Imaging Appearance And Imaging-Pathologic Correlative Study On Computed Tomography During Splenoportography

Objectives: Through clinical application on computed tomography during splenoportography(CTSP), the main purpose of this study was: (1) To study the normal imaging features, scanning parameters and evaluate the enhancement effect of CTSP on the liver, and further to elucidate the safety of CTSP technique. (2) To increase diagnostic confidence and decrease the false-positive rate or false- negative rate on hepatic parenchymal perfusion defects detected by CTSP on imaging-pathologic correlative study. Materials and Methods: 60 cases were divided into two groups: (1) All imaging data of 30 cases in the first group were collected to. show the enhancement effect of CTSP on the liver parenchyma, portal and hepatic veins. All cases are chosen from the patients who suffered from small space-occupying lesions of liver or negative findings on CTSP which did not affect the observation, including primary hepatocellular carcinoma (n= 13), hepatic metastases (n= 13), bepatic cyst (n=1), and negative findings (n=3). The CT values of above mentioned regions of interest (ROT), including normal hepatic parenchyma, portal vein and aorta, were collected in the dynamic sequence contrast. The density-time (D-T) curves were established respectively, and the results were analyzed. (2) All imaging data of 30 cases in the second group were collected to show the characteristics of hepatic parenchymal perfusion defects detected with CTSP. All diagnoses, including primary hepatocellular carcinoma (n= 19), hepatic metastases(n=7), chronic hepatic abscess (n=1), nodular cirrhosis (n=l), focal nodular hyperplasia (n=1), and hepatic hemangioma (n=l), were confirmed by operation, pathology or punctural cytology. The correlation was compared between the gross samples and the imaging on CTSP. Conventional paraffin slices, Gomori's reticular fiber stain and immunohisto-chemistry stain slices were prepared in the corresponding tumorous tissues. Their slices were examined with optical microscope. RESULT: (1) The density-time curves about the regions of interest (ROT) were showed to describe the enhancement characteristics of CTSP on the hepatic parenchyma, portal vein and aorta vividly. The results proved that CTSP was a safety and trustworthy of technique, and could be used as a procedure to evaluate the portal blood supply of hepatic neoplasms. (2) The correlation was showed between different attenuation values of individual focal tumorous perfusion defects and the benignity or malignancy of the lesions. And the characteristic appearances about focal non-tumorous perfution defects on CTSP were revealed. (3) Vascular invasion of small portal vein was depicted. The feature, cause and clinical significance about 搒traight line sign 搘ere described and discussed together with the review of the literature. (4) The causes and clinical values of overestimating the sizes of hepatic malignancy on CTSP were explored and summarized. CONCLUSIONS: (1) CTSP can not only enhance the hepatic parachymia conspicuously, show the anatomy and variations in the intrahepatic hepatic and portal veins accurately but be used as a procedure to evaluate the portal blood supply of hepatic neoplasms. (2) The different attenuation values of individual focal tumorous perfusion defects and vascular invasion of small portal veins are helpful to differentiate that the lesions detected by CTSP are malignant or not. (3) There are characteristic location and appearance in focal not-tumorous perfution defects. (4) The clinical significi...