【摘要】 目的　探讨多层 CT经动脉门静脉成像三维重建 (3D- MSCTAP)与经动脉间接门静脉造影数字减影技术(DSA)检测肝细胞癌门静脉受侵的价值。方法　收集共 79例肝细胞癌患者先后行 MS- CTAP和 DSA检查。 3D- MSCTAP和 DSA用于诊断门静脉主干、左支和右支有否门静脉侵犯。门静脉受侵分成包埋、闭塞和癌栓形成三种 ,以病理或综合影像诊断结果为标准 ,对总共 2 35支门静脉主干及分支的 3D- MSCTAP和 DSA结果做了评价 ;同时对 3D- MSCTAP各重建算法和 DSA的图像质量进行评估。结果　病理或综合影像结果表明 ,5 8支门静脉受肿瘤侵犯。3D- MSCTAP VR、MIP、SSD、DSA分别正确检出了 5 8、5 8、5 4、4 8支 ,敏感度分别为 10 0 %、10 0 %、93%、83%。 3D- MSCTAP和 DSA的敏感度、阳性预测值及阴性预测值之间具有显著性差异 (P<0 .0 1) ,特异度之间具有统计学差异 (P<0 .0 5 ) ,准确度无统计学差异 (P>0 .0 5 )。VR、MIP和 DSA的敏感度和阴性预测值之间具有统计学差异 (P<0 .0 5 )。图像质量评估结果数值由高到低依次为 VR、MIP、F、DSA和 SSD,各组之间均具有显著性差异 (P<0 .0 5 )结论　检测肝细胞癌门静脉侵犯 ,3D- MSCTAP比 DSA更敏感、更特异 ;门静脉受侵的检测中 ,以 VR尤佳更多还原

【Abstract】 Objective To assess the value of three-dimernsional multislice CT during arterial portography(3D-MSCTAP) in detecting portal vein invasion in patients with hepatocellular carcinoma.Methods 79 patients with hepatocellualr carcinoma were included.All underwent MS-CTAP and intraarterial digital subtraction angiography(DSA) successively in a day.The ability of SSD,MIP,and VR images were compared as a whole and retrospectively with DSA in detecting portal vein invasion by hepatocellular carcinoma.The main,right and left portal veins were evaluated separately.A total of 235 veins were assessed for encasement,occlusion and stenosis.Besides,the image quality of 3D-MSCTAP and DSA were also assessed.Results SSD,MIP,VR and DSA depicted 54,58,58 and 48 of 58 involved portal veins and 172,174,174 and 166 of 174 noninvolved portal veins respectively.SSD,MIP,VR and DSA had a sensitivity of 93%,100%,100%and 83% for the combined evaluation of all portal veins(main,left and right)respectively;specificity as 98.3%,98.3%,97.2% and 93.8% respectively;accuracy as 98.7%,98.7%,96.1% and 91.1%.And there were significant statistical difference in specificity(P<0.05) and markedly significant statisical differences in sensitivity,positive predictive value and negative predictive value(P<0.01) between 3D-MSCTAP and DSA.besides,there was significant statistical difference between VR and DSA,MIP and DSA(P<0.05).And the efficacy of VR and MIP was similar,with the sensitivity and negative predictive value higher than DSA.With regard to the score of the quality,VR was the highest,MIP was the second and SSD was the lowest.Conclusion 3D-MSCTAP proved to be more sensitive and specific than DSA in evaluating portal vein invasion by hepatocellular carcinoma,and VR was preferred among the three rendering techniques of 3D-MSCTAP.更多还原