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［Abstract］ Objective To investigate the value of multiple spiral CT dynamic contrastenhanced scan in diagnosis of arterioportal shunt in hepatocellular carcinoma. Methods 52 patients with hepatocellular carcinoma were all checked with multislice spiral CT three stages dynamic contrast enhancement scan and the delayed time is 27 seconds,60 seconds and 90 seconds. Results In this 52 patients with hepatocellular carcinoma,18 cases complicated with arterioportal shunt (34.6%) and in this group,12 cases are peripheral and 6 cases are central.Moreover,this 6 central patients are all complicated with portal vein tumor thrombus and in this 12 peripheral cases,8 cases appears interrupt and the portal vein looks like “interruption”;4 patients appears accompanying between portal vein and hepatic artery and it looks like “doubleway”.In this group,the imaging finds ratio of arterioportal shunt in hepatocellular carcinoma are 34.6%,and it is lower compared with the reports. Conclusion Multiple spiral CT dynamic contrastenhanced scan and angiography can really supply effective value in diagnosing arterioportal shunt in hepatocellular carcinoma.The portal vein and its branch,the relationship between arteries can be clearly appeared by spiral CT angiography.
［Key words］ hepatocellular carcinoma；portal vein；hepatic artery；tomography,spiral computed
由于多层螺旋CT扫描速度快，能够在注射对比剂后的肝动脉期、门静脉期、肝静脉期进行多次肝脏薄层扫描，因此，不仅能够显示肿瘤及其并发症的相关信息，提高病变的检出率，还能够显示肿瘤营养血管的解剖、走行及动静脉瘘的有无［1］。约63％的肝细胞癌患者发生肝动脉－门静脉瘘［2］，正确识别肝细胞癌合并肝动脉－门静脉瘘具有重要临床价值，高流量性肝动脉－门静脉瘘能明显加重肝癌患者的门静脉高压，直接导致上消化道出血、腹泻、腹胀等门静脉高压症状；低流量性肝动脉－门静脉瘘则可引起和加快肝细胞癌的扩散和转移，及时发现和治疗肝动脉－门静脉瘘，可明显改善患者预后，提高患者的生存质量和生存率［3］。既往肝动脉－门静脉瘘诊断主要依据DSA检查，因其具有创伤性，不能作为常规检查手段，致使许多患者因漏诊而延误治疗。多层螺旋CT能够实现高质量的肝脏多期动态增强薄层扫描，从而为无创性诊断肝动脉－门静脉瘘提供了重要工具［4］。
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