磁共振血管造影在门静脉高压症外科中的临床应用

Preliminary application of magnetic resonance angiography in surgical treatment of portal hypertension

目的 将磁共振血管造影 (MRA)与多普勒超声对门静脉系统解剖影像及血流动力学的检查结果作对比 ,评价MRA在门静脉高压症外科中的应用价值。方法 对肝硬变门静脉高压症组病人包括行手术者和非肝硬变对照组进行 3D DCEMRA(三维动态对比增强磁共振血管造影 )和 2D PCMR(二维相位对比磁共振 )检查 ,检测门静脉系统解剖显像和血流量 ,后者与多普勒超声 (DUS)进行比较。结果 3D DCEMRA能较好显示PV、SV、SMV和头向侧支以及分流术的吻合口。 2D PCMR对门脉系统血流量的测定与DUS无显著差别。结论 MRA为无创性检查 ,能较好显示门静脉系统的解剖影像 ,可与传统X线血管造影媲美 ,并可测得血流动力学资料 ,在门静脉高压症外科中具有实用价值。

Objective To compare results of portal venous anatomy and hemodynamics obtained by magnetic resonance angiography (MRA) with those got by Doppler ultrasonography (DUS) to evaluate role of MRA in portal hypertensive surgery. Methods Three dimensional dynamic contrast-enhanced (3D-DCE) MRA and two dimensional phase-contrast (2D-PC) MR were used for study of portal venous anatomy and portal blood flow (PBF) in the patients with portal hypertension and those without. In addition, the PBF measured with 2D-PC MR was compared with that measured with DUS. Results The portal vein, splenic vein, superior mesenteric vein, cephalic collateral veins and anastomic stoma of surgical shunting were clearly displayed by 3D-DCE MRA. There was no marked difference between PBE measured with 2D-PC MR and that measured with DUS. Conclusions MRA is a non-traumatic examination and can display well the anatomy of the portal system. So it is similar to the conventional X-ray angiography. PBF can be accurately measured with 2D-PC MR. MRA is a useful tool in the study of portal venous anatomy and portal blood flow in patients with portal hypertension. In addition, it is valuable for portal hypertensive surgery.