三维对比剂增强MR门静脉成像与直接门静脉造影术对照

目的通过与直接门静脉造影术的比较，评价三维对比剂增强MR门静脉成像（3D CE MRP）的准确性。方法26例患者行3D CE MRP和直接门静脉造影检查。分析3D CE MRP上门静脉主干、肝内左右分支的开放性和侧支循环发生情况，其结果与直接门静脉造影对照，评价两者符合情况，并分析两者不符的原因。结果3D CE MRP和直接门静脉造影显示门静脉主干的结果完全一致。对肝内门静脉分支，有21例2种检查结果符合，但有5例不符。1例肝右叶巨大肿瘤，3D CE MRP显示门静脉右后支闭塞，但直接门静脉造影显示明显狭窄。3例左叶肝癌患者，3D CE MRP显示门静脉左支闭塞，但直接门静脉造影显示其近段狭窄和远端闭塞。另有1例肝癌患者，3D CE MRP显示门静脉左支矢状段小癌栓，而直接门静脉造影却未能显示。除1例脐静脉重开由于扫描范围较小未显示之外，3D CE MRP显示侧支循环的结果和直接门静脉造影相符。结论多数病例，3D CE MRP的显示结果与直接门静脉造影符合。3D CE MRP在鉴别肝内门静脉分支狭窄或闭塞时有一定限度，而在显示门静脉小栓子方面却有优势。

3D contrast-enhanced MR portography and direct X-ray portography: a correlation study

Objective To evaluate the accuracy of 3D contrast-enhanced MR portography (3D CE MRP) by correlating with direct X-ray portography. Methods Twenty-six patients underwent 3D CE MRP study. The findings of 3D CE MRP including the patency of the portal vein and its intrahepatic left and right branches, as well as collaterals were evaluated and compared with those from direct x-ray portography. Causes of disagreement between the two methods were analyzed. Results The main portal vein appearance was accordant with 3D CE MRP and direct x-ray portography in all cases. For intrahepatic portal veins, the results agreed in 21 patients but disagreed in 5. In one patient with a huge tumor in right liver, the right posterior portal vein was classified as occluded at 3D CE MRP, but displaced and diffusely narrowed at direct x-ray portography. The findings of left intrahepatic portal vein were discordant in three patients with hepatocelluar carcinoma in the left lobe. 3D CE MRP demonstrated complete occlusion of the left portal veins, whereas direct x-ray portography showed proximal narrowing and distal occlusion. In another patient with hepatocelluar carcinoma, a small non-occlusive thrombus involving the sagittal segment of the left portal vein was seen on MRP but not on direct x-ray portography. With demonstration of portosystemic collaterals, 3D CE MRP showed results similar to those of X-ray portography, except one recanalized para-umbilical vein was excluded from the limited scan coverage. Conclusion 3D CE MRP correlated well with direct x-ray portography in most cases. Compared with direct portography, 3D CE MRP had limitation in distinguishing narrowing of an intrahepatic portal vein from occlusion. But it showed advantage in demonstrating small thrombus within portal vein.