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目的 探讨肝静脉阻塞型Budd Chiari综合征 (BCS)多层螺旋CT动态增强规律及CT血管成像的诊断价值,评价多层螺旋CT检查对BCS治疗的指导意义。方法 经血管造影证实的 21例肝静脉阻塞型BCS患者,在DSA检查前 2周内行肝脏多层螺旋CT动态增强扫描,并对其相关血管进行重建。病程短于 3个月的有 4例, 3个月以上的 17例。结果 病程短于 3个月的 4例,CT平扫显示肝脏体积弥漫性增大,肝脏密度普遍降低;增强后表现为以肝门区和尾状叶为中心的斑片状强化,并随扫描时间延长强化范围扩大。病程 3个月以上的 17例,CT平扫显示肝脏形态异常,肝萎缩区或肝外周为低密度;增强后肝萎缩区及肝外周强化程度低,密度不均匀,其静脉引流血管闭塞,而静脉引流良好的区域强化均匀,其静脉引流至少有 1支开通的肝静脉或扩张的副肝静脉。肝实质CT强化规律与肝静脉阻塞部位及肝内外侧支静脉形成密切相关。21例患者,共计 42条肝静脉闭塞,其中肝左静脉 9条,肝中静脉 12条,肝右静脉 16条,副肝静脉 6条。横断面和CT血管成像显示肝静脉阻塞的正确率分别为 61 9%和 100%。结论 多层螺旋CT动态增强扫描能够较准确地反映肝静脉阻塞型BCS肝内血流动力学变化,结合CTA可准确显示肝静脉阻塞部位、性质及肝内外侧支静脉,对指导BCS的治疗具有重要价值。
Objective To investigate the dynamic enhancement of multi-slice spiral CT in Budd-Chiari syndrome (BCS) and the diagnostic value of CT angiography in hepatic vein occlusion. To evaluate the guiding significance of multi-slice spiral CT in the treatment of BCS. Methods Twenty-one patients with hepatic veno-occlusive BCS who were confirmed by angiography were scanned with dynamic multi-slice spiral CT in 2 weeks before DSA and their related blood vessels were reconstructed. 4 cases were shorter than 3 months and 17 cases were more than 3 months. Results 4 cases of disease duration of less than 3 months, CT scan showed diffuse enlargement of the liver volume, liver densities generally reduced; enhanced showed hilar and caudate lobe as the center of the patch-like enhancement, and with the scan Extended time to strengthen the scope of expansion. Thirteen patients with a history of more than 3 months showed abnormal liver morphology, low density of hepatic atrophy or extrahepatic periphery, low enhancement of liver atrophy and extrahepatic peripheral enhancement, uneven density and venous drainage of vascular occlusion Vein drainage area is well enhanced, the venous drainage at least one open hepatic vein or dilated accessory hepatic vein. CT enhancement of hepatic parenchyma and hepatic venous occlusion site and the formation of the lateral extrahepatic branch vein are closely related. Twenty-one patients had a total of 42 hepatic vein occlusions, including 9 of the left hepatic vein, 12 of the middle hepatic vein, 16 of the right hepatic vein and 6 of the accessory hepatic vein. Cross-sectional and CT angiography showed hepatic vein occlusion rates of 61.9% and 100%, respectively. Conclusions Multi-slice spiral CT dynamic contrast-enhanced scanning can accurately reflect intrahepatic hemodynamic changes in hepatic vein obstruction BCS. Combined with CTA, hepatic vein occlusion site, nature, and extrahepatic lateral vein can be accurately displayed. Important value.