一站式完成肝脏磁共振动态增强并血管成像对食管胃静脉曲张的诊断价值

The diagnostic value of one-stop liver magnetic resonance dynamic enhanced MRA for esophageal and gastric varces

目的评价一站式完成的肝脏磁共振动态增强并血管成像对胃食管静脉曲张的诊断价值。方法使用Philips Achieva1．5TMRI扫描仪对82例临床及实验室检查诊断肝硬化门静脉高压患者同时行肝脏平扫及多时相三维动态增强，将原始图像在工作站作最大强度（MIP）重建，提取门静脉期图像，观察门静脉及其分支走形、分布，并结合横断面图像仔细观察食管和胃有无静脉曲张及曲张静脉的来源、程度、深浅、有无其他部位曲张静脉及肝脏病理情况。与胃镜检查结果对照，观察食管、胃是否存在静脉曲张。结果所有患者均可清晰显示门静脉主干及门静脉三级分支，诊断食管及胃静脉曲张78例，其中胃底静脉曲张合并食管静脉曲张27例，单纯胃静脉曲张19例，单纯食管静脉曲张32例。同时诊断肝硬化合并肝癌6例，提示肝硬化结节癌变8例。内镜发现食管及胃底静脉曲张68例，其中胃静脉曲张合并食管静脉曲张25例，单纯胃静脉曲张8例，单纯食管静脉曲张35例。结论肝脏一站式三维动态增强及血管成像对门静脉高压患者食管、胃底静脉曲张部位、程度诊断有重要价值，检查效果优于内镜。

Objective To investigate the diagnostic value of one-stop liver magnetic resonance dynamic enhanced MRA for esophageal and gastric varces. Methods 82 patients with liver cirrhosis portal hypertension who were diagnosed by clinical and laboratory detect were taken, conducting liver horizontal scanning and muhitemporal three dimensional dynamic enhanced scanning using Philips Achieva 1.5T MRI scanner,and then make maximum intensity projection（MIP） at work station to draw up portal vein image, observing the form and distribution of portal vein and its branches, meanwhile refer to cross sectional image to carefully observe whether there was cirsoid vein in esoph- agns and stomach, and further the source, degree and depth of cirsoid vein were compared, and whether there was cir- soid vein in other parts, and the pathological situation of liver. Compared with the result of gastroscope inspection, whether there is cirsoid vein in esophagus and stomach. Results The trunk and class-Ⅲ branches of portal vein of all patients had been clearly shown. In this team, there were esophageal and gastric varces in 78 patients, specifically including varices of fundus of stomach ＆ esophageal varices in 27 patients, and varices of fundus of stomach and varices of body of stomach in 19 patients. Meanwhile,it diagnose 6 patients with liver cirrhosis and liver cancer and indicate 8 patients with liver cirrhosis nodule cancerization. The endoscope found out esophageal varices and varices of fundus of stomach in 68 patients, specifically including gastric varicesa and esophageal varices in 25 patients, sole gastric varicesa in 8 patients, and sole esophageal varices in 35 patients. Conclusion The one-stop liver three dimensional dynamic enhanced MRA is with great value in diagnosing the location and degree of esophageal varices and varices of fundus of stomach of patients with portal hypertension. The overall effect is better than endoscope.