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Objective To summarize the characteristics of multi-slice computed tomography (MSCT) of portal vein diseases and investigate the CT diagnosis of its primary and secondary diseases.Methods The imaging data of 62 patients from Xi'an Xidian Group Hospital,28 patients from Nuclear Industry 215 Hospital of Shanxi Province and 16 patients from Xi'an Gaoxin Hospital with portal vein diseases from January 2012 to March 2015 were retrospectively analyzed.The CT findings,primary and secondary diseases of portal vein lesions were recorded through plain scan and enhanced scan of MSCT.Results Changes in the width of portal vein:among 106 patients,dilation of main portal vein was detected in 45 cases,stenosis of stem or branches of portal vein in 39 cases,portal vein obstruction in 49 cases (21 patients accompanied with enlargement in stem of portal vein and 6 patients with normal width).The diameters of dilated portal vein were 1.4-2.2 cm with a mean diameter of 1.8 cm.The diameters of portal vein with stenosis and occlusion caused by carcinomas were 1.8-4.0 cm with a mean diameter of 2.3cm.Portal vein fistula and pneumatosis:hepatic artery-portal vein fistulas were detected in 12 patients,posterior right branches of portal vein-inferior vena cava fistulas in 2 patients,inferior vena cavaportal vein fistulas and portal-hepatic vein fistulas in 2 patients,pneumatosis in 2 patients.Lesions of portal vein occlusions:occlusions located at main portal veins were detected in 4 cases,left and right branches in 34 cases,both main portal veins and left or right branches in 11 cases.Malignant stenosis and occlusion were detected in 29 and 42 cases,benign stenosis and occlusion were detected in 10 and 7 cases,respectively.Protopathies of portal vein dilation:there were 43 patients with liver cirrhosis and 2 patients with inferior vena cava-portal vein-hepatic vein fistula of Budd-Chiari syndrome.Protopathies of benign stenosis and occlusion:portal vein thrombosis in liver cirrhosis,giant cavernous haemangioma,polycystic disease of liver,pylephlebitis caused by liver abscess,portal vein thrombosis caused by polycythemia vera.Protopathies of hepatic artery portal vein fistula and portal veininferior vena cava fistula:liver cancer and liver cirrhosis,protopathy of inferior vena cava-portal vein fistula and portal vein-hepatic vein fistula were Budd-Chiari syndrome.Protopathies of pneumatosis:intestinal infarction after superior mesenteric artery embolus and acute gastric dilatation.Portacaval collateral circulation occurred in 58 patients (partial patients complicated with multi-point varices and shunts),ascites in 44 patients,portal vein cavernous transformation in 12 patients,ischemia and edema of intestinal wall in 5 patients,intrahepatic cholangiectasis in 19 patients including 17 cases of biliary obstruction caused by malignant tumors and 2 cases of portal vein cavernous transformation complicated with intrahepatic cholangiectasis (portal hypertensive biliopathy).Conclusions The MSCT for portal vein diseases is presented as portal vein stenosis,occlusion or dilation,pneumatosis.Secondary lesions are portacaval collateral circulation,portal vein cavernous transformation,intestinal ischemia and portal hypertensive biliopathy,and primary lesions are mainly liver cirrhosis and malignant tumors.MSCT can show clearly the portal vein lesions and diagnose accurately its primary and secondary lesions.
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Objective To investigate the clinical value of the combination of routine magnetic resonance imaging (MRI),magnetic resonance cholangiopancreatography (MRCP),diffusion weighted imaging (DWI)and enhanced magnetic resonance imaging in the diagnosis of recurrent pyogenic cholangitis (RPC).Methods The clinical and MRI data of 2 1 cases of RPC confirmed by surgery or puncture were retrospectivly analyized.Results All of 2 1 patients were performded with routine MRI (FSE T2 WI,FSPGR T1 WI and FIASTA),MRCP and DWI.1 2 cases were underwent three-dimensional dynamic contrast-enhanced MRI with a liver volume accelerated acquisition sequence (LAVA).The raw data was uploaded to GE ADW4.4 station and the three dimensional MRCP and DWI were analyzed.(1)All of 21 cases were hepatolithiasis complicated with irregular expansion.11 cases were involved left intra-hepatic bile duct,7 cases were right intrahepatic duct,and 3 cases were involved left and right intrahepatic bile duct.Wall thickening was in 19 cases,normal biliary duct wall was in 2 cases.(2)Common bile duct disease:calculus of intrahepatic and extrahepatic bile duct complicated with bile duct dilatation were in 8 cases.Calculus of intrahepatic bile duct were individually in 13 cases.(3)Gall-bladder disease:there were 5 cases of gallstone,9 cases of chronic cholecystitis,3 cases of acute cholecystitis and 4 cases of chole-cystectomy.(4)Liver parenchyma disease:there were 6 cases of liver atrophy in all the cases (left lobe atrophy of 4 cases,right lobe atrophy of 4 cases).The inflammatory changes around dilated bile ducts were found in 1 2 cases.The MRI findings of those were slight patchy hyperintensity signal on conventional T2 WI,the area of hyperintensity signal on T2 WI was extended on DWI.On dynamic contrast-enhanced MRI,the inflammatory areas were uniformity minor enhancement on arterial phase,and hardening in-creases on portal and delayed phase.Conclusion Multi-sequences MRI can be more fully reflected the pathologic changes of RPC, which is important for imaging diagnosis of the disease.
