三维动态增强磁共振血管成像在肝移植术前的应用

Diagnostic value of 3-dimensional dynamic contrast-enhanced magnetic resonance angiography before liver tansplantation

目的探讨三维动态增强磁共振血管成像(3D DCE MRA)三期扫描技术,评价其在肝移植术前的诊断价值.方法对拟进行肝移植的183例患者进行术前3D DCE MRA成像扫描,采用Siemens Symphony 1.5T超导MRI扫描机,圆形极化相控阵体线圈,3D DCE MRA三期(动脉期、门脉期和静脉期)扫描技术,即对所得图像进行综合评价.结果全部病例均获得了满意的血管成像图像,肝动脉可显示2～3级分支,门静脉可显示2～5级分支,肝静脉可显示1～2级分支.183例肝移植患者,5例显示肝动脉变异,其中2例起自肠系膜上动脉,2例直接起自腹腔干,1例起自胃左动脉.单纯肝硬化门脉高压103例,其中,冠状静脉和食道胃底静脉曲张23例、脐周静脉曲张5例、肠系膜静脉曲张2例、脾门周围静脉曲张30例,门静脉玻璃样变性1例;原发性肝癌79例,5例肝动脉包埋、僵直、推移,2例肝内动-静脉瘘,门静脉右支癌栓23例,门静脉左支癌栓7例,门静脉主干癌栓3例,同时发生门静脉左右支癌栓的2例,MRA表现为门静脉呈半月形或杯口形缺损或不显影.7例肝静脉出现栓塞,5例下腔静脉受压推移,1例下腔静脉瘤栓.结论 3D DCE MRA三期扫描能很好的显示肝动脉、门静脉、肝静脉及下腔静脉系统病变,肝移植术前应用3D DCE MRA,基本达到临床要求,是术前血管评估的有效方法.

Purpose To evaluate the diagnostic value of three - phase scan technology of 3D DCE MRA （3 - dimensional dynamic contrast- enhanced magnetic resonance angiography） before liver transplantion. Methods 3D DCE MRA was performed on 183 patients before liver tramplantion, using Siemens Symphony 1.5T superconduet MRI machine, circular polarized phased- array coil, three- phase （arterial phase,portal venous phase, and venous phase）3D DCE MRA; the images were assessed synthetieally.Results Satisfactory angingraphie images were obtained in all patients. The grade 2 - 3 branches of the hepatic artery, the grade 2 - 5 branches of the portal vein, and the grade 1 -2 branches of the hepatic vein could clearly be visualized. Of 183 eases of liver transplatation, there were 5 eases of variations of hepatic artery, and among them 2 eases came from superior mesenteric artery, 2 eases from celiac tnmeus, and one from left gastric artery. There were 103 eases of hepatecirrhosis with portal hypertension among 183 eases of liver transplatation, including 23 eases of varicosity of coronal vein or esophageal vein, 5 eases caput medusae, 2 eases of mesenterie vein varicosity, and 30 eases of varicose vein around the splenic hilus and 1 ease of hyaline degeneration of portal vein. There were 79 eases of hepatecarcinoma, including 5 eases of hepatic artery embedding, rigidity or shift, 2 cases of hepatic arteriovenous fistula.35 eases of portal vein tumor thrombus （23 in right portal vein, 7 in left portal vein, 3 in portal vein Iruncus, and 2 in right and left portal veins） ,7 eases of hepatic vein tumor thrombus, 1 ease of inferior vena cava embolism, and 5 eases of inferior vena eava shift. Condutions In most eases, three- phase 3D DCE MRA clearly demonstrates lesions in the hepatic arteriy , portal vein, hepatic vein, and inferior vena eava simultaneously. Application of 3D DCE MRA before liver transplantation can basically meet the clinical requirements; it is an efficient method for preoperative blood vessel evaluation.