1.5TMRI在布-加综合征中的诊断价值

Value of 1.5T MRI in the Diagnosis of Budd-Chiari Syndrome

目的探讨1.5TMRI在布-加综合征(BCS)中的诊断价值。资料与方法经临床、超声和数字减影血管造影(DSA)确诊的35例BCS患者行MRI与磁共振血管成像(MRA)检查,分析BCS影像的直接和间接征象。结果 35例BCS中,Ⅰ型26例,Ⅱ型8例,Ⅲ型1例;急性期9例,亚急性期和慢性期26例。35例患者中,经MRI诊断30例(85.7%),其中Ⅰa型10例,Ⅰb型16例,Ⅱ型3例,Ⅲ型1例;经DSA诊断31例(88.6%),其中Ⅰa型6例,Ⅰb型16例,Ⅱ型8例,Ⅲ型1例。MRI显示直接征象为下腔静脉或(和)肝静脉主干血栓或阻塞32例;间接征象为肝外侧支循环血管23例,肝内侧支血管15例,副肝静脉3例,肝脏体积增大12例,体积缩小11例,肝尾叶增大13例,肝脏信号不均匀15例,肝脏边缘不均匀异常强化12例,腹腔积液7例,肝再生结节2例。MRI与DSA对BCS的诊断正确率比较,差异无统计学意义(χ2=2.248,P>0.05),但在显示Ⅰa型和Ⅱ型BCS上差异有统计学意义(χ2=9.270、8.015,P<0.05)。结论 1.5TMRI能满意地显示BCS的直接征象和间接征象,能够比较准确地进行分型,诊断正确率高,为临床诊断提供有价值的影像学信息。

Purpose To evaluate the diagnostic value of 1.5T MR[ in Budd-Chiari syndrome （BCS）. Materials and Methods Thirty-five patients with BCS confirmed by clinical data, ultrasound examination and digital subtraction angiography （DSA） examination were selected. All patients received MRI examinations and magnetic resonance angiography （MRA）. The direct and indirect signs of BCS were analyzed. Results Of the 35 BCS, 26 were type I, 8 were type 11, 1 was type Ill, 9 cases were in acute phase and 26 were in sub-acute and chronic phase. 30 cases （85.7%） were correctly diagnosed by MRI, including 10 cases of type I a, 16 cases of type I b, 3 cases of type ]I and 1 case of type llI; 31 cases （88.6%） were correctly diagnosed by DSA, including 6 cases of type Ia, 16 cases of type Ib, 8 cases of type I] and 1 case of type II. Direct MR signs included interior vena cava and/or liver vein thrombosis or obstruction （n=32）. The indirect signs included extra-hepatic collateral vessels （n=23）, intrahepatic collateral vessels （n=l 5）, accessory hepatic vein （n=3）, increased liver volume （n-12）, decreased liver volume （n=ll）, increased caudate lobe （n=13）, heterogeneous liver signal intensity （,=15）, inhomogeneous enhancement of the liver edge （n=12）, ascites （n=7） and hepatic regenerative nodules （n=2）. No statistical difference in the diagnostic accuracy of BCS was shown between MRI and DSA （x2=2.248, P〉0.05）, but there were significant differences in the diagnostic accuracy of type I a and type 1I BCS. Conclusion 1.5T MRI can display the direct and indirect signs of BCS, and can correctly show the type of BCS, thus it provides important imaging information tbr clinical diagnosis.