磁共振THRIVE增强扫描对显示食管和胃静脉曲张侧支循环血管的价值

The Value of Enhanced T1 High Resolution Isotropic Volume Examination (eTHRIVE) on Evaluation of Collateral Vessels in Esophageal Gastric Varices

目的探讨MR T1高分辨力各向同性容积激发多期动态增强扫描(e-THRIVE)序列对食管和胃静脉曲张侧支循环血管显示的价值。方法回顾分析82例经临床病史及相关化验检查证实的肝硬化门静脉高压患者上腹部e-THRIVE表现,观察食管和胃静脉曲张部位与程度,同时观察食管静脉曲张侧支循环供血血管及分流血管的特点。应用Kappa检验与内镜检查结果进行一致性分析。结果 82例中,e-THRIVE诊断食管和胃静脉曲张78例。其中食管静脉曲张合并胃底静脉曲张27例,单纯胃底静脉曲张19例,单纯食管静脉曲张32例。59例食管静脉曲张均由胃左静脉供血;单纯胃底静脉曲张19例中由胃左静脉供血11例,由胃左静脉、胃短静脉及胃后静脉混合供血5例,由胃短、胃后静脉供血3例。82例中,伴脾/胃-左肾静脉分流10例,胃左静脉-左肾静脉分流2例。eTHRIVE与内镜诊断结果对比,对食管静脉曲张具有高度一致性(Kappa=0.845),对胃静脉曲张一致性一般(Kappa=0.721)。结论 e-THRIVE能较好地显示食管和胃静脉曲张并能同时显示血供特点,对临床治疗方案的选择有重要意义。

Objective To investigate the value of enhanced T1 High Resolution Isotropic Volume Examination （e THRIVE） on evaluation of collateral vessels in esophageal gastric varices. Methods The eTHRIVE data of 82 cases with esophageal varices confirmed by the clinical history and relevant laboratory tests were analyzed retrospectively, the position, extent of esophageal variees, the characteristics of collateral blood supply and shunt vessels in esophageal varices were observed. The results were consistency analyzed with the endoscopy using Kappa test. Results 78 of 82 cases were diagnosed as esophageal gastric varices with eTHRIVE inspection, there were 27 cases with esophageal variees and gastric vari- ces. There were 19 cases with simple gastric varices. There were 32 cases with simple esophageal varices. 59 esophageal varices were supplied by left gastric vein. 11 of 19 simple gastric varices were supplied by lefr gastric vein. 5 of 19 simple gastric varices were supplied by left gastric vein, short gastric veins and posterior gastric veins. 3 of 19 were supplied by short gastric vein/posterior gastric vein. 10 cases with splenorenal shunt. 2 cases with left gastric vein and left renal vein shunt. Compared with gastroscopy, esophageal varices had well correlation with eTHRIVE inspection （ Kappa = 0. 845 ） ; gastric variees had an ordinary correlation with eTHRIVE inspection（ Kappa = 0. 721 ）. Conclusion eTHRIVE inspection is able to show the esophageal variees and gastric varices; meanwhile it is able to show characteristics of blood supply, which has great significance in choosing clinical treatment plans