斜冠状位最大密度投影及容积再现重建CT门静脉血管成像用于诊断脾/胃-左肾分流  

Oblique coronal position-maximum intensity projection and volume rendering reconstructed CT portal vein angiography for diagnosing spleen/stomach-left kidney shunt

作　　者：邓琳[1] 梁萍[1] 黄仲奎[2] 朱定娇 陈更瑞[1] DENG Lin;LIANG Ping;HUANG Zhongkui;ZHU Dingjiao;CHEN Gengrui(Department of Radiology,Beihai People’s Hospital,Beihai 536000,China;Department of Radiology,the First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]北海市人民医院放射科,广西北海536000 [2]广西医科大学第一附属医院放射科,广西南宁530021

出　　处：《中国介入影像与治疗学》2025年第1期32-36,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：北海市科技计划项目(北科合20210113Z)。

摘　　要：目的 探讨斜冠状位最大密度投影(OC-MIP)及容积再现(VR)重建CT门静脉血管成像(CTPA)用于诊断脾/胃-左肾分流(S/sLKS)的价值。方法 回顾性收集接受TIPS治疗的62例肝硬化失代偿期患者,基于TIPS前门静脉期增强CT以OC-MIP和VR技术重建获得CTPA,以之诊断S/sLKS并进行分型。以TIPS中数字减影血管造影(DSA)所见为标准,评估OC-MIP和VR图像诊断S/sLKS的效能及其结果与DSA结果的一致性。结果 DSA显示,62例中,14例(14/62,22.58%)存在S/sLKS、48例(48/62,77.42%)未见S/sLKS。OC-MIP及VR图诊断S/sLKS的敏感度、特异度、准确率均一致,分别为92.86%(13/14)、95.83%(46/48)、95.16%(59/62);其诊断结果与DSA的一致性均较高(Kappa均0.865)。14例S/sLKS中,DSA显示1例(1/14,7.14%)为脾-肾分流(SRS),1例(1/14,7.14%)为胃-肾分流(GRS),7例(7/14,50.00%)为脾-胃-肾分流(SsRS),4例(4/14,28.57%)SRS与GRS并存(SRS&GRS),1例(1/14,7.14%)为SRS&GRS+SRS双分流道。1例GRS OC-MIP及VR图均未显示分流道;4例SRS&GRS中,2例DSA显示各1支脾静脉(SPV)属支较细小,而OC-MIP及VR图均未显示;其余病例OC-MIP及VR图所示来源静脉均与DSA一致。结论 OC-MIP及VR重建CTPA对诊断S/sLKS具有较高临床价值。Objective To explore the value of oblique coronal position-maximum intensity projection(OC-MIP)and volume rendering(VR)reconstructed CT portal vein angiography(CTPA)for diagnosing spleen/stomach-left kidney shunt(S/sLKS).Methods A total of 62 patients with decompensated liver cirrhosis who underwent TIPS were retrospectively collected.Based on pre-TIPS enhanced portal vein stage CT,CTPA was reconstructed with OC-MIP and VR technology to diagnose S/sLKS and judging the types.Taken digital subtraction angiography(DSA)findings during TIPS treatment as standards,the efficacy of OC-MIP or VR images for diagnosing S/sLKS were evaluated,and their consistency with DSA for diagnosing S/sLKS were evaluated.Results DSA showed S/sLKS in 14 cases(14/62,22.58%),while no S/sLKS in 48 cases(48/62,77.42%).The sensitivity,specificity and accuracy of OC-MIP and VR images for diagnosing S/sLKS were all consistent,which was 92.86%(13/14),95.83%(46/48)and 95.16%(59/62),respectively.OC-MIP and VR images diagnosed S/sLKS were both consistent with that of DSA(both Kappa=0.865).Among 14 cases of S/sLKS,DSA showed spleen-renal shunt(SRS)and gastro-renal shunt(GRS)each in 1 case(1/14,7.14%),spleen-stomach-renal shunt(SsRS)in 7 cases(7/14,50.00%),both SRS and GRS(SRS&GRS)in 4 cases(4/14,28.57%)and SRS&GRS+SRS dual shunt in 1 case(1/14,7.14%).OC-MIP and VR images did not show the shunt of GRS in 1 case.Among 4 cases of SRS&GRS,DSA showed 1 small branch of splenic vein(SPV)each in 2 cases,while OC-MIP and VR images did not show.The findings of OC-MIP and VR images for source veins were consistent with DSA in the other cases.Conclusion OC-MIP and VR reconstructed CTPA had high clinical value for diagnosing S/sLKS.

关 键 词：门静脉 CT血管成像 脾-肾分流 胃-肾分流 

分 类 号：R57[医药卫生—消化系统] R814.42[医药卫生—内科学]