The Optimization Of Portal Venous System Imaging And Diagnostic Value Of Portal Venous System Thrombosis With 64-slice Spiral CT

The first partObject: Use two different injection methods on patients with liver cirrhosis and portal hypertension for portal systemic vascular imaging , and explore the optimization of portal vein systemic vascular imaging.Method: Use single-phase injection (group A) or biphasic injection (group B) on 40 patients(Male 26 cases, female 14 cases) by random for portal systemic vascular imaging. Compare and analyze the imaging quality and technical superiority between them.Results:1. There was no significant difference in image quality between two kinds of injections(P>0.05).Group B contrast agent dosage (90mL) is less than group A(100mL).2. Group B patients with portal vein, liver parenchyma and the P-L discrepancy between CT values are slightly lower than group A,but had no significant statistically difference (P>0.05).After 45 second group B was larger than group A on the P-L discrepancy. The peak times of group B were longer than group A on portal vein, liver parenchyma and the P-L discrepancy.And had significant statistically difference (P<0.05).3. The graph of P-L discrepancy showed: group B was longer than group A on the threshold interval of P-L discrepancy.Conclusion:1. On imaging of portal venous system, biphasic injection had reliable imaging quality for cirrhotic patients with portal hypertension. And the total dose of contrast agent was less.2. Biphasic injection had a significant advantage in the imaging technology of portal venous system compared with single-phase injection. Biphasic injection could be used as an optimal choice of technology for patients with liver cirrhosis and portal hypertension for portal systemic vascular imaging.The second part Object: Using DSA as the gold standard to assess the clinical application of portal venous system thrombosis diagnosis by MSCTP.Methods: Use MSCTP and DSA respectively in 34 patients with liver cirrhosis and portal hypertension who were suspected of portal vein thrombosis.Compare the display consequence of portal vein and its branches between MSCTP and DSA. Assess the diagnosis of portal venous system thrombosis by MSCTP. And summarized the clinical data and characteristic CT performance of the patients with portal venous system thrombosis.Results:1. There was no significant difference in the show extent of the three or more intrahepatic portal vein branches between MSCTP and DSA(P>0.05).2. For the 34 patients who were suspected of portal vein thrombosis, the sensitivity of MSCTP was 87.0% (20/23), the specificity was 90.9% (10/11), the accuracy was 88.2% (30/34). The diagnosis results between MSCTP and DSA in 34 patients who were suspected of portal vein thrombosis are consistent(χ2=0.25,P>0.05).3. There were 21 patients showed varying degrees of portal system widened diameter and intravascular thrombosis in the 23 patients who had portal vein thrombosis. Another two patients with thrombosis did not appear the CT signs of portal vein embolizationin in MSCTP. 20 patients could be seen edema and thicken bowel wall. 15 patients appeared intestinal expansion and gas accumulation and intestinal fluid. 18 patients showed diffuse increased density of mesenteric and fuzzy mesenteric density; 19 patients had ascites.Conclusion: MSCTP had reliable quality on patients with liver cirrhosis and portal hypertension. MSCTP had high sensitivity and specificity,and is fully capable of replacing the traditional DSA as the first choice of portal vein thrombosis inspection method.