CT 血管成像對(duì)肝細(xì)胞癌合并肝動(dòng)脈-門靜脈
分流的診斷價(jià)值
孟曉春 單鴻 朱康順 張建生 王曉紅 覃杰 谷惠珍
【摘要】 目的 探討CT 血管成像( CTA) 對(duì)肝細(xì)胞癌( HCC) 合并肝動(dòng)脈-門靜脈分流( APS) 的
診斷價(jià)值。方法 127 例HCC 患者分別接受肝臟多層螺旋CT 動(dòng)態(tài)增強(qiáng)掃描和DSA 檢查, 間隔時(shí)間
3 ～15 d。所有患者進(jìn)行CTA 檢查, 并以DSA 為標(biāo)準(zhǔn), 對(duì)照分析CT 動(dòng)態(tài)增強(qiáng)掃描基礎(chǔ)上進(jìn)行CTA 成
像對(duì)APS 的診斷價(jià)值。結(jié)果 DSA 證實(shí)52 例( 40. 94%) HCC 患者合并APS, 中央型33 例, 周圍型
19 例。CT 橫斷面與橫斷面基礎(chǔ)上結(jié)合CTA 診斷APS 的敏感度均為94. 23% ( 49 /52) , 特異度分別為
84. 00%( 63 /75) 和97. 33%( 73 /75) , 正確率分別為88. 19% ( 112 /127) 和96. 06% ( 122 /127 ) , 陽性預(yù)
測值分別為80. 33% ( 49 /61 ) 和96. 08% ( 49 / 51 ) , 陰性預(yù)測值分別為95. 45% ( 63 /66 ) 和96. 05%
( 73 /76) 。CTA 排除了橫斷面CT 對(duì)4 例中央型APS 和6 例周圍型APS 的假陽性診斷。與DSA 比
較, 多層螺旋CT 對(duì)APS 的分型符合率達(dá)88. 46% ( 46 /52) , 其中, 中央型90. 91% ( 30 /33 ) , 周圍型
84. 21%( 16 /19) 。CTA 還直觀地顯示23 例重度分流中央型APS 的供血?jiǎng)用}, 其中19 例為肝固有動(dòng)
脈分支, 4 例為胃十二指腸動(dòng)脈分支。結(jié)論 在多層螺旋CT 動(dòng)態(tài)增強(qiáng)掃描基礎(chǔ)上進(jìn)行CTA 成像, 能
有效提高APS 診斷的特異度和正確率。
【關(guān)鍵詞】 癌, 肝細(xì)胞; 肝動(dòng)脈; 門靜脈; 體層攝影術(shù), X 線計(jì)算機(jī); 血管造影術(shù), 數(shù)字
減影
The clinical significance of CT angiogr aphy in the diagnosis of a rter iopor tal shunts associated with
hepatocellular ca rcinoma MENG Xiao-chun, SHAN Hong, ZHU Kang-shun, ZHANG Jian-sheng,
WANG Xiao-hong, QIN J ie, GU Hui-zhen. Depa rtment of Radiology, the Third Affiliated Hospital of Sun Yat-
Sen University, Guangzhou 510630, China
Corresponding author: SHAN Hong, Email: sa nkyk@21cn. com
【Abstra ct 】 Objective To evaluate the clinical significance of CT angiography ( CTA) in the
diagnosis of arterioportal shunts ( APS) associated with hepatocellular carcinoma ( HCC) . Methods One
hundred and twenty-seven consecutive HCC patients accepted both dynamic enhancement CT and DSA
examinations. The interval between CT and DSA exam was from 3 to 15 days. Based on transverse CT
images in hepatic artery phase, CTA was performed for all the patients. By contrast with DSA results , the
capabilities of transverse CT and transverse images combined with CTA in APS diagnosis were analyzed.
Results In all 127 HCC cases, 52 cases with APS were confirmed by DSA ( 40. 94% ) , 33 with central
type of APS and 19 with peripheral type. Diagnostic sensitivity of APS based on transverse CT and combined
CTA with transverse CT images were both 94. 23% ( 49 /52) . However, specificity was 84. 00% ( 63 /75 )
and 97. 33% ( 73 /75 ) , respectively, accuracy was 88. 19% ( 112 /127 ) and 96. 06% ( 122 /127 ) , the
predictive value of positive cases was 80. 33% ( 49 /61) and 96. 08% ( 49 /51) , and the predictive value of
negative cases was 95. 45% ( 63 /66) and 96. 05% ( 73 /76) . Combined with CTA, false positive cases of
4 central type of APS and 6 peripheral type of APS were excluded which were demonstrated by transverse CT
images. By contrast with DSA, the coincidence rate of the type of APS diagnosed by transverse images
combined with CTA was 88. 46% ( 46 / 52 ) , including 90. 91% ( 30 /33 ) of central type of APS and
84. 21% ( 16 /19) of peripheral type. The supplying arteries of central type of APS were intuitively displayed
by CTA in 23 cases, 19 from proper hepatic artery and 4 from gastro-duodenal artery. Conclusion CTA
techniques based on the dynamic enhancement CT exams could effectively promote the specificity and the
accuracy of APS diagnosis.
【Key wor ds】 Carcinoma, hepatocellular; Hepatic artery; Portal vein; Tomography, X-ray

CT 血管成像對(duì)肝細(xì)胞癌合并肝動(dòng)脈-門靜脈--腹部.rar