Anatomy and clinical importance of cholecystic venous drainage: Helical CT observations during injection of contrast medium into the cholecystic artery
Anatomy and clinical importance of cholecystic venous drainage: Helical CT observations during injection of contrast medium into the cholecystic artery
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DOI：
10.2214/ajr.169.2.9242765
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发表时间：
1997-08-01
影响因子：
5
通讯作者：
Masuda, K
中科院分区：
文献类型：
--
作者：
Yoshimitsu, K;Honda, H;Masuda, K
OBJECTIVE.本研究的目的是利用螺旋CT阐明胆囊静脉引流的解剖和临床意义。我们在28例患者中通过超选择性导管胆囊动脉（胆囊动脉CT）注射造影剂期间进行了上腹部螺旋CT检查，所有患者均为疑似肝胆异常的手术候选人。在这些患者中的9例中，还进行了动脉门静脉造影（CTAP）期间的CT检查。胆囊静脉血最常进入肝段V（27/28例，96%）和肝段IV（26/28例，93%）的外周门静脉分支。胆囊静脉血也以频率递减的顺序引流至I、VI、VIII、III和VII段。胆囊静脉血随后流入肝中静脉（21/28，75%）或肝右静脉2例胆囊腺癌合并多发性肝转移灶，转移灶周围可见胆囊静脉回流，9例同时行胆囊动脉CT和CTAP检查者，胆囊静脉回流率为71%（20/28）。非肿瘤性门脉灌注缺陷可归因于胆囊静脉引流。认识到胆囊静脉引流是疾病从胆囊扩散到肝脏的可能途径，也是CTAP上看到的非肿瘤性门脉灌注缺陷的原因之一，这一点很重要。
OBJECTIVE. The purpose of this study was to use helical CT to elucidate the anatomy and clinical importance of cholecystic venous drainage.SUBJECTS AND METHODS. We performed helical CT of the upper abdomen during injection of contrast medium through a superselectively catheterized cholecystic artery (cholecystic artery CT) in 28 patients, all of whom were surgical candidates for suspected hepatobiliary abnormality. In nine of these patients, CT during arterial portography (CTAP) was also performed.RESULTS. Cholecystic venous blood most frequently entered peripheral portal branches of hepatic segment V (27 of 28 patients, 96%) and segment IV (26 of 28, 93%). In order of decreasing frequency, cholecystic venous blood also drained to segments I, VI, VIII, III, and VII. Cholecystic venous blood subsequently drained into the middle hepatic vein (21 of 28, 75%) or right hepatic vein (20 of 28, 71%), In two patients with adenocarcinoma involving the gallbladder associated with multiple liver metastases, cholecystic venous drainage was seen around each metastatic focus, In the nine patients in whom both cholecystic artery CT and CTAP were performed, nontumorous portal perfusion defects were attributable to cholecystic venous drainage.CONCLUSION. Recognition of cholecystic venous drainage as a possible pathway for spread of disease from the gallbladder to the liver and also as one of the causes of nontumorous portal perfusion defects seen on CTAP is important.