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目的探讨多层螺旋CT血管成像(MSCTA)在先天性肝内门-体静脉分流(CIPSVS)诊断中的价值。方法搜集经筛查后确诊的29例CIPSVS患者,由2名放射科医师采用盲法对其MSCT常规成像(平扫及增强)和MSCTA重组(MPR、MIP、VR)的图像共同阅片,分析CIPSVS的MSCTA特征,分别统计和比较两种技术对CIPSVS的发现率、漏诊率、诊断正确率,并采用配对资料χ2检验。结果 29例患者中,病灶分流局部情况:2例通过侧侧相贴吻合,6例通过短或长管状血管吻合,21例通过大小不一结节状或不规则形静脉瘤吻合分流,其中14个交通静脉瘤瘤体直径<2 cm,7个瘤体直径≥2 cm。对CIPSVS的发现率、漏诊率、诊断正确率在常规的平扫及增强成像为93.1%(27/29)、6.9%(2/29)、75.9%(22/29);在MSCTA重组为100%(29/29)、0%(0/29)、100%(29/29),两者间的发现率和漏诊率差异无统计学意义(χ2=0.518、0.518,P=0.472、0.472);正确率差异有统计学意义(χ2=5.849,P=0.016)。结论 MSCTA能清晰、直观地显示CIPSVS的分流病灶及供血引流静脉,对诊断CIPSVS、判断其分型具有较高的应用价值。
Objective To investigate the value of multislice spiral CT angiography (MSCTA) in the diagnosis of congenital intrahepatic portal-venous shunt (CIPSVS). Methods Twenty-nine patients with CIPSVS diagnosed after screening were enrolled in this study. Two radiologists performed blinded radiographic examinations on MSCT images (plain and enhanced) and MSCTA (MPR, MIP, VR) The MSCTA features of CIPSVS were calculated and compared respectively. The detection rate, misdiagnosis rate and diagnostic accuracy of CIPSVS were calculated and compared respectively. Chi-square test was used to detect CIPSVS. Results Among the 29 patients, the local lesion shunting was performed in 2 cases, the lateral anastomosis was performed in 2 cases, the short or long tubular anastomosis in 6 cases, and the anastomosis shunt in 21 cases with nodules or irregular-shaped aneurysms. Among them, 14 A vehicle vein tumor diameter <2 cm, 7 tumor diameter ≥ 2 cm. The detection rate, misdiagnosis rate and diagnostic correct rate of CIPSVS were 93.1% (27/29), 6.9% (2/29), 75.9% (22/29) in routine plain scan and enhanced imaging; (29/29), 0% (0/29), 100% (29/29). There was no significant difference between the two groups (χ2 = 0.518,0.518, P = 0.472,0.472) ; The correct rate difference was statistically significant (χ2 = 5.849, P = 0.016). Conclusion MSCTA can clearly and intuitively show the shunt lesion and blood supply and drainage veins of CIPSVS. It is of high value in diagnosing CIPSVS and judging its classification.