利用磁共振肝脏加速容积采集技术研究布加综合征患者不同侧支循环类型与分型

Using liver acceleration volume acquisition enhanced MRI to study the different collateral pathways in patients with various types of Budd-Chiari syndrome

目的利用磁共振肝脏加速容积采集技术（LAVA）研究布加综合征（BCS）患者肝内外侧支循环类型与其分型的相关性。方法回顾性分析240例行LAVA增强磁共振（MRI）和数字减影血管造影（DSA）检查的BCS患者的临床资料。用DSA判断其分型，用磁共振LAVA技术统计肝内外侧支的种类及数量。采用χ^2检验判断侧支循环类型与BCS分型的相关性。选用Cramer修正列联系数描述两者的相关程度。结果240例BCS患者中，DSA显示肝静脉阻塞型60例，下腔静脉阻塞型39例，混合型141例。MRI显示副肝静脉扩张157例，肝内交通支建立69例，膈下静脉扩张43例，腹壁浅静脉扩张135例，脐静脉扩张94例，奇／半奇静脉扩张195例。6种侧支循环中，仅副肝静脉和奇／半奇静脉侧支建立与分型具有相关性（分别为χ^2=30．239，P〈0．05、χ^2=51．295，P〈0．05）。两者与BCS分型的相关程度分别为0．355、0．462。副肝静脉扩张在混合型中最多见，占79．4％，奇／半奇静脉扩张在下腔静脉阻塞型和混合型中均多见，分别占92．3％、91．5％。结论副肝静脉、奇／半奇静脉侧支循环的建立与布加综合征分型相关，而肝内交通支、膈下静脉、腹壁浅静脉、脐静脉侧支的建立与分型无相关性。LAVA技术可为BCS诊断与治疗提供有用信息。

Objective To study the intra- and extra-hepatic collateral pathways in various types of Budd-Chiari syndrome （BCS） using liver acceleration volume acquisition （LAVA） enhanced MRI. Methods The clinical data and imaging findings of 240 patients with BCS were collected and analyzed. The types of BCS confirmed by DSA. Intra- and extra-hepatic collateral pathways were studied using LAVA enhanced MRI with a 3.0T scanner. Correlations of the intra-/extra-hepatic collateral pathways with the types of BCS were analyzed using the Chi-square test. Then, the degrees of correlation were calculated by the Cramer correction coefficient of contingency. Results Among the 240 patients, DSA confirmed 60 patients to have hepatic vein occlusion, 39 patients to have inferior vena cava occlusion and 141 patients to have both hepatic vein and inferior vena cava occlusion. MRI demonstrated dilated accessory hepatic veins in 157 patients, intra-hepatic communicating branches in 69 patients, inferior phrenic veins in 43 patients, superficial epigastric veins in 135 patients, umbilical veins in 94 patients and hemiazygos/azygos veins in 195 patients. Accessory hepatic veins and hemiazygos/azygos veins as collateral pathways were associated with the types of BCS （χ^2 = 30. 239, P 〈 0. 05 ; χ^2 = 51. 295, P 〈 0. 05, respectively）. The degrees of correction were 0. 355 and 0. 462, respectively. Accessory hepatic veins as collateral pathways were most common in the mix type, accounting for 79.4%. Hemiazygos/azygos veins were most common in the inferior vena cava occlusion type and the mix type, accounting for 92.3 % and 91.5 %, respectively. Conclusions Accessory hepatic veins and hemiazygos/azygos veins as collateral pathways were associated with the types of BCS, while the intra-hepatic communicating branches, inferior phrenic veins, superficial epigastric veins and umbilical veins were not correlated with the types of BCS. LAVA may help to diagnose and determine the best choiceof treatment for the various types of BCS.