双源64层CT诊断布加综合征

Diagnosis of dual source 64 slices computed tomography for Budd-Chiari syndrome

目的:探讨双源64层CT(dual source 64slices computed tomography,DSCT)在布加综合征(Budd-chiari syn-drome,BCS)中的诊断价值。方法:回顾性分析11例经DSA或手术证实的布加综合征双源64层CT影像特点。血管重建采用最大密度投影(MIP)、容积再现(VR)和多平面重建(MPR)技术。结合多角度旋转及切割功能,下腔静脉应侧重于冠状及矢状位观察,肝静脉及肝内侧支血管侧重于轴位及冠状位的显示。结果:肝脏体积增大8例(72.7%),尾叶增大7例(63.6%)。平扫肝脏密度不均6例(54.56%),增强扫描7例肝脏密度不均,尾叶、肝门附近的肝实质呈现斑片状强化,延迟扫描肝脏呈等密度改变。肝静脉未显示者10例(90.9%),肝后段下腔静脉狭窄或阻塞以下下腔静脉扩张8例(72.7%)。明显的肝外侧支血管8例(72.7%),腹腔或腹膜后静脉明显曲张5例(45.5%),腹壁静脉曲张3例(27.3%),食管静脉曲张3例(27.3%)。其它脾肿大7例(63.6%),胆囊增大、壁增厚6例(54.5%),腹腔积液5例(45.5%),肝硬化2例(18.2%)。结论:DSCT具有扫描速度快,连续扫描能力强,大范围及薄层扫描的优势,能准确直观反映布加综合征阻塞的性质、部位、范围、侧支血管及其与周围器官的空间关系,能从形态学及功能上反映肝脏损害程度,在诊断布加综合症上有较大的价值。

Objective：To investigate the diagnostic value of dual source 64 slices computed tomography for Budd-Chiari syndrome. Methods：The DSCT features of ll cases with Budd-Chiari syndrome eonfimed by DSA or operation were analyzed retrospectively＇. The vessels were reconstituted through multiplanar reconstruction （MPR）, volume rendering （VR） and maximum intensity projection （MIP）. With multi-angle rotation and dissection function, the observation of inferior vena cava should lay particular emphasis on coronal and sagittal view, hepatic veins and collateral vessels inside liver on axial and coronal view. Results： 8 （72.7%）cases showed enlargement of entire liver, 7 of 11 cases （63.6%） caudal lobe showed enlarged, and 6（54.56%） showed uneven density. 10（90.9%） hepatic veins were not showed. 8（72.7%） inferior vena cava showed stenotic, 8 （72.7 % ） cases showed collateral vessels outside liver, 5 （45.5 %） with abdominal cavity or retroperitoneal varicose veins, 3（27.3 % ） with abdominal wall varicose veins, 3 （27.3 % ） with esophageal varices, 7 （63.6 9% ） with splenomegaly, 6（54.5 %0） with gallbladder enlarged, 5 （45.5 %） with seroperitoneum, and 2 （18.2） with cirrhosis. Conclusion：Dual source 64 slices computed tomography has a scanning speed fast, successive scanning capability strong, and can scan in wide-scale and thin slice. It can accurately and directly reflect the nature, position, scope, collateral circulation and space relation, as well as the morphological and functional damage of live, and playing an important role in diagnosis of 13udd-Chiari syndrome.