肝小静脉闭塞症与布-加综合征的CT鉴别诊断

目的探讨肝小静脉闭塞症(HVOD)与布-加综合征(BCS)的CT鉴别诊断要点。资料与方法收集20例经病理或临床诊断的HVOD及20例经介入或手术确诊的BCS患者,回顾性分析两组患者的临床资料及CT表现,总结具有特征性的临床及CT表现。结果HVOD患者侧支循环数显著少于BCS患者,差异有统计学意义(P<0.05);两组患者均可出现肝静脉狭窄,但BCS患者更易出现闭塞及远端下腔静脉扩张(P<0.05)。BCS患者更易出现下肢水肿(P<0.05)。16例HVOD患者有服用“土三七”等中药史。HVOD患者中,17例出现3支肝静脉周围正常肝实质强化(即“三叶草”样强化);BCS患者中无此征象出现。HVOD及BCS患者均可出现“地图样”强化,差异无统计学意义(P>0.05)。结论HVOD患者肝静脉可狭窄,但多保持通畅,下腔静脉无扩张,侧支循环少,较少出现下肢水肿,且多有服用“土三七”等中药史。“三叶草”样强化是HVOD的重要强化特点。

CT Differential Diagnosis of Hepatic Veno-Occlusive Disease and Budd-Chiari Syndrome

Purpose To investigate the CT differential features of hepatic veno-occlusive disease(HVOD)and Budd-Chiari syndrome(BCS).Materials and Methods Twenty patients with HVOD diagnosed by pathology or clinical diagnosis and 20 cases patients with BCS diagnosed by intervention or surgery were enrolled,the clinical data and CT manifestations of the two groups were retrospectively analyzed,and the clinical and CT features were also analyzed.Results The number of collateral circulation in HVOD patients was significantly less than that in BCS patients(P<0.05);the hepatic veins in both groups were narrow,but patients with BCS were more prone to occlusion and distal inferior vena cava dilation(P<0.05).BCS patients were more likely to have lower extremity edema(P<0.05).Sixteen patients with HVOD had a history of taking herbal medicine(gynura segetum).Among HVOD patients,17 patients had normal liver parenchymal enhancement around three hepatic veins(Trifolium-like enhancement);no such signs appeared in BCS patients.Both HVOD and BCS patients could have"map-like"enhancement,and the difference was not statistically significant(P>0.05).Conclusion The hepatic veins in patients with HVOD can be narrowed,but mostly kept unobstructed,the inferior vena cava is not dilated,the collateral circulation is less,the lower extremity edema is less,and there is a history of taking herbal medicine such as gynura segetum.Trifolium-like strengthening is an important strengthening feature of HVOD.