增强CT成像对肝窦阻塞综合征的诊断价值

目的:探讨增强CT成像对肝窦阻塞综合征（HSOS）的诊断价值。材料和方法:收集临床和影像诊断为HSOS的6例（男2例，女4例）纳入本研究，所有患者均行增强CT检查，观察分析增强CT成像上肝实质、肝脏相关血管及其他扫描范围相关影像变化，并参考肝脏血管超声、血管造影或增强MR检查结果，总结分析HSOS增强CT的特征。结果:CT平扫6例均表现肝脏肿大，肝实质密度不均匀减低。增强后6例均表现为“斑片状”或“地图样”异常强化，1例除此之外还可见特征性的以第二肝门为中心沿三支肝静脉周围“放射状”异常强化。5例三支肝静脉均未见显示，1例肝左静脉未显影，肝中静脉和肝右静脉变细成线样改变。下腔静脉肝段3例重度狭窄，3例稍受压，但所有病例经肝脏血管超声、血管造影或增强MR检查均证实肝静脉及下腔静脉血流通畅。结论:CT平扫所显示肝脏肿大、密度不均匀减低和增强扫描所显示肝实质“斑片状”或“地图样”异常强化或特征性的以第二肝门为中心沿三支肝静脉周围“放射状”异常强化特点有助于HSOS的诊断。但增强CT对诊断肝静脉和下腔静脉肝段是否狭窄或闭塞有一定的局限性。 

The Contrast-enhanced CT Diagnostic Value on Hepatic Sinusoidal Obstruction Syndrome

Objective: To evaluate the diagnostic value of contrast-enhanced CT in hepatic sinusoidal obstruction syndrome (HSOS). Materials and Methods: Six patients (2 males and 4 females) diagnosed with HSOS by clinical and imaging in our hospital were included in this study. All patients underwent contrast-enhanced CT examination. Observed the changes of liver parenchyma, liver related blood vessels and other images within the scanning range in contrast-enhanced CT imaging. The results of hepatic vascular ultrasound, angiography or contrast-enhanced MR were also referred. The characteristics of contrast-enhanced CT in HSOS were analyzed and summarized. Results: All 6 cases showed liver swelling and uneven decrease of liver parenchyma density in non-enhanced CT image. After enhancement, 6 cases displayed "patchy" or "geographic pattern" enhancement. In 1 case, there was also characteristic "radial shape" high density centered on the second hilum along the around of three hepatic veins. The three hepatic veins in 5 cases were not shown. In the other 1 case, the left hepatic vein was not shown, the middle and right hepatic vein became thin like a line. The hepatic segment of inferior vena cava was severely narrowed in 3 cases and slightly compressed in 3 cases. However, hepatic vascular ultrasound, angiography or contrast-enhanced MR examination confirmed that the venous blood flow in the hepatic vein and the inferior vena cava was smooth. Conclusion: Liver swelling and uneven decrease of liver parenchyma density in non-enhanced CT image and "patchy" or "geographic pattern" enhancement or characteristic "radial shape" high density centered on the second hilum along the around of three hepatic veins in contrast-enhanced CT, which contributes to the diagnosis of HSOS. However, contrast-enhanced CT has some limitations in the diagnosis of hepatic vein or inferior vena cava hepatic segment stenosis or occlusion.