64层螺旋CT对布-加综合征的诊断价值

Diagnostic Value of 64 Slice Spiral Computed Tomography for Budd-Chiari Syndrome

目的探讨布-加综合征(Budd-Chiari syndrome,BCS)的64层螺旋CT(64 slice spiral CT,64SCT)的表现特征及诊断价值。方法29例被64SCT诊断为BCS且有数字减影血管造影(digital substractionangiography,DSA)资料的患者纳入本研究,由2位从事腹部放射诊断的医师回顾性分析图像,除了观察肝脏形态学改变和门静脉高压情况外,重点观察肝静脉和(或)下腔静脉的病变,64SCT结果与DSA结果对照。结果①64SCT对BCS的诊断准确率为93.1%(27/29),出现2例假阳性,无假阴性患者。64SCT对肝静脉和(或)下腔静脉血栓形成及下腔静脉隔膜形成诊断准确率高,对狭窄诊断能力有限。②肝脏的异常改变包括肝脏肿大(24例)、密度降低(27例)、不均匀强化(动脉期5例,门脉期19例)。③所有患者均有不同程度的门静脉高压。结论64SCT对BCS的诊断准确率高,很少出现假阴性,能准确显示BCS患者肝脏的形态学异常和侧支循环,但对判断肝静脉和(或)下腔静脉狭窄准确率不高。

Objective To investigate the imaging features of Budd-Chiari syndrome （BCS） on 64 slice spiral computed tomography （64SCT） and the diagnostic value of 64SCT for BCS. Methods Twenty-nine patients diagnosed as BCS by 64SCT were retrospectively included into this study and all the patients were researched by digital substraetion angiography （DSA）. Two abdominal radiologists analyzed the CT imaging features of BCS, paying at tention to the vascular lesion, the morphology abnormality of the liver and the degree of portal hypertension, with review of DSA findings. Results ①The accuracy of 64SCT for BCS was 93. 1% （27/29）, and there were 2 false positive cases and no false negative case. The accuracy of 64SCT for those patients with thrombosis of inferior vena cava （IVC） and （or） hepatic vein （HV） was high as compared to those with stenosis of IVC and （or） HV. ②The morphology abnormality of the liver included hepatomegaly （24 cases）, low attenuation （27 cases） and inhomogeneous pattern of parenchymal contrast enhancement （5 patients in arterial phase and 19 patients in portal vein phase）. ③The images of all the patients showed the features of portal hypertension. Conclusion The accuracy of 64SCT for BCS is satisfactory and the false negative is seldom. The 64SCT could accurately display the morphology abnormality of the liver and the compensatory circulation in BCS patients. For those patients with stenosis of IVC and （or） HV, however, the diagnostic power of 64SCT is limited.