MRI诊断24例肝静脉型布-加综合征的分析

Magnetic resonance imaging of 24 cases of Budd-Chiari syndrome with hepatic venous obstruction

目的探索MRI对肝静脉型布-加综合征的诊断价值。方法经DSA证实的24例肝静脉型布-加综合征患者,分析其MRI影像特点。结果直接征象:24例患者中,肝静脉或副肝静脉近心端阻塞19例(79.2%),其中膜性阻塞12例,节段性阻塞7例;肝静脉显示不清5例(20.8%);肝静脉内或肝内侧支血管内血栓形成6例(25.0%),其中新鲜血栓4例,陈旧性血栓2例。间接征象:肝尾状叶增大17例(70.8%);肝实质不均匀强化16例(66.7%);副肝静脉增粗9例(37.5%);肝内侧支血管形成20例(83.3%);肝外侧支血管15例(62.5%);肝内再生结节3例(12.5%)。结论 MRI能从血管病变、侧支循环以及肝实质病变多个角度来诊断肝静脉型BCS。

Objective To investigate the value of MRI for diagnosing Budd-Chiari Syndrome （BCS） with hepatic venous （HV） obstruction. Methods MRI of 24 patients with hepatic venous obstruction confirmed by digital subtraction angiography （DSA） was reviewed. Results Of 24 patients, proximal HV or accessory hepatic venous （AHV） obstruction was found in 19 （79.2%） including membranous obstruction （12） and segmental obstruction （7）. HV was not well seen in the remaining 5 patients （20.8%）. Thrombus was detected in HV or collateral vein in 6 patients （25.0%）, of whom 4 were fresh and 2 were chronic thrombi. Indirect signs included caudate lobe hypertrophy （17, 70.8%）, heterogeneous enhancement of the liver （16, 66.7%）, AHV dilatation （9, 37.5%）, intrahepatic collaterals （20, 83.3% ）, extrahepatic collaterals （15, 62.5% ）, and regenerating nodules （3, 12.5% ）. Conclusions BCS with HV obstruction can been accurately diagnosed on MRI, which displays clearly the vascular lesions, collaterals and liver parenchyma lesions.