胰源性区域性门静脉高压的MRI表现

MR imaging features of pancreatic segmental portal hypertension

目的：探讨胰源性区域性门静脉高压（PSPH）的MR特点及临床意义。方法收集2005年5月～2012年12月73例PSPH患者的MRI图像，包括T1 WI双回波序列，轴位T2 WI压脂序列及轴位和冠状位多期动态增强扫描序列（LAVA），分析原发病灶、脾静脉及侧支循环的MR表现。结果73例PSPH均表现为脾静脉狭窄、闭塞、中断。（1）胃冠状静脉（GCV）入口未受累的52例中，胃冠状静脉迂曲扩张43例、胃短静脉（GSV）扩张52例、胃网膜静脉（GEV）扩张52例、胃结肠干（GCT）迂曲扩张30例，食管静（esophageal vein，EV）迂曲扩张2例，脾静脉-（左）肾静脉交通支3例；（2）胃冠状静脉入口受累的21例病例中，胃冠状静脉、胃短静脉、胃网膜静脉及胃结肠干均迂曲扩张，食管静脉迂曲扩张16例，脾静脉-（左）肾静脉交通支19例。结论 MR可显示胰腺原发病灶及其相关的胰源性门静脉高压的侧支循环特点。

Objective To explore the value of MRI in diagnosing pancreatic segmental portal hypertension（PSPH）. Methods 73 patients with PSPH underwent MRI between May 2005 and December 2012.MRI included dual-echo T1-,fat-saturated T2-and multiphasic contrast-enhanced T1-weighted sequences.The imaging features of primary pancreatic lesion,splenic vein and collateral circulation were analyzed.Results Occlusion or stenosis of the splenic veins with collateral vessels was seen in all patients.Of 52 patients with patent gastric coronary veins,there was varicosity of the gastric coronary veins（43）,short gastric veins （52）,gastroepiploic veins（52）,gastrocolic trunks（30）and esophageal veins（2）as well as left renal-splenic venous shunt（3）.Of 21 patients with gastric coronary vein compression,there was varicosity of the gastric coronary veins,short gastric veins,gastroepiploic veins,and gastrocolic trunks in all patients,varicosity of the esophageal veins in 16 and left renal-splenic venous shunt in 19 patients. Conclusion MRI can display the features of the primary pancreatic lesion and collateral circulation of PSPH.