遗传性出血性毛细血管扩张症多排螺旋CT影像特征分析  

Analysis of image features of multi-detector helical computed tomography in hereditary hemorrhagic telangiectasia

作　　者：丁金立[1] 李香芬[2] 宋文艳[1] 赵大伟[1] 李宏军[1] 夏振营[1] Ding Jinli Li Xiangfen Song Wenyan Zhao Dawei Li Hongjun Xia Zhenying(Department of Radiology, Beijing You ＇an Hospital, Capital Medical University, Beijing 100069, China)

机构地区：[1]首都医科大学附属北京佑安医院放射科,100069 [2]郑州市第六人民医院放射科

出　　处：《北京医学》2016年第12期1271-1274,F0002,共5页Beijing Medical Journal

摘　　要：目的总结遗传性出血性毛细血管扩张症(hereditary hemorrhagic telangieetasia,HHT)患者多排螺旋CT(multi-detector helical computed tomography,MDCT)的影像学特征。方法回顾性分析14例HHT患者的MDCT影像特征,所有病例均行容积再现(VR)、最大密度投影(MIP)及多平面重建(MPR)。结果 14例患者中,肺部受累5例,CT轴位显示结节状或团块状强化灶,VR及MIP显示瘤体及供血动脉和引流静脉。肝脏受累12例,包括肝动脉-肝静脉分流6例,肝动脉-门静脉分流2例,门静脉-肝静脉分流4例。肝动脉-肝静脉分流:轴位动脉期可见肝门增粗、迂曲的血管影,肝静脉提前显影,MIP及VR显示肝动脉及其分支迂曲扩张;肝动脉-门静脉分流:MIP及MPR肝动脉和门静脉同时显影,MPR同时显示肝内多发斑片状异常强化区;门静脉-肝静脉分流:门静脉期MPR及MIP可见门静脉与肝静脉分支间迂曲扩张的交通血管及斑片状强化区。胰腺受累5例,动脉期MPR及MIP显示胰头周围扩张的血管团2例及瘤样扩张1例,胰头或胰尾部结节状异常强化灶2例。脾脏受累1例,动脉期MPR表现为脾脏内多发斑片状异常强化灶及脾动脉瘤形成。小肠受累1例,VR及MIP显示为肠系膜上静脉分支远端迂曲的血管团。结论 HHT累及多脏器的影像表现具有特异性,CT血管重建能够清晰显示HHT的血管变异,MDCT有助于临床诊断。Objective To summarize the image features of multi-detector helical computed tomography（MDCT） in hereditary hemorrhagic telangiectasia（HHT） patients. Methods Clinical manifestations and imaging findings of 14 HHT cases were retrospectively studied. Volume representation（VR）, maximum density projection（MIP） and multiplanar reconstruction（MPR） were performed in all cases. Results Lung involvement was found in 5 cases. Mass-like or nodular strengthening signals were shown in conventional CT transverse images; and tumor, feeding arteries and draining veins were shown through VR and MIP. Liver involvement was found in 12 cases, including arteriovenous shunt（hepatic artery to hepatic vein） in 6 cases, arterioportal shunt（hepatic artery to portal vein） in 2 cases, and portovenous（portal vein to hepatic vein） in 4 cases. Pancreas involvement was found in 5 cases. Expanded arteriolar mass（2 cases） and aneurysm like ectasia（1 case） were found via MPR and MIP during arterial phase; and nodular enhanced signals（2 cases） were found near the head and tail of pancreas. Spleen involvement was found in 1 case. Multiple patchy-like strengthening signal and splenic aneurysm were found via MPR during arterial phase. Small intestine involvement was found in 1 case. Circuitous arteriolar mass was observed in the distal branches of superior mesenteric vein via VR and MIP. Conclusion The image manifestations of HHT with multiple organ involvement are specific. Vascular variations of HHT are clearly detectable via post CT technology.

关 键 词：遗传性出血性毛细血管扩张症 多排螺旋CT 

分 类 号：R543[医药卫生—心血管疾病] R816.2[医药卫生—内科学]