门静脉海绵样变性门脉胆支及胆系改变的MRI研究

目的　探讨门静脉海绵样变性(CTPV)门脉胆支及胆系改变在 MRI上的表现及其诊断价值。方法　对18例行门体分流术的CTPV病人手术前后均行MR平扫、增强、门静脉动态对比增强MRA (dynamic contrast enhanced magnetic resonance angiography, DCE MRA)、MRCP检查,所有病例均经手术病理或DSA证实。结果　CTPV门脉胆支改变:18 例 CTPV病人门体分流术前MRI及DCE MRA显示Petren胆囊周围静脉和胆总管外表面的Saint网状静脉丛17例,表现为迂曲扩张或呈结节状。分流术后显示胆囊周围静脉 3 例,Saint网状静脉丛 2 例。胆系改变:门体分流术前胆总管狭窄伴远端扩张6例、胆总管壁不规则5例、胆总管壁增厚4例、胆总管成角移位3例、胆囊壁增厚8例。分流术后胆系改变部分恢复。结论　MRI能准确检测 CTPV病人门脉胆支及胆系的改变,早期正确判断门脉胆支及胆系的改变对胆系病变的鉴别诊断及临床采取正确的治疗措施具有重要意义。

MRI for biliary collateral veins and biliary abnormalities in patients with cavernous transformation of portal vein

Objective To investigate the MRI features of biliary collateral veins and associated biliary abnormalities in patients with cavernous transformation of the portal vein and to determine the diagnostic value of MRI for biliary collateral veins and associated biliary abnormalities. Methods Eighteen patients with CTPV underwent plain and contrast enhancement scanning, dynamic contrast enhanced magnetic resonance angiography and MRCP MR imaging before and after portosystemic shunt. All the 18 cases were confirmed by operation and pathological examination or DSA. MR features in these 18 patients were analyzed. Results MR findings in biliary collateral veins of the portal vein in CTPV: 17 cases showed the paracholedochal veins of Petren and the epicholedochal plexus of Saint and presented with varices or tumor like, nodosity tissue before the surgery of shunt. After shunt, 3 cases showed the paracholedochal veins of Petren and 2 showed the epicholedochal plexus of Saint. MR findings in biliary abnormalities: Before the surgery of shunt, stenosis with dilatation of the proximal bile duct could be seen in 6 cases, the ductal wall was irregular in 5, and thickened in 4, angulation showed in 3 and the gallbladder wall was thickened in 8. After the surgery of shunt, biliary abnormalities recovered in some cases. Conclusions Biliary collateral veins and associated biliary abnormalities in the patients with CTPVA can be correctly identified by MRI. These collaterals frequently alter the biliary system, which must be considered in differential diagnosis of biliary abnormalities, and is important for clinical therapy planning.