摘要
目的 探讨肝细胞癌 (HCC)合并近端肝动脉 门静脉分流 (arterioportalshunt,APS)的多层螺旋CT动态增强表现、形成机制 ,并与肝动脉数字减影血管造影 (DSA)比较 ,评价多层螺旋CT在诊断近端APS中的作用及临床价值。方法 16 8例HCC患者分别进行了肝脏多层螺旋CT动态增强扫描和DSA检查 ,间隔时间为 3～ 15d。其中 ,巨块型 37例 ,结节型 10 2例 ,弥漫型 2 9例。以DSA诊断近端APS为标准 ,对照分析多层螺旋CT诊断近端APS的能力及近端APS的CT表现特征。近端APS的诊断不包括肝段或亚段的外周APS。结果 16 8例HCC患者 ,42例 ( 2 5 0 %)DSA证实为合并近端APS ,此 42例均在CT增强动脉期发现与近端APS相关的阳性征象 ;另外 ,CT还发现 6例假阳性患者 ,其中 2例门静脉显影密度低于主动脉增强密度。CT诊断近端APS的敏感度、特异度、准确度、阳性和阴性预测值分别为 10 0 0 %、95 2 %、96 4%、87 5 %和 10 0 0 %。 42例近端APS患者中 ,CT与DSA显示APS范围 (门静脉主干、左右支、肠系膜上静脉、脾静脉及胃冠状静脉显影 )相符的患者有 35例( 83 3 %) ,对门静脉主干及左右支显影的符合率达 90 5 %。CT上近端APS的直接征象表现为肝动脉期门静脉主干和 (或 )左右支提早显影 。
Objective To evaluate the dynamic enhanced multi-slice spiral CT features and the formative mechanisms of proximal arterioportal shunt (APS) associated with hepatocellular carcinoma (HCC), and to assess the CT diagnostic ability and clinical value for proximal APS by comparing with digital subtraction angiography (DSA). Methods One hundred and sixty-eight patients with HCC received both dynamic enhanced multi-slice spiral CT scan and DSA of the liver, and the time lapse between these two examinations was from 3 to 15 days. Of the 168 patients, 37 were massive tumors, 102 were nodular, and 29 were diffuse, respectively. Spiral CT signs and its diagnostic ability for proximal APS were analyzed and compared with the golden standard of DSA. Peripheral hepatic segmental or subsegmental small APS were excluded in our study. Results Of the 168 patients with HCC, 42 (25.0%) were demonstrated to have proximal APS on DSA, and all the of 42 patients had positive CT findings related to proximal APS in arterial phase. Of the 6 patients proved to have false positive CT signs, 2 showed lower enhancement of portal vein (PV) than that of the aorta. The sensitivity, specificity, accuracy, and positive and negative predictive value of spiral CT in diagnosing proximal APS were 100.0%, 95.2%, 96.4%, 87.5%, and 100.0%, respectively. There was a good correlation on the extent of APS to main PV, left or right PV, superior mesenteric vein, splenic vein, and coronary vein between CT and DSA in 35 patients (83.3%). The extent of APS to main PV and left or right PV was well correlated between CT and DSA in 38 patients (90.5%). The direct CT signs of proximal APS in arterial phase were revealed as early and strong enhancement of main PV and/or left or right PV approaching the density of the aorta (n=38). The indirect CT signs of proximal APS in arterial phase were demonstrated as high attenuation of normal hepatic parenchyma in the lobar distribution ipsilateral to the tumor (n=4). Conclusion The dynamic enhanced multi-slice spiral CT can be used as an important tool for the diagnosis of proximal APS associated with HCC, and its diagnostic accuracy could be comparable to that of DSA. The transvascular route is the main formative mechanism of proximal APS in HCC. CT diagnosis of proximal APS is of important clinical significance in the treatment of HCC.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2003年第5期408-412,共5页
Chinese Journal of Radiology
