门静脉和肠系膜上静脉血栓形成的CT、MRI诊断

目的探讨门静脉（PV）和肠系膜上静脉（SMV）血栓形成的CT、MRI征象及其诊断价值。方法回顾性分析25例经手术与病理证实的PV-SMV血栓形成病例CT和MRI检查资料。结果PV-SMV血栓形成的直接征象CT表现为PV-SMV血管内充盈缺损，PV周围呈轨道样增强；MRI表现为PV和SMV正常流空信号消失；急性、亚急性期血栓T1WI呈等或高信号，T2WI呈高信号；GD-DTPA增强扫描静脉期PV-SMV管腔内对比剂充盈缺损。PV-SMV血栓形成的间接征象包括肠腔扩张积液，肠管积血，肠壁增厚，肠黏膜水肿，薄纸样肠壁，缆绳征，肠系膜积液，肠壁积气，腹腔积液，门静脉海绵样变，肝脏异常灌注。结论CT、MRI是诊断PV-SMV血栓形成最有效的影像检查方法，MRI对PV-SMV血栓形成的定位、定量及血栓的分期优于CT。

Diagnosis of portal vein and mesenteric venous thrombosis with CT and MRI

Objective To determine the value of CT and MRI for diagnosis of portal vein and mesenteric venous thrombosis. Methods The CT and MRI data of 25 patients with operatively and pathologically confirmed portal vein and mesenteric venous thrombosis were retrospectively analyzed. Results The direct signs of portal vein and mesenteric venous thrombosis were contrast medium filling defects in PV and SMV, double track-like enhancement around PV and diminishing of flow empty signal of PV and SMV. On T1WI, the acute and subacute thrombi showed i sointensity or hyperintensity, but it represented high signal in T2WI images. At venous phase of Gd-DTPA enhancement scanning, contrast medium filling defects could be seen in the PV and SMV. Indirect signs of the portal vein and mesenteric venous thrombosis were intestinal distension, intestinal hematocele, thickening of the intestinal wall, edema of the intestinal mucosa, mesenteric haziness, ascites PV sponginess. Conclusions CT and MRI are the best imaging methods for diagnosis of the portal vein and mesenteric venous thrombosis.