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目的探讨肝血管瘤并发周围型肝动脉-门静脉瘘(APS)多层螺旋CT血管成像的影像表现和诊断价值。方法搜集12例经多层螺旋CT三期扫描确诊的肝血管瘤并发周围型APS,对肝动脉期CT血管成像进行回顾性分析。结果容积再现(VR)和最大密度投影(M IP)三维重建法均可较好地显示周围型APS和肝实质一过性强化。APS血管成像可分为4种类型,类型Ⅰ:瘤周可见早显的门静脉分支,多有肝动脉支伴行,有时可见“双轨”征;类型Ⅱ:自瘤体发出数条纤细的早显小门静脉支,呈细线或虚线状,无肝动脉支伴行,早显的小门静脉支多位于短暂肝实质强化区中;类型Ⅲ:同时具备类型Ⅰ和类型Ⅱ的影像表现;类型Ⅳ:瘤周无早显的门静脉分支,仅显示楔形或片状浓染区。肝实质一过性强化表现为瘤周片状浓染区。结论多层螺旋CT血管成像是诊断肝血管瘤并发周围型APS有效的检查手段。
Objective To investigate the imaging findings and diagnostic value of hepatic hemangiomas with multislice spiral CT angiography of peripheral hepatic artery-portal venous fistula (APS). Methods A retrospective analysis of hepatic arterial CT angiography was performed in 12 cases of hepatic hemangiomas diagnosed by multi-slice spiral CT three-phase scanning with peripheral APS. Results Volume rendering (VR) and maximum density projection (M IP) three-dimensional reconstruction method can better show the surrounding APS and hepatic parenchymal enhancement. APS angiography can be divided into four types, type Ⅰ: early visible peritubular portal vein branches, and more hepatic artery accompanying line, sometimes seen “double track” sign; Type Ⅱ: from the tumor issued a number of slender Early small portal vein branch was thin or dotted line, without hepatic artery branch line, early small portal vein branch in the short-term liver parenchyma enhancement area; type Ⅲ: with both type Ⅰ and type Ⅱ imaging performance; type Ⅳ: Portae of the portal vein without early signs of tumor showed only wedge-shaped or patchy areas. A temporary enhancement of the liver parenchyma performance of tumor-like patchy area. Conclusion Multi-slice spiral CT angiography is an effective method to diagnose hepatic hemangiomas complicated with peripheral APS.