摘要
目的探讨BuddChiari综合征(BCS)肝脏多层CT动态强化规律及形成机制,分析CT血管成像(CTA)在BCS诊断中的应用价值。方法经DSA证实的28例BCS患者,在DSA检查前1周内行多层CT动态增强扫描,并对其相关血管分别以最大密度投影法(MIP)、容积成像法(VR)和多平面重建法(MPR)进行血管重建。分析BCS患者的肝脏多层CT动态强化规律,并以DSA结果为对照,评价多层CT动态增强扫描及CTA技术在判断血管梗阻平面及显示肝内、外侧支循环中的价值。结果与DSA对照,28例BCS中多层CT扫描准确判断梗阻平面者26例,未能诊断者2例,为膈肌水平以上的下腔静脉膜性阻塞。22例肝静脉梗阻的患者中,CT动态增强扫描表现为肝脏典型斑片状强化者19例,不典型强化者3例,8例出现肝内良性结节,同时还显示门脉分支狭窄、僵直20例,肝动脉增粗14例,肝内侧支静脉开放20例。6例单纯性下腔静脉梗阻患者未出现肝脏异常表现。结论肝内、外侧支静脉的出现与梗阻部位有关。多层CT动态增强扫描能够准确地反映BCS患者肝脏血流动力学变化,结合CTA技术,能够更直观、准确地显示血管梗阻平面及肝内、外侧支循环。
Objective To investigate the dynamic enhancement regulations of liver and their mechanism in Budd-Chiari syndrome(BCS) by using multi-slice CT and evaluate the value of CT angiography in the diagnosis of BCS. Methods 28 cases with BCS confirmed by digital subtraction angiography(DSA) were retrospectively analyzed. All patients underwent dynamic enhancement examinations with multi-slice CT within 1 week before DSA. The relevant vessels were reconstructed respectively with MIP, VR and MPR. Compared with the results of DSA, we analyzed the dynamic enhancement regulations of liver in BCS, estimated the value of dynamic enhancement CT exams and CTA techniques in judging the obstruction level and showing collateral vessels. Results Of all 28 cases, CT correctly showed the obstruction level in 26 cases, and 2 had incorrect results which proved to be membranous obstruction of the inferior vena cava superior to diaphragm. In 22 cases with hepatic vein obstructions, hepatic parenchyma displayed typical patchy enhancement in 19, atypical patchy enhancement in 3. 8 cases among these showed benign nodules. Simultaneously, CT showed stenosis and rigidity of portal vein branches in 20, enlargement of hepatic artery in 14, hepatic collateral vessels in 20 out of 22 cases. In 6 cases with simple obstruction of inferior vena cava, hepatic changes were not found. Collateral circulations in or out of liver corresponded to the obstruction level. Conclusion Dynamic enhancement examinations with multi-slice CT can correctly reflect the hepatic hemodynamic changes. Transverse images, combined with CTA, can explicitly display the obstruction level of vascular lesions and collateral circulations in BCS.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2005年第6期652-656,共5页
Chinese Journal of Radiology
