肝脏三维容积超快速多期动态增强磁共振成像在布加综合征副肝静脉检出中的应用价值

Value of three - dimensional liver acceleration volume acquisition multiphase dynamic contrast-enhancedmagnetic resonance imaging in detection of accessory hepatic veins in Budd - Chiari syndrome

目的探讨肝脏三维容积超快速多期动态（LAVA）增强磁共振成像（MRI）技术在检测布加综合征副肝静脉中的应用价值。方法回顾性分析202例行LAVA增强MRI和血管造影（DSA）检查的布加综合征患者的病例资料。分别用MRI和DSA计数直径≥5mm副肝静脉支数。以DSA为金标准，采用Kappa检验评估两种检查方法对检出副肝静脉的一致性，并绘制受试者工作特征曲线评价MRI对副肝静脉的检出率。用配对X。检验比较两者观察副肝静脉开口闭塞情况有无差异性。结果202例患者中，MRI检出副肝静脉139例，未检出副肝静脉63例。DSA检出副肝静脉123例，未检出副肝静脉79例，两种检查方法对检出副肝静脉的一致性较好（Kappa值=0．631）。受试者工作特征曲线下面积为0．868，MRI检出副肝静脉的敏感度及特异度高。MRI和DSA分别检出27、24支副肝静脉开口闭塞，差异无统计学意义（X2=0．342，P=0．558）。结论LAVA多期动态增强扫描技术可较准确地检出布加综合征副肝静脉，能够对患者病情评估及治疗方法选择提供帮助。

Objective To investigate the application value of three-dimensional liver acceleration volume acquisition （LAVA） multiphase dynamic contrast-enhanced magnetic resonance imaging （MRI） in the detection of accessory hepatic veins （AHVs） in Budd-Chiari syndrome. Methods A retrospective analysis was performed for the clinical data of 202 patients with Budd-Chiari syndrome who underwent LAVA multiphase dynamic contrast-enhanced MRI and digital subtraction angiography （DSA）. MILl or DSA was used to determine the number of AHVs with a diameter of 〉5 mm. With DSA as the gold standard, the Kappa test was used to evaluate the consistency between these two methods in the detection of AHVs. The receiver operating characteristic （ROC） curve was plotted to evaluate the detection rate of AHVs by MR/. The paired chi-square test was used to compare the difference between MRI and DSA in the detection of occluded openings of AHVs. Results Among the 202 patients, 139 had AHVs detected by MRI, and 63 did not have AHVs detected by MRI; 123 had AHVs detected by DSA, and 79 did not have AHVs detected by DSA. These two methods showed good consistency in the detection ofAHVs （k= 0.631）. The area under the ROC curve was 0.868, and MRI had high sensitivity and specificity in the detection ofAVHs. MRI detected the occluded openings of 24 AHVs, and DSA detected the occluded openings of 27 AHVs; there was no significant difference in the number of AHVs with occluded openings detected between MR/and DSA （X2 = 2.2568, P = 0.1330）. Conclusion LAVA multiphase dynamic contrast-enhanced MR/can accurately detect AHVs in Budd-Chiari syndrome and helps to evaluate the patient＇s condition and select therapeutic methods.