摘要
目的 探讨门静脉系统血栓与癌栓的 CT影像表现及其鉴别诊断。方法 对 5 0例经临床及病理证实的门脉栓塞的患者 (血栓 18例 ,癌栓 32例 )进行了螺旋 CT扫描检查 ,分析了门脉血栓与癌栓的不同影像特点。结果 18例良性栓塞中 ,栓子发生于主干 15例 ,右支 10例 ,左支 7例 ,脾静脉 6例 ,肠系膜上静脉 4例 ;栓子出现高密度 8例 ,等密度 5例 ,低密度 2例 ;栓子为部分偏心栓塞 13例 ,呈现小条状、柴捆状 ;出现受累管腔扩张 5例 ,附栓管壁连续光滑、无外突结节 16例 ,无一例出现管壁强化 ;出现食管胃丛及脾丛侧支循环 10例 ;无一例出现动—门脉瘘。 32例恶性栓塞中 ,栓子发生于右支 2 6例 ,左支 14例 ,主干 12例 ,肠系膜上静脉 2例 ,脾静脉 1例 ;栓子出现低密度 2 0例 ,等密度 10例 ,高密度 2例 ;栓子为完全性栓塞 2 6例 ,呈现局部结节状、团状及分支型 ;受累管腔扩张 2 9例 ,附栓管壁呈现不连续光滑 ,有外突结节 17例 ,有 8例出现血管壁强化 ;出现胆囊周围丛及胆总管周围丛侧支 18例 ,食管胃丛侧支 8例 ;动—门脉瘘出现 4例。结论 良性栓塞与恶性栓塞在栓塞的位置、栓子的表现、附栓管腔的情况及肝外侧支循环等方面都有不同特征性表现 。
Objective To study the CT images of thrombus and cancer embolus in porta vein to describe the respective features and summarize the diferentiation completely.Methods Fifty cases(18 cases with thrombus and 32 with cancer embolus cases) confirmed by autopsy and therapy were examined with CT to analysis the different traits of the two diseases.Results In 18 cases with benign embolism,15 cases(83%) occurred in reunk vein.However,in 32 cases with malignant embolism,26 cases(81.2%)took place in righe branch.8 bengin embolism cases(44.4%)showed high-dense in thrombus whereas 20 malignant embolism cases(62.5%)appeared low-dense in cancer embolus.13 benign embolism cases(72.2%)presented partial filling defect,which is described as stripe and bundles in contrasted vein,and 26 malignant embolism cases(81.3%)presented wholly filling defect likenodes,mass and irreular Y shapes.16 cases(88.9%)with thrombus showed smooth and successive in involved vien wall where 17 cases(53.1%)with cancer embolus showed unsuccessive lines and appeared nodes protrude out 8 cases(25%) of malignant embolism showed prominently contrast in involved vein wall at portalvein period.5 cases(27.7%) of thrombus lead to dilation of the involved vein distinctly form 29 cases(90.6%)of cancer embolus in 32 malignant embolism.10 cases(55.6%) with benign embolism displayed collateral circulation in esophagogastric and splenic vein,comparatively,18 cases(56.3%) with malignant embolism displayed pericholecystic and pericholedochal collateral branches.4 cases(12.5%) visualized A-P shunt in 32 malignant embolus which never occurred exclusively in benign exbolism.Conclusion Between benign and malignant emblolism,there are great differentitation in some aspects such as embolus position and shapes,including vein and collateral circulation and so on .All mentioned above will be the great help to improve the accurate diagnosis of the portal vien embolism.
出处
《肝胆外科杂志》
2002年第4期257-260,共4页
Journal of Hepatobiliary Surgery
关键词
门静脉血栓
癌栓
CT
鉴别诊断
Portal vein
Embolism
Thrombus
emboli
Cancer embolus
Collateral circulation
Tomography
X-ray computed
