布-加综合征合并下腔静脉血栓形成的磁共振诊断

Magnetic resonance imaging diagnosis of Budd-Chiari syndrome associated with inferior vena cava thrombosis

目的探讨磁共振成像(magnetic resonance imaging,MRI)在布-加综合征(Budd-Chiarisyndrome,BCS)合并下腔静脉(inferior vena cava,IVC)血栓形成的临床应用价值。方法 2009年5月至2012年7月诊断为BCS合并IVC血栓形成患者36例,所有患者均于入院1周内行MRI、数字减影血管造影(digital subtraction angiography,DSA)检查及IVC置管溶栓治疗。剔除溶栓治疗后IVC血栓部分溶解患者,共纳入IVC急性血栓(溶栓治疗后IVC血栓完全溶解)患者13例,IVC慢性血栓(溶栓治疗后IVC血栓未见明显溶解)患者12例作为研究对象。结果在IVC急性血栓患者,血栓在SE序列T1WI上多为低、等信号表现,在FSE序列T2WI多为高信号表现。在IVC慢性血栓患者,血栓在SE序列T1WI上多为等、高信号表现,在FSE序列T2WI多为低或等信号表现。另外,比较IVC急性与慢性血栓患者的磁共振血管增强成像(contrast enhanced magnetic resonance angiography,CE-MRA)发现,急性血栓多为中心性腔内充盈缺损(12/13),而慢性血栓多为偏心性腔内充盈缺损(6/12),组间差异有统计学意义(P=0.03);慢性血栓附壁率高于急性血栓(83%比23%),且急性血栓内对比剂渗入的概率明显高于慢性血栓(54%比0%),组间差异均有统计学意义(P=0.005)。MRI对急性血栓诊断的敏感度为69.2%,特异度为83.3%。结论 MRI检查在诊断BCS合并IVC血栓及急、慢性程度判别方面具有重要的临床参考价值。

Objective To discuss the clinical application of magnetic resonance imaging （MRI） in diagnosing Budd-Chiari syndrome （BCS） complicated by inferior vena cava （IVC） thrombosis. Methods During the period from May 2009 to July 2012, a total of 36 patients with proved BCS with IVC thrombosis were admitted to authors＇ hospital. MRI scanning, digital subtraction angiography （DSA） and transcatheter thrombolytic therapy were carried out in all patients within one week after admission. Eleven patients whose IVC thrombosis was partially dissolved after thrombolytic therapy were excluded from this study. Thirteen patients with IVC thrombosis that was completely dissolved after thrombolytic therapy were classified as acute thrombosis group, and twelve patients with IVC thrombosis that was not obviously dissolved after thrombolytic therapy were classified as chronic thrombosis group. The clinical results were analyzed. Results In patients of acute thrombosis group, the acute thrombi were characterized by lower or iso-signal intensity on %WI （SE sequence） and high signal intensity with heterogeneous internal structures on T2WI （FSE sequence）. In patients of chronic thrombosis group, the thrombi were manifested as iso-signal or high signal intensity on TIWI and lower or iso-signal intensity on T1WI. Besides, contrast-enhanced magnetic resonance angiographyshowed that most acute thrombi took the form of central intraluminal filling defect （12/13）, while many chronic thrombi presented as eccentric intraluminal filling defect （6/12）, and the difference between the twogroups was statistically significant （P = 0.03）. The mural thrombus rate in chronic thrombosis group （83%） was significantly higher than that in acute thrombosis group （23%）, while the infiltration rate of contrast into the thrombi in acute thrombosis group （54%） was strikingly higher than that in chronic thrombosis group （0%）, （P = 0.005）. The sensitivity and specificity of MRI in diagnosing acute IVC thrombosis were 69.2% and 83.3% respectively. Conclusion MRI is of great value in diagnosing Budd- Chiari syndrome complicated by inferior vena cava thrombosis as well as in differentiating the acute thrombi with chronic ones. （ J Intervent Radiol, 2013, 22 ： 372-376）