Budd-Chiari综合征下腔静脉阻塞端形态的磁共振静脉成像与数字减影血管造影的对照研究

目的 评价磁共振静脉成像(MRV)对Budd-Chiari综合征下腔静脉阻塞端形态的诊断价值. 方法 对44例下腔静脉阻塞的Budd-Chiari综合征患者进行MRV检查,评价下腔静脉阻塞端形态,并与数字减影血管造影(DSA)表现进行对比.采用配对x2检验并计算Kappa值,对比MRV及DSA对下腔静脉形态显示的一致性.结果 44例Budd-Chiari综合征患者中包括下腔静脉完全阻塞37例,不完全阻塞7例;MRV显示其中不完全阻塞4例.37例完全阻塞中,MRV显示近心端圆锥形36例,平台形1例;远心端圆锥形30例,平台形4例,不规则形3例.以DSA为金标准,MRV诊断下腔静脉完全阻塞的灵敏度为100％ (37/37)、特异度为57.1％ (4/7);阳性预测值为92.5％ (37/40),阴性预测值为100％.结论 MRV成像有利于Budd-Chiari综合征下腔静脉阻塞端,尤其是远心端的观察,有助于介入治疗方案的制订.

Study on between magnetic resonance venography and digital subtraction angiography on the inferior vena cava obstructive interface morphology of Budd-Chiari syndrome

Objective To evaluate magnetic resonance venography (MRV) in diagnosing obstructive interface morphology of Budd-Chiari syndrome(BCS).Methods MRV examination was performed on 44 cases of BCS,and the images of obstructive interface morphology of the inferior vena cava were reviewed by two radiologists.Results In all 44 cases,there were 37 cases with complete obstruction and 7 with incomplete obstruction.MRV showed 4 cases with membrane with hole of incomplete obstruction.The morphologies MRV demonstrated that the proximal part of the 37 cases with complete obstruction were mainly divided into the cone type (36 cases) and the planurm type (1 case).Besides,the type of distal end of obstruction were the cone type (30 cases),the planum type (4 cases) and the irregular type (3 cases).The overall sensitivity,specificity,positive and negative predictive values for the diagnosis of MRV were respectively 100％％,57.1％,92.5％ and 100％ as compared to the DSA.Conclusion The examination of MRV is capable of revealing the obstructive interface morphology of the inferior vena cava,especially for the distal end of obstruction.MRV can provide guidelines in interventional treatment of Budd-Chiari syndrome.