布加综合征的3D-CEMRA表现及诊断价值

目的：分析布加综合征（BCS）的三维对比剂增强MR血管成像（3D-CE-MRA）表现特征,探讨MRI对BCS的诊断价值.材料与方法：对39例BCS采用3.0T MR扫描仪进行常规MRI平扫及3D-CEMRA检查.观察肝静脉（HV）、下腔静脉（IVC）和门静脉（PV）的开放性,观察有无肝内外侧支循环、门静脉-体静脉间曲张静脉和肝实质病变.其中,17例行超声检查,10例行DSA检查,12例行CT检查.结果：39例BCS中,IVC阻塞型（Ⅰ型）6例,HV阻塞型（Ⅱ型）5例,混合性阻塞型（Ⅲ型）28例;39支IVC中,MRI清晰显示34支IVC阻塞（膜性阻塞15例,节段性阻塞19例）;117支HV中,MRI显示62支HV阻塞（肝右静脉24支,肝中静脉17支,肝左静脉21支）.MRI直接征象表现为HV和/或IVC狭窄、闭塞;间接征象表现为HV和/或IVC阻塞远端血管扩张,肝大、尾叶肿大、脾大,肝内侧枝血管,副HV,肝外侧枝血管,肝硬化,肝癌和肝脏其他占位特别是第二肝门周围占位,腹水,IVC和HV血栓形成.结论：MRI能直接显示HV和/或IVC阻塞的部位、程度及侧枝循环情况,MRI可作为诊断BCS的一种优选的非侵袭性的影像学检查方法.

The 3D-CEMRA Features and Diagnositic Value in BCS

Purpose： To analyze the various features of Budd-Chiari syndrome （BCS） on three-dimensional contrast-enhanced magnetic resonance angiography （3DCEMRA） and to evaluate the diagnositic value in BCS of MRI. Materials and Methods： Conventional MRI and 3D-CEMRA were performed in 39 cases cases on 3.0T MRI unit. The patency of the hepatic veins （HV）, inferior vena（IVC） and portal veins（PV） were assessed. The presence of intra-and extrahepatic collaterals, liver parenchymal abnormalilies and porto-systemic varices were evaluated. Uhrasonograph were performed in 17 cases, DSA in 10 cases and CT in 12 cases. Results： All BCS cases included 6 cases of IVC type, 5 cases of HV type and 28 cases of HV-IVC type. 34 branches of 39 IVC were clear-displayed （membrane-obstruction in 15 cases, segment-obstruction in 19 cases）. 62 branches of 117 HV, were well-displayed （right hepatic veins in 24 cases, venae hepaticae intermediae in 17 cases, left hepatic veins in 21 cases）. Direct findings of MRI was HV and/or IVC stenosis or obstruction. Indirect signs included distant vasodilatati（,n of HV and/or IVC, hepatomegaly, swell of caudal lobe, splenomega- ly, intrahepatic collaterals, para-HV, extrahepatic collaterals, cirrhosis, hepatoma and other mass of the second porta hepatis, ascites and thrombosis of HV or IVC. Conclusion： MR can directly reveal the stenosis of HV and/or IVC in the location, detent and collaterals. Therefore, MR presents an absolute non-invasive technique in comprehensive evaluation of BCS.