Proximal arterioportal shunt in hepatocellular carcinoma: multi-slice spiral CT features and its clinical significance
- Author:
- No author available
- Journal Title:
- CHINESE JOURNAL OF RADIOLOGY
- Issue:
- 5
- DOI:
- 10.3760/j.issn:1005-1201.2003.05.006
- Key Word:
- 癌,肝细胞;动静脉瘘;体层摄影术,X线计算机;血管造影术,数字减影
Abstract： 目的探讨肝细胞癌(HCC)合并近端肝动脉-门静脉分流(arterioportal shunt, 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 168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3～15 d.其中,巨块型37例,结节型102例,弥漫型29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 168例HCC患者,42例(25.0%)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100.0%、95.2%、96.4%、87.5%和100.0%.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,其门静脉显影密度接近于主动脉增强密度,有38例.间接征象表现为肝动脉期肿瘤所在肝叶的非癌变肝实质提早强化,有4例.结论多层螺旋CT诊断近端APS的准确性可与DSA相比.经血管路径为HCC形成近端APS的主要发生机制.螺旋CT近端APS的诊断对指导肝癌的治疗具有重要意义.
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