多层螺旋CT门静脉成像在评估肝硬化门脉侧枝血管中的价值

目的：评价多层螺旋CT门静脉成像显示门静脉高压的价值。材料与方法：30例门脉高压患者进行了螺旋CT门脉成像检查，其中10例患者又进行了门静脉造影检查(间接法)。30例患者中全部存在侧枝循环，多数病例有2个或2个以上部位侧枝循环。结果：多层螺旋CT门静脉成像不仅显示了肝内门静脉2-3级分支，还显示了整套门脉侧枝血管系统。在三维门脉像上，脾门静脉曲张29例(占96．7％)，其中1例脾静脉因栓子部分闭塞而狭窄，另有1例则完全栓塞血管未显示。胃左静脉曲张28例(占93％)，食管或食管旁静脉曲张27例(占90％)，胃短静脉(胃后静脉)曲张19例(占63％)，胃肾分流血管10例(占33％)，腹膜后静脉曲张9例(占30％)，脐周静脉曲张伴腹壁静脉曲张6例(占20％)。10例患者CT三维门脉像与间接门静脉造影作比较，前者对门静脉及其侧枝循环的显示好于后者。结论：多层螺旋CT门脉成像是门静脉无创性检查的可靠方法，有较高的临床运用价值。

Value of MSCT in Assessing Portal System and Its Collateral in Portal Hypertension

Objective: To evaluate multi-spiral CT(MSCT) in demonstrating portal system and its collateral in portal hypertension. Materials and Methods: Multi-spiral CT portography was performed in 30 patients with cirrhosis complicated by portal hypertension, and 10 patients were performed conventional portography simultaneously(transarterial indirect portography) . Result: Three-dimensional helical CT portography simultaneously depicted second or third branches of the intrahepatic portal vein and provided images of entire portosystemic collaterals. On 3D helical CT portography, splenic varices were seen in 29 patients(96.7%) , left gastric veins in 28(93%) ,esophageal and paraesophageal varices in 27(90%), posterior gastric veins or short gastric veins in 19(63%) ,gastrorenal shunts in 10(33%),retroperitoneal varices in 9(30%),abdominal wall and paraumbilical varices in 6(20%) .Findings of 3D helical CT portography in 10 patients were superior to conventional angiographic portography(transarterial indirect portography) .Conclusion: As a non-invasive and reliable method, multi-spiral CT portography can provide valuable information about the portal venous system