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간세포암의 문맥종양전에 의한 혈류동태학적 변화:나선형 간동맥조영 CT와 문맥조영 CT 소견에 대한 고찰
Hemodynamic Change by Portal Tumor Thrombus in Hepatocellular Carcinoma : Evaluation by Combined Spiral CT Hepatic Arteriography and CT Arterial Portography

이미란    (고려대학교 의과대학 진단방사선과학 교실  );
  • 초록

    Purpose : To evaluate the hemodynamic change by portal tumor thrombus in hepatocellular carcinoma(HCC).Materials and Methods : We reviewed 35 cases of combined spiral CTHA and CTAP in 25 HCC patients with portal tumorthrombus from April 1993 to October 1994, regarding to portal tumor thrombus, the involved area ofarterioportal(AP) shunt and the development of cavernous transformation of portal vein, in comparison with hepaticand superior mesenteric arteriography. Results : Spiral CTHA showed hyperattenuating tumor, portal tumor thrombusand hyperattenuating peritumoral parenchymal area. Spiral CTAP showed perfusion defect area including tumor, portal tumor thrombus and peritumoral area distal to portal vein obstruction. In 15 cases, portal tumor thrombusshowed intraluminal and marginal hyperattenuating linear structures on CTHA due to transvasal AP shunt and tumorfeeding arteries, which were corresponding to thread and streaks sign on hepatic arteriography. Cavernoustransformation of portal vein was demonstrated in 15 cases as irregular periportal hyperattenuating collateralvessels on spiral CTAP. In 32 cases, portal vein was visualized on CTHA due to AP shunt. And according to shuntamount, we classified AP shunt into 4 grades. Grade I means only the presence of portal tumor thrombus without APshunt, grade II with segmental AP shunt, grade III with one lobar AP shunt, and grade IV with both lobar AP shuntor the presence of cavernous transformation of portal vein. Grade I was seen in 3, grade II in 4, grade III in 13and grade IV in 15 cases. Conclusion : Variable CTHA and CTAP findings were shown in HCC patients with portaltumor thrombus according to the amount of AP shunt and the presence of cavernous transformation of portal vein.Combined CTHA and CTAP are useful to differentiate the tumor thrombus from simple thrombus and are very sensitivemethod for detecting AP shunt. Understanding these findings related with portal tumor thrombus is important topredict patient}s prognosis and to decide treatment method.


  • 주제어

    Liver neoplasms, blood supply .   Liver neoplasms, CT .   Portal vein, thrombosis.  

  • 참고문헌 (16)

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    16. 문맥의 해면상 변형을 동반한 간세포암 , 서흥석;이승호;함창곡 , 대한방사선의학회지 / v.21,pp.772-776,
         
  • 이 논문을 인용한 문헌 (2)

    1. 1996. "Pattern analysis of Hemodynamic Changes of the Liver on Combined CT Hepatic Arteriography and CT Arterial Portography" 대한방사선의학회지 = Journal of the Korean Radiological Society, 35(5): 757~764     
    2. 1997. "Comparison of Enhancement Pattern of Nodular and Masive hepatocellular Carcinoma with and without Portal Vein Thrombosis in Three-Phjase Spiral CT" 대한방사선의학회지 = Journal of the Korean Radiological Society, 36(6): 1021~1028     

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  • 이미란 (1)

    1. 1995 "경부 청소술후 CT 소견" 대한방사선의학회지 = Journal of the Korean Radiological Society 32 (2): 231~236    

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