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目的探讨原发性肝癌门静脉癌栓(PVTT)多层螺旋CT血管成像(CTA)的影像特征及其诊断价值。方法对179例诊断为原发性肝癌的患者行多层螺旋CT扫描平扫和三期动态增强扫描,并行多平面重建(MPR)、最大密度投影(MIP)及容积再现(VRT)血管成像,选择其中合并PVTT的87例患者比较其横轴位图像及CTA图像在诊断中的差异。结果轴位及CTA显示门静脉主干一级分支及二级分支PVTT无显著差异(P>0.05),而二级以下分支PVTT显示有显著差异(P<0.05);CTA图像对于肿瘤供血动脉及侧支循环血管的显示较轴位图像立体、直观。结论多层螺旋CT动态增强扫描并血管重建,可提高较门静脉小分支的检出率,较好地多方位显示门静脉癌栓的位置、范围、程度及侧支血管,直接显示肿瘤与门静脉血管的关系。
Objective To investigate the imaging features and diagnostic value of multi-slice spiral CT angiography (CTA) of portal vein tumor thrombus (PVTT) in primary liver cancer. Methods 179 patients with primary hepatocellular carcinoma were diagnosed by multi-slice spiral CT scan and three-phase dynamic contrast enhancement, parallel multiplanar reconstruction (MPR), maximum intensity projection (MIP) and volume rendering (VRT) angiography. The 87 patients with PVTT were selected to compare the differences in axial and CTA images in the diagnosis. Results There was no significant difference in PVTT between the first and second branches of the portal vein in the axial and CTA groups (P>0.05), while PVTT in the sub-two branches showed significant differences (P<0.05). The CTA images were used for the tumor feeding arteries and collaterals. The display of the circulation vessels is more stereoscopic and intuitive than the axial images. Conclusion Dynamic contrast-enhanced multi-slice spiral CT scan and vascular reconstruction can improve the detection rate of portal vein branchlets. The location, extent and extent of portal vein tumor thrombus and the collateral vessels can be displayed in multiple directions. The tumor and portal vein vessels can be directly displayed. relationship.