3D DCE MRP在评价肝硬化门脉高压症门静脉系统血管解剖及侧支循环的价值

目的:探讨三维动态对比增强磁共振门脉血管造影(3DDCEMRP)在肝硬化门脉高压症门静脉系统及门体侧支循环显像中的应用价值.方法:对19例肝硬化门脉高压症组病人及51例非肝硬化对照组行3DDCEMRP检查,测量门脉系统各主要干支的径线并比较两者差异;于3DDCEMRP检查前后10d内,对所有肝硬化症组患者行门脉间接造影,以其结果为标准,分析侧支循环发生的部位和分布范围,评价两者的符合情况.结果:肝硬化门脉高压症组MPV、SPV及SMV直径明显大于对照组(P<0.05),门脉分支级数明显减少;但Child A、B级患者间MPV直径及门脉分支级数的减少无明显差别(P>0.05).同时,3D DCE MRP显示2例门脉主干海绵样变并检出48条肝外侧支血管,与DSA结果相对照,除1例脐静脉开放及1例自发性脾肾分流未见显示外,其余侧支循环在3D DCE MRP 上均清楚显影,总符合率为96.0%(48/50).结论:3DDCEMRP能较好显示门脉系统的解剖影像,并对曲张静脉、侧支循环显影良好,也是诊断门脉海绵样变的有效方法.对于门脉高压症的诊断及手术治疗有重要指导意义.

Role of contrast-enhanced 3D magnetic resonance portography in evaluating hepatic vascular anatomy of portal hypertension in cirrhotic liver

Objective: To evaluate the capability of contrast-enhanced three-dimensional (3D) MR portography in detecting vascular anatomy of portal system and shunt branch in portal hypertension patients. Methods: 19 and 51 cases with or without portal hypertension were detected. The main branches in portal venous system were measured and analyzed in 3D DCE MRP,while additional DSA was done in those with portal hypertension after 3D DCE MRP about ten days. The results of3D DCE MRP assessing the distribution and extent of the collateral vein were compared with the results of portography. Result: For portal hypertension cases,MPV,SPV and SMV were larger than that of control respectively. The differences of MPV and decreased sub-branching of portal vein between Child A and B patients were not significant. Furthermore,2 cases of portal cavernous transformation and 48 collateral veins were detected in our study. 3D DCE MRP displayed the collateral veins well,with a coincidence rate of 96.0%(48/50). Conclusions: 3D DCE MRP is a very useful technique in visualizing portal veins,by it,a significant positive imaging of collateral veins in portal hypertension cases can be obtained. It is proved to be a reliable and useful modality .for diagnosing portal cavernous transformation and portal hypertension.