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目的探讨 CT 血管成像(CTA)对肝细胞癌(HCC)合并肝动脉-门静脉分流(APS)的诊断价值。方法 127例 HCC 患者分别接受肝脏多层螺旋 CT 动态增强扫描和 DSA 检查,间隔时间3～15 d。所有患者进行 CTA 检查,并以 DSA 为标准,对照分析 CT 动态增强扫描基础上进行 CTA 成像对 APS 的诊断价值。结果 DSA 证实52例(40.94%)HCC 患者合并 APS,中央型33例,周围型19例。CT 横断面与横断面基础上结合 CTA 诊断 APS 的敏感度均为94.23%(49/52),特异度分别为84.00%(63/75)和97.33%(73/75),正确率分别为88.19%(112/127)和96.06%(122/127),阳性预测值分别为80.33%(49/61)和96.08%(49/51),阴性预测值分别为95.45%(63/66)和96.05%(73/76)。CTA 排除了横断面 CT 对4例中央型 APS 和6例周围型 APS 的假阳性诊断。与 DSA 比较,多层螺旋 CT 对 APS 的分型符合率达88.46%(46/52),其中,中央型90.91%(30/33),周围型84.21%(16/19)。CTA 还直观地显示23例重度分流中央型 APS 的供血动脉,其中19例为肝固有动脉分支,4例为胃十二指肠动脉分支。结论在多层螺旋 CT 动态增强扫描基础上进行 CTA 成像,能有效提高 APS 诊断的特异度和正确率。
Objective To investigate the value of CT angiography (CTA) in the diagnosis of hepatocellular carcinoma (HCC) combined with hepatic artery-portal vein shunt (APS). Methods A total of 127 HCC patients underwent multi-slice spiral CT dynamic contrast-enhanced scanning and DSA, respectively, with an interval of 3-15 days. All patients underwent CTA examination, and DSA was used as a standard to analyze the diagnostic value of CTA imaging on APS based on CT dynamic contrast-enhanced scan. Results DSA confirmed 52 cases (40.94%) of HCC patients with APS, 33 cases of central type and 19 cases of peripheral type. The sensitivity and specificity of CTA in the diagnosis of APS were 94.23% (49/52), 84.00% (63/75) and 97.33% (73/75), respectively. The correct rates were 88.19 The positive predictive value was 80.33% (49/61) and 96.08% (49/51) respectively, the negative predictive values were 95.45% (63/66) and 96.05% (96/51) respectively % (73/76). CTA ruled out cross-sectional CT in 4 cases of central APS and 6 cases of peripheral APS false positive diagnosis. Compared with DSA, the coincidence rate of multislice spiral CT in the classification of APS was 88.46% (46/52). Among them, the central type was 90.91% (30/33) and the peripheral type was 84.21% (16/19). CTA also visually shows the feeding arteries of 23 patients with severe shunt central APS, of which 19 were branches of hepatic artery and 4 were branches of gastroduodenal artery. Conclusions CTA imaging based on multi-slice spiral CT can enhance the specificity and correctness of APS diagnosis.