磁共振多期动态增强扫描与血管重建对Budd-Chiari综合征的评价

Budd-Chiari syndrome:evaluation with multiphase dynamic contrast-enhanced MR and revascularization

目的:分析Budd-Chiari综合征(BCS)磁共振多期动态增强扫描的影像学征象,评价磁共振三维动态增强血管成像(3DDCEMRA)对BCS的诊断价值。材料与方法:33例BCS患者进行了磁共振多期动态增强扫描,对其相关血管分别以最大强度投影法(MIP)和多平面重建法(MPR)进行3DDCEMRA。以手术或DSA结果作对照,评价磁共振多期动态增强扫描与血管重建对判断BCS血管梗阻部位、程度以及肝内外侧支循环建立的价值。结果:磁共振多期动态增强扫描显示:下腔静脉狭窄21例,下腔静脉闭塞12例。肝静脉狭窄或闭塞15例,副肝静脉增粗10例,肝内或肝外侧支循环形成23例。MIP血管重建可显示血管和侧支循环总体情况,而MPR血管重建可多角度直接显示血管。肝实质异常包括:肝脏各叶比例失调、尾状叶增大11例,肝实质信号不均匀并斑片状强化25例,显示良性结节7例。结论:磁共振多期动态增强扫描能够准确地反映BCS肝脏血流动力学变化,结合3DDCEMRA,能够更直观、准确地显示血管梗阻平面及肝内、外侧支循环,是一种有效的术前全面评价BCS的无创性检查技术。

Objective： To analyze the images of the Budd-Chiari syndrome（BCS） by muhiphase dynamic contrast-enhanced MR and evaluate the clinical value of three-dimensional dynamic contrast-enhanced MR angiography（3D DCE MRA）. Materials and Methods： Thirty-three patients with BCS underwent multiphase dynamic contrast-enhanced MR examinations. The relevant vessels were reconstructed respectively with MIP and MPR, i.e. 3D DCE MRA. Compared with the findings of surgery or DSA, we estimated the value of muhiphase dynamic contrast-enhanced MR examinations and their revascularization in judging the obstruction level and showing intra/extra-hepatic collateral vessels. Results： Muhiphase dynamic contrast-enhanced MR examinations of 33 patients with BCS demonstrated narrowed IVC in 21, obstructed IVC in 12, narrowed or obstructed HV in 15, enlarged accessory hepatic veins in 10, intrahepatic or extrahepatic collateral vessels in 23. The information of vessels and collateral pathways could be showed with MIP reconstruction, and MPR could directly display vessels by multiangles. Liver parenchymal abnormalities displayed by muhiphase dynamic contrast-enhanced MR examination showed irregularities of liver contours and hypertrophy of the caudate lobe in 11 cases, heterogeneous patchy enhancement in 25 cases and complicated benign regenerative nodules in 7 cases. Conclusion- Multiphase dynamic contrast-enhanced MR examination can correctly reflect the hepatic hemodynamic changes in patients with BCS, and combined with 3D DCE MRA, can explicitly display the obstruction level of vascular lesions and collateral circulations in BCS. So, it is an effective, noninvasive method for evaluating BCS before surgery or intervention.