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目的 :探讨螺旋CT门静脉血管造影 (SCTP)及三维重建对肝炎后肝硬化门静脉高压的诊断和临床应用价值。方法 :5 7例肝炎后肝硬化患者行SCTP及三维重建。三维重建方法包括最大强度投影 (MIP) ,表面阴影成像 (SSD)和多平面重建 (MPR)。结果 :MIP和SSD显示 5 1例门静脉 1～ 2级分支增粗 ,肝内门静脉 2级以下分支细小、扭曲 ,3 5例呈枯枝或残根状。 6例仅见门静脉 1～ 2级分支增粗 ,肝内门静脉 2级以下分支未见显影。侧支循环血管开放表现为食管下段静脉曲张 (n =2 1) ,食管周围静脉曲张 (n =14 ) ,胃周静脉曲张 (n =2 4) ,脐静脉曲张 (n =11)及腹膜后静脉曲张 (n =9)。结论 :SCTP是诊断和评价肝炎后肝硬化门静脉高压有效方法 ,对门静脉高压程度 ,上消化道出血预测及门静脉高压术前评估有较大价值。
Objective: To investigate the value of spiral CT portography and three-dimensional reconstruction in diagnosis of post-hepatitis cirrhosis and portal hypertension. Methods: Fifty-seven patients with posthepatitic cirrhosis underwent SCTP and three-dimensional reconstruction. Three-dimensional reconstruction methods include Maximum Intensity Projection (MIP), Surface Shadow Imaging (SSD), and Multiplanar Reconstruction (MPR). Results: MIP and SSD showed thickening of branches 1 ~ 2 in 51 cases of portal vein and small and distorted branches below grade 2 in portal vein of portal vein. 35 cases showed dead branches or remnants. 6 cases only see portal vein 1 to 2 branches thickening, intrahepatic portal vein less than 2 branches no development. Collateral circulation was characterized by lower esophageal varices (n = 21), peripheral esophageal varices (n = 14), gastric varices (n = 24), umbilical varices (n = 11) and retroperitoneal Varicose veins (n = 9). Conclusions: SCTP is an effective method for the diagnosis and evaluation of portal hypertension in patients with posthepatitic cirrhosis. It is of great value in the preoperative evaluation of the degree of portal hypertension, upper gastrointestinal bleeding and portal hypertension.