门静脉系统的影像学检查与病理结果的对比研究

目的探讨彩色多普勒超声（CDU）和磁共振血管成像（MRA）对门静脉血栓和瘤栓诊断的临床应用价值。方法165例肝移植病例术前针对门静脉系统作BUS及MRA检查,所得结果与肝移植术中解剖及术后病理证实的门静脉栓子的部位和性质进行对比,分析两者对门脉阻塞诊断的敏感性和特异性,对门脉血栓或瘤栓性质诊断的正确率,从而评价此二项检查的临床应用价值。结果病理解剖发现肝硬化77例中6例门脉血栓形成,88例肝癌中7例门脉血栓形成,28例瘤栓形成。BUS对门静脉阻塞总的敏感性为86．5％,特异性为97．4％,阳性预测值和阴性预测值分别为85．3％及97．6％;MRA对门静脉阻塞总的敏感性为90．5％,特异性为99．3％,阳性预测值和阴性预测值分别为95．7％及98．4％。但两者对术前门脉血／瘤栓性质的诊断正确率均低于70％。结论BUS和MRA均为门静脉系统无创性检查,各有优缺点,均存在一定数量的假阳性和假阴性率,MRA的敏感性高于BUS,但两者均不能准确诊断门脉阻塞的性质,需要进一步的临床研究。

Clinical values of color doppler ultrasound and magnetic resonance angiography in diagnosis of the tumor emboli and thrombi in portal venous system

OBJECTIVE: To evaluate the clinical values of color Doppler ultrasound (BUS?) and magnetic resonance angiography (MRA) in diagnosis of the tumor emboli and thrombi in portal venous system. METHODS: Examination of the portal venous system by BUS and MRA was conducted on 165 patients with undergoing liver transplantation because of cirrhosis or primary hepatic carcinoma before the operation. The extrahepatic portal vein was observed during operation and pathological examination was conducted after the operation. The results of BUS and MRA were compared as regards the sensitivity and specificity in discovering the tumor emboli and thrombi in portal venous system. RESULTS: The overall sensitivity, specificity, and positive predictive rate of BUS for the portal vein embolus were 86.5%, 97.4%, and 85.3% respectively. The overall sensitivity, specificity, and positive predictive rate of MRA for the portal vein embolus were 90.5%, 99.3%, and 95.7% respectively. However the accuracy in diagnosing the nature of the portal venous embolus was less than 70% for these 2 methods. CONCLUSION: Non-invasive, both BUS and MRA help discover the portal vein embolus. However, false positivity and false negativity still exist. And both fail to diagnose the nature of the portal venous embolus.