Elsayes Khaled M, Shaaban Akram M, Rothan Sarah M, Javadi Sanaz, Madrazo Beatrice L, Castillo Rosa P, Casillas Victor J, Menias Christine O
From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (K.M.E., S.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (A.M.S.); Department of Diagnostic and Interventional Imaging, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Tex (S.M.R.); Department of Diagnostic Radiology, University of Miami Health System, Miami, Fla (B.L.M., R.P.C., V.J.C.); and Department of Diagnostic Radiology, Mayo Clinic, Scottsdale, Ariz (C.O.M.).
Radiographics. 2017 May-Jun;37(3):813-836. doi: 10.1148/rg.2017160161. Epub 2017 Apr 21.
The liver has a complex vascular supply, which involves the inflow of oxygenated blood through the hepatic artery (systemic circulation) and deoxygenated blood through the portal vein (portal circulation), as well as the outflow of deoxygenated blood through the hepatic veins to the inferior vena cava. A spectrum of vascular variants can involve the liver. Some of these variants may result in areas of enhancement that can mimic more serious pathologic conditions. In this article, the authors discuss a spectrum of variants and pathologic conditions that may involve the liver vasculature. These include variants, anomalies, and diseases involving the portal vein, such as rudimentary portal vein, thrombosis, cavernous transformation, thrombotic angiitis, thrombophlebitis, transient hepatic attenuation difference or transient hepatic intensity difference, portal venous aneurysm, and portal vein gas. The hepatic artery can be involved by various diseases, including thrombosis, stenosis, and aneurysm or pseudoaneurysm. Unusual "third inflow" sources of venous inflow are also discussed, including aberrant right gastric vein, aberrant left gastric vein, epigastric-paraumbilical veins, and cholecystic vein. A spectrum of variants and diseases involving the inferior vena cava and hepatic veins, including thrombosis, Budd-Chiari syndrome, veno-occlusive disease, stenosis, torsion, congestive hepatopathy, and peliosis hepatis, are discussed. Vascular shunts are illustrated, including portosystemic shunts (intra- and extrahepatic), arterioportal shunt, shunts of hereditary hemorrhagic telangiectasia, and acquired arteriovenous fistula. Familiarity with the pathogenesis and imaging features of these vascular entities can aid radiologic diagnoses and guide appropriate patient management. RSNA, 2017.
肝脏具有复杂的血管供应，包括通过肝动脉（体循环）流入的含氧血液和通过门静脉（门脉循环）流入的脱氧血液，以及通过肝静脉将脱氧血液流出至下腔静脉。一系列血管变异可累及肝脏。其中一些变异可能导致强化区域，可模拟更严重的病理状况。在本文中，作者讨论了一系列可能累及肝脏脉管系统的变异和病理状况。这些包括累及门静脉的变异、异常和疾病，如门静脉发育不全、血栓形成、海绵样变性、血栓性血管炎、血栓性静脉炎、短暂性肝衰减差异或短暂性肝密度差异、门静脉瘤和门静脉积气。肝动脉可被多种疾病累及，包括血栓形成、狭窄以及动脉瘤或假性动脉瘤。还讨论了不常见的静脉流入“第三流入”来源，包括异常的右胃静脉、异常的左胃静脉、腹壁 - 脐周静脉和胆囊静脉。讨论了一系列累及下腔静脉和肝静脉的变异和疾病，包括血栓形成、布加综合征、肝静脉闭塞性疾病、狭窄、扭转、充血性肝病和肝紫癜。展示了血管分流，包括门体分流（肝内和肝外）、动门分流、遗传性出血性毛细血管扩张症的分流以及后天性动静脉瘘。熟悉这些血管病变的发病机制和影像特征有助于放射学诊断并指导适当的患者管理。RSNA，2017年。
