3D DCE MRA在诊断Budd-Chiari综合征中的应用价值

目的评价三维对比动态增强磁共振血管成像(3D DCE MRA)在诊断Budd-Chiari综合征(BCS)中的价值。方法8例BCS术前接受了常规MRI和3D DCE MRA检查,着重于回顾性分析其3D DCE MRA表现。结果8例3D DCE MRA检查显示下腔静脉阻塞3例,下腔静脉和肝静脉阻塞5例。下腔静脉阻塞部位在肝段5例、膈段1例及膈上段2例,阻塞表现形式包括膜性1例及节段性7例。伴有肝静脉阻塞的5例中肝静脉开口处阻塞3例,肝静脉分支阻塞2例。8例中有5例显示肝内侧枝循环,包括肝包膜下静脉侧枝循环、叶间静脉侧枝循环及肝内未定型侧枝循环。8例均显示肝外侧枝循环,包括深层静脉侧枝循环、中层静脉侧枝循环、浅层静脉侧枝循环及门静脉侧枝循环。8例BCS的其他征象包括肝实质信号异常、肝脏形态改变、下腔静脉内血栓形成、脾大、腹水及胸水。结论3D DCE MRA在诊断BCS中具有很高的价值,是诊断和治疗前后全面评价BCS的无创性血管成像技术。

The Value of 3D DCE MRA in Diagnosing Budd -Chiari Syndrome

Objective To evaluate the value of three-dimensional dynamic contrast-enhanced MR angiography (3D DCE MRA) in diagnosing of Budd-Chiari syndrome (BCS). Methods 8 patients with BCS underwent conventional MRI and 3D DCE MRA examination before operation. In this study, 3D DCE MRA features were retrospectively analyzed with emphasis. Results 3D DCE MRA demonstrated the emphraxis of inferior vena cava (IVC) in 3 cases,the occlusion of IVC and hepatic vein (HV) in 5 cases. The position of IVC obstruction occurred at hepatic section in 5 cases, diaphragmatic section in 1 case and above diaphragmatic section in 2 cases. The manifestation of IVC obstruction included membranaceous obstruction in 1 case and sectional obstruction in 7 cases. The obstruction occurred at hatch of HV in 3 cases and the branches in 2 cases among 5 cases with HV and IVC occlusion. There were 5 cases with intrahepatic collateral circulations including subcapsule HV collateral circulations, hepatic interlobar vein collateral circulations and unstereotypia collateral circulations. Extrahepatic collateral circulations was demonstrated in all patients, including deep layer collateral circulations, middle layer collateral circulations, superficial layer collateral circulations and portal vein. Other signs in 8 patients were displayed, including signal abnormalities of hepatic parenchyma, hepatic deformation, IVC thrombus, splenomegaly, ascitic fluid and pleural fluid.Conclusion 3D DCE MRA is one no-invasion angiography and has important value in evaluating BCS comprehensively.