Table 1 Portal Branch level to which the retro- grade flow reached. Table 2 Spectral analysis of retrograde portal flow signal. Table 3 Relationship b

Size: px

Start display at page:

Download "Table 1 Portal Branch level to which the retro- grade flow reached. Table 2 Spectral analysis of retrograde portal flow signal. Table 3 Relationship b"

しほこうなだ
5 years ago
Views:

2 Table 1 Portal Branch level to which the retro- grade flow reached. Table 2 Spectral analysis of retrograde portal flow signal. Table 3 Relationship between waveform pattern of retrograde portal flow on Doppler sonogram and A-P shunt on angiogram. A-Pshunt (+)

3 Fig. 1 Difference of maximum velocity (Vmax) of portal flow among three groups: pulsatile wave (PW), continuous wave (CW) with or without A-P shunt. Table 4 Existence of A-P shunt in cases with continuous retrograde portal flow.

4 Fig. 2 Case of hepatocellular carcinoma (HCC) with pulsatile retrograde portal flow.

5 肝細胞癌に伴う肝内A-P が断層画像上一面にリアルタイムにカラー表示される8)ため,パルスドプラ法に比べ門脈系の血行動態的異常を検出するのに有用12)である.特に,色調により血流方向を視覚的に把握でき,門脈内血流の逆流現象8 13)を検出することは容易である. A-P shuntは,血 shuntの 19:601 カラードプラ診断つの所見と考えられる.今を捉らえたHCC症回我々は,門脈内逆流血流例の血流ドプラ所見を検討し,血管造影所見と対比検討した. その結果,カラードプラ法にて捉らえられた門脈内逆流症例の内,拍動性の門脈逆流例には,血管造影上, 管造影法が登場して以来評価され全例にA-P shuntを認めた.拍動性の血流シグナルは始めた肝内の血行動態的異常である.その程度や部位動脈血流に由来していることは,既により,さらに病理組織学的なshuntの形成の仕方3,6), angiography14,15)とにより,いくつかに分類されるが,いずれの場合でもにUS の対比により明らかにされている18).従って,門脈内に認められた拍動性血流は動脈血程度の差はあれ門脈内に流入した動脈血流のいくらか流を表現したものであり,A-P は圧較差により門脈内を逆流する2,3,6,7).従って,門脈推察される.この所見はA-P 内血流の逆流現象はA-P に診断する上で大きな意義を持つと考えられる. shuntの存在を示唆する一 shuntの shuntの存在は容易に存在を非侵襲的

6 Fig. 3 Case of hepatocellular carcinoma (HCC) with continuous retrograde portal flow.

8 Angiographic demonstration of intrahepatic arterio-potal anastomoses in hepatocellular carcinoma. Radiology 122: 53-58, ) Adler J, Goodgold M, Mitty H, et al: Arterio- venous shunting involving the liver. Radiology 129: , ) Bookstein JJ, Cho KJ, Davis GB, et al: Arteriopotal communications: Observations and hypotheses concerning transsinusoidal and transvasal types. Radiology 142: , ) Kessler RE, Tice DA, Zimmon DS: Retrograde flow of potal vein blood in patients with cirrhosis. Radiology 92: , ) Tanaka S, Kitamura T, Fujita M, et al: Small hepatocellular carcinoma: Differentiation from adenomatous hyperplastic nodule with color Doppler flow imaging. Radiology 182: , ) Farrell R, Steinman R, Green WH: Arteriovenous shunting in regenerating liver simulat- 15) Kudo M, Tomita S, Tochio H, et al: Sonogra- ing hepatoma. Radiology 102: , 1972 phy with intraarterial infusion of carbon dioxide microbubbles (sonographic angiography): Intrahepatic arterial potal communications: Angiographic study. AJR 121: , ) Okuda K, Musha H. Yamasaki T. et al: Value in differential diagnosis of hepatic tumors. AJR 158: 65-74, 1992

9 17) Koslin Berland LL: Duplex Doppler examination of the liver and portal venous system. J Clin Ultrasound 15: , 1987 Diagnosis of intrahepatic arterio-portal shunt in hepatocellular carcinoma with color Doppler flow imaging Hitoshi TOCHIO, Syusuke TOMITA, Masatoshi KUDO, Yoshihiro OKABE, Kazushi MINOWA, Hiroshi KASHIDA, Jun MIMURA, Michio HAMADA, Masahiro HIRASA, Yasuyoshi IBUKI, Hideshi KOMORI, Akio ORINO and Akio TODO* It is considered that retrograde portal flow is an evidence for the existence of arterio-portal (A-P) shunt. Fifteen patients with hepatocellular carcinoma (HCC), in whom retrograde portal flow was detected by color Doppler flow imaging, were studied. The correspondence between existence of A-P shunt on angiogram and retrograde portal flow identified by spectral analysis with pulsed Doppler was evaluated. A-P shunt was observed in all 4 cases with pulsatile retrograde portal flow. Out of 11 cases with continuous retrograde portal flow, A-P shunt was observed in 5 cases (45%). In 11 cases with was observed in all cases with maximum velocity of retrograde portal flow more than 10cm/sec. We concluded that pulsatile retrograde portal flow or continuous retrograde portal flow faster than 10 cm/sec in velocity is diagnostic of the existence of A-P shunt relating to HCC. * Section of Abdominal Ultrasound and Division of Gastroenterology, Kobe City General Hospital (Kobe)

Table 1 Laboratory data on admission. Fig. 1 US shows a hyperechoic large tumor. Fig. 2 CT shows a large hepatic tumor. Central necrosis and dilatatio

Table 1 Laboratory data on admission. Fig. 1 US shows a hyperechoic large tumor. Fig. 2 CT shows a large hepatic tumor. Central necrosis and dilatation of the intrahepatic bile duct can be found. Fig.