摘要
目的探讨原发性肝细胞癌(HCC)患者合并肝动脉-门静脉瘘(APFs)的多层螺旋CT(MSCT)动态增强的影像学表现,并与肝动脉血管造影的影像学表现相比较。方法对38例HCC合并APFs的患者进行肝脏MSCT动态增强及DSA检查。以DSA诊断APFs为金标准,对照分析MSCT诊断APFs的准确率及APFs的CT的影像学特征。结果 38例HCC在MSCT增强动脉期均发现与APFs相关的阳性影像学征象。MSCT增强影像学表现可分为:中央型(29例)和周围型(9例)。中央型表现为:①肝动脉期门静脉主干和/或左右一级分支提早显影,显影段门静脉密度接近主动脉增强密度。②动脉期低密度门静脉癌栓内及其周围见网状滋养动脉显影。周围型表现为:①肝动脉期肿瘤所在的肝叶瘤周肝实质出现片状强化区,门静脉期该区域密度与其他部位正常肝组织密度一致;②肝动脉期肿瘤内门静脉提前显影呈线条状、圆点状强化,密度较高,边缘较清晰。结论 MSCT诊断APFs可作为无创检查的首选,并对指导肝癌的化疗栓塞术(TACE)具有重要意义。
Objective To evaluate the dynamic enhanced multi-slice CT（MSCT） features of HCC with arterioportal fistulas（APFs） and compare with arteriographic imaging fingdings. Methods 38 cases of HCC with APFs underwent dynamic enhanced MSCT scan and DSA. Using the results of DSA as the standard to analyse the diagnostic accuracy and the imagine signs of MSCT. Results All the patients had positive CT findings which related to APFs in arterial phase.The dynamic enhanced MSCT signs of APFs were divided into two types： the central type and the peripheral type, Central type of 29 cases： ①The main portal vein （ PV ） and/or the first class branches of PV were in advance revealed in the arterial phase, the density approaching the aorta. ②The embolus and its network artery of PV were revealed. While in the 9 cases of peripheral type ： ① In the arterial phase,patchy high attenuation was appeared in the tumorous rim liver parenchyma： while in the PV phase, this allenuation＇s density became the same as that of the normal liver： ②The PV branches which inside the tumor in advance enhanced in shape of lines in the arterial phase. Conclusion As a noninvasive method,dynamic enhanced MSCT should be preterrde for the diagnosis of hepatic APFs. MSCT diagnosis of APFs is of great clinical significance in the transcatheter arterial chemoembolization（TACE）.
出处
《中国CT和MRI杂志》
2013年第2期38-40,52,共4页
Chinese Journal of CT and MRI
