布-加综合征影像学的诊断价值比较

The comparison of the imaging diagnostic value in Budd - Chiari syndrome

目的探讨布-加综合征（Budd-Chiarisyndrome，BCS）的影像学表现特征，比较不同影像技术诊断BCS的价值。方法选择108例BCS患者，在介入数字减影血管造影（digital subtraction angiography,DSA）前1周完成超声及磁共振血管成像（ magnatie resonance angiorgraphy, MRA）检查。以x线、DSA诊断结果为金标准，分别计算超声及MRA诊断BCS的敏感度、特异度、准确率、阳性预测值和阴性预测值，采用χ2检验比较超声、MRA对BCS的临床诊断准确率；采用Kappa检验比较超声及MRA显示受累血管病变情况的一致性。蛄果以DSA检查作为金标准，超声诊断BCS的敏感度为92．2％、特异度为63．6％、准确率为93．5％、阳性预测值为95．9％、阴性预测值为70．O％。MRA诊断BCS的敏感度为98．0％、特异度为66．7％、准确率为95．4％、阳性预测值为97．0％、阴性预测值为75．0％。超声及MRA检查在BCS临床诊断的正确率方面的差异没有统计学意义（χ2=0．353，P=0．55）；超声及MRA显示肝静脉和下腔静脉的病变情况与DSA具有良好的一致性（Kappa〉0．7）。结论超声与MRA检查在BCS的诊断正确率方面没有差异，超声因其方便、无创及较高的诊断正确率在BCS诊断方面具有不可替代的优势。

Objective To compare the diagnostic value of different imaging techniques for Budd - Chiari （BCS）. Methods 108 cases of BCS were selected in this study. Ultrasonography （US） and magnetic resonance angiography （MRA） were completed 1 week before the intervention of DSA. The X - ray digital subtraction angiography （DSA） diag- nosis was applied as the gold standard of diagnosis results. The sensitivity, specificity, accuracy, positive predictive val- ue and negative predictive value for ultrasound and MRA diagnosis of BCS were calculated, accuracy was used chi - square test to compare US and MRA to BCS clinical diagnosis; by Kappa test comparison of ultrasound and MR.＆ showed consistent involvement of vascular lesions. Results DSA examination as the gold standard, US in the diagnosis of BCS, the sensitivity was 92.2%, specificity was 63.6%, the accuracy rate was 93.5%, the positive predictive value was 95.9%, the negative predictive value was 70%, MRA diagnosis of BCS the sensitivity was 98%, specificity was 66.7%, the accuracy rate was 95.4% ; the positive predictive value was 97.0%, the negative predictive value was 75.0%, the correct rate of US and MRA examination in the diagnosis of BCS was not statistically significant （χ2 = 0.353, P = 0.55 ） ; US and MRA showed that the pathological changes of hepatic vein and inferior vena cava and DSA had good consistency （ Kappa 〉 0.7）. Conclusion Ultrasound and MRA examination have no difference in the diagnos- tic accuracy of BCS, Ultrasound has irreplaceable advantages in diagnosis of BCS because of its convenient ultrasonic di- agnosis, noninvasive and high correct rate.