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目的探讨门静脉系统血栓(portal vein thrombosis,PVT)的64层螺旋CT表现特征。资料与方法15例PVT者行64层螺旋CT平扫和双期增强扫描,采用最大密度投影(MIP)、容积再现(VR)及多平面重组(MPR)观察其影像学特征。结果15例中,血栓发生于门静脉(PV)主干13例,右支6例,左支7例,脾静脉(SV)3例,肠系膜上静脉(SMV)9例,其中血栓同时累及PV主干和SMV 8例,同时累及PV左右支、主干和SMV 4例,累及PV主干和右支6例,累及PV主干和左支6例,累及SV和SMV2例,PV主干、SV、SMV三岔口处血栓1例。Yerdel分级:Ⅰ级1例,Ⅱ级10例,Ⅲ级3例,Ⅳ级1例;血栓呈高密度10例,等密度2例,低密度3例;血栓为部分偏心性栓塞12例,呈小条状、“柴捆”状;附栓管壁均连续光滑、无外突结节,局部PV管壁呈典型的线样“强化征”或“轨道征”;出现食管胃丛及脾丛侧支循环12例,胆管丛及胆囊丛侧支循环4例,无一例出现肝动脉-门静脉瘘。结论64层螺旋CT能够清晰、立体地显示PVT的部位、累及范围,具有特征性,是PVT重要的检查方法。
Objective To explore the features of 64-slice spiral CT in portal vein thrombosis (PVT). Materials and Methods Fifteen PVT patients underwent 64-slice spiral CT scan and double-phase enhanced scan. The imaging features were observed by maximum density projection (MIP), volume rendering (VR) and multiplanar reconstruction (MPR). Results Of the 15 cases, thrombus occurred in 13 cases of portal vein (PV) trunk, 6 cases of right branch, 7 cases of left branch, 3 cases of splenic vein (SV) and 9 cases of superior mesenteric vein (SMV) 8 cases of SMV, involving 4 cases of left and right PV, trunk and SMV, 6 cases involving PV trunk and right branch, 6 cases involving PV trunk and left branch, 2 cases involving SV and SMV, PV trunk, SV, SMV thrombus 1 case. Yerdel classification: Ⅰ grade in 1 case, Ⅱ grade in 10 cases, Ⅲ grade in 3 cases, Ⅳ grade in 1 case; thrombus was high density in 10 cases, equal density in 2 cases, low density in 3 cases; thrombosis was partial eccentric embolization in 12 cases Small strips, “Chai bundles ” shape; attached to the bolt tube wall are smooth, no sudden nodules, the local PV tube wall showed a typical line pattern “enhanced sign” or “track sign ”; Gastroesophageal and splenic plexus collateral circulation in 12 cases, biliary plexus and gallbladder plexus collateral circulation in 4 cases, no case of hepatic artery - portal vein fistula. Conclusion 64-slice spiral CT can clearly and stereoscopically display the location and extent of PVT, and is characteristic of PVT. It is an important method of PVT examination.