门静脉高压镰状韧带内门体侧支循环在三维动态增强MR血管成像上的表现

目的 探讨门静脉高压镰状韧带内门体侧支循环在三维动态增强MRA(3D DCEMRA)的表现及临床意义.方法 回顾性分析53例镰状韧带内门体侧支循环形成的门静脉高压患者影像资料,分析其3D DCE MRA图像,总结曲张静脉卣径、数目、走行的位置以及引流静脉的变化情况.结果镰状韧带内门体侧支循环均起自门静脉左支,直径0.4～2.6 cm,数目1～3支,分为上下2组,镰状韧带下组静脉即脐静脉或附脐静脉,共47例,向脐水平以上引流16例,7例经腹壁上静脉、9例经胸腹壁静脉向上引流;向脐水平以下引流40例,7例经腹壁下静脉,33例经腹壁浅静脉向下引流;其中向上向下引流并存9例.镰状韧带上组静脉直接经胸廓内静脉向上引流6例.结论门静脉高压镰状韧带内门体侧支循环分为上下2组,3D DCE MRA可全面评价其开放情况以及引流静脉的走行和起止位置.

Portosystemic collateral circulation in the falciform ligament: evaluation with three dimensional dynamic contrast enhanced MR angiography in patients with portal hypertension

Objective The purpose of our study was to investigate three dimensional dynamic contrast enhanced MR angiography(3D DCE M RA) in the detection of portosystemic collateral circulation in the falciform ligament in patients with portal hypertension. Methods From April 2003 to July 2008, 53 portal hypertension patients with varices in the falciform ligament were evaluated with 3D DCE MRA.Two radiologists independently assessed the number, diameter, location and drainages of the portosystemic collateral circulation in the falciform ligament according to the information on the 3D DCE MRA.Results The veins in the falciform ligament were classified into the superior and inferior groups, and both groups arise from the left trunk of the portal vein.In our study, the number of varices detected on 3D DCE MRA images varied from 1 to 3, and the diameters of these vessels varied from 0.4 to 2.6 cm.The inferior group consisted of paraumbilical/umbilical veins (47 cases), which flowed toward umbilicus and then drained upwards (n = 16) including deep superior epigastric veins (n = 7), superficial superior epigastric veins (n = 9), downwards (n = 40) including deep inferior epigastric veins (n = 7), superficial inferior epigastric veins (n = 33), or upwards and downwards at the same time (n = 9).The superior group of vessels in the falciform ligament were directly anastomosed with the internal thoracic vessels (n = 6).Conclusion In patients with portal hypertension, 3D DCE MRA can optimally demonstrate the portosystemic collateral circulation in the falciform ligament, which includes the superior and inferior drainage groups.