CT 血管成像对肝细胞癌合并肝动脉-门静脉
分流的诊断价值
孟晓春 单鸿 朱康顺 张建生 王晓红 覃杰 谷惠珍
【摘要】 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。
【关键词】 癌, 肝细胞; 肝动脉; 门静脉; 体层摄影术, X 线计算机; 血管造影术, 数字
减影
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 血管成像对肝细胞癌合并肝动脉-门静脉--腹部.rar