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目的:总结肝细胞癌合并门静脉癌栓所致肝血异常CT表现,探讨其血流动力改变的机理及临床意义。方法:在2004年7月至2011年6月于我院CT检查诊断为肝细胞癌病例中,对存在肝血异常病例作为研究对象。全部病例均常规进行肝动脉期、门静脉期、平衡期增强扫描。结果:具有肝血异常CT表现者120例,全部病例见原发性肝细胞癌灶和肯定的门静脉癌栓,癌灶外肝血异常的增强扫描表现可分为三种:肝实质局部早期强化,门静脉提前显影,门静脉海绵样变。在同一病例中,可单独以一种表现,也可同时以两种表现(双重表现)或三种表现(三重表现)。结论:肝细胞癌肝血异常由门静脉癌栓引起,其发生机理为肝动脉或门静脉对肝脏的灌注异常,肝静脉或下腔静脉的引流异常,肝动脉-门静脉异常分流,侧支循环的建立等。
Objective: To summarize the CT manifestations of hepatocellular carcinoma with portal vein tumor thrombus caused by hepatic abnormalities, and to explore the mechanism and clinical significance of hemodynamic changes. Methods: From July 2004 to June 2011 in our hospital CT diagnosis of hepatocellular carcinoma cases, the presence of abnormal liver blood as the research object. All cases were routine hepatic artery phase, portal venous phase, balanced enhanced scan. Results: There were 120 cases of abnormal liver CT manifestations, all cases of primary hepatocellular carcinoma and confirmed portal vein tumor thrombus, extracranial liver blood abnormalities enhanced scan performance can be divided into three types: liver parenchyma early local enhancement , Portal vein development in advance, portal vein sponge-like change. In the same case, it can be taken as a single performance or as two performance (dual performance) or as three performance (triple performance). CONCLUSION: Hepatic cancer with abnormal hepatic blood flow is caused by portal vein tumor thrombus. The mechanism is the abnormal perfusion of hepatic artery or portal vein to liver, abnormal drainage of hepatic vein or inferior vena cava, abnormal hepatic artery-portal vein shunt, establishment of collateral circulation Wait.