤体的DCESCT所见作回顾性分析 ,并与其中 12例肝动脉DSA和10例经导管动脉平阳霉素碘油栓塞 (LP TAE)术后X线摄片所见进行对比。瘤体直径取其最长径测算。瘤体强化速率于DCESCT早期图像中确定并分为快、中和慢速强化 3类。结果　 10 8例 2 4 9个CHL中有 74个瘤体出现PWSEA(2 9.7% )。快速强化瘤体有 87.2 %出现PWSEA ,明显多见于中速和慢速强化瘤体 (P <0 .0 0 1)。中速强化瘤体平均直径 (40 .35± 16 .88mm)明显大于快速 (17.0 5± 13.0 1mm)和慢速强化瘤体 (17.84± 13.6 1mm) (P <0 .0 0 1) ,但快速与慢速强化瘤体之大小无统计学上差异 (P >0 .0 5 )。PWSEA的形态、大小、数目和方位等表现不一 ,常伴有早显的门静脉支。DSA和LP TAE术后X线摄片证实伴有PWSEA的瘤体皆有APVS ,瘤旁肝组织 (与DCESCT显示的PWSEA部位相对应 )可见充盈对比剂的纤细网条状血管聚集 ,并伴有数条早显的导出门静脉支。结论　PWSEA出现频率为 2 9.7% ,多见于快速强化小瘤体 。Objective To study the features and the forming mechanism of peritumoral wedge shaped enhanced area (PWSEA) of arterial portal venous shunt (APVS) in hepatic cavernous hemangioma seen on dynamic contrast enhanced spiral CT (DCESCT) scan, and to study the relationship of its frequency with the tumor enhancement speed and the tumor volume.Materials and Methods DCESCT findings in 108 patients with hepatic cavernous hemangioma (total 249 lesions) were retrospectively analyzed. A comparison of CT findings with DSA (n=12) and X ray films after transcatheter arterial embolization with Pingyangmycin and Lipiodol (LP TAE) was made (n=10). The tumor volume was calculated using the largest dimension of the lesion. The enhancement speed of the tumor was determined on early CT scan, and was categorized as rapid, intermediate and slow pattern.Results Of 249 lesions, 74 (29.7%) had PWSEA. 87.2% of lesions showing rapid enhancement pattern. showed PWSEA, which was significantly higher than that in intermediate or slow enhancement lesions (P<0.001). The mean diameter of the hemangiomas of intermediate enhancement (40.35±16.88mm) was significantly bigger than that of rapid (17.05±13.01mm) and slow (17.84±13.61mm) enhancement lesions (P<0.001). No significant difference in the mean diameter was found between the rapid and slow enhancement lesions (P>0.05). The shape, size, number and site of PWSEA were different from patient to patient. On DSA and plain films after LP TAE, the presence of AVPS was confirmed in all lesions with PWSEA, and lots of tiny reticular or tubular of opacified vessels were seen in the peritumoral liver tissue with several early opacified portal outflow branches.Conclusion PWSEA is present in 29.4% of hamangiomas in this series, it is usually seen in small lesions showing rapid enhancement pattern, although it shows no significant correlation with the tumor volume. The formation of PWSEA is closely related with thepathological changes of the peritumoral liver tissue and the associated APVS, that i

关 键 词：肝肿瘤 动静脉短路 肝海绵状血管瘤 并发症 螺旋CT 诊断 

分 类 号：R735.7[医药卫生—肿瘤] R730.44[医药卫生—临床医学]