SLEEK非增强磁共振血管成像技术诊断Budd-Chiari综合征的初步探索

Budd-Chiari syndrome: the initial diagnostic experience of unenhanced MR angiography using spatial labeling with multiple inversion pulses

目的探索多翻转脉冲空间标记(SLEEK)序列的非增强磁共振血管成像(NEC-MRA)对Budd-Chiari综合征(BCS)的诊断价值。方法对临床怀疑BCS的55例患者,行SLEEK扫描,并将患者的MRI、彩色多普勒超声(US)检查资料和数字减影血管造影(DSA)对比,评估SLEEK序列对BCS的诊断能力。包括检出肝静脉、下腔静脉病变及显示下腔静脉、肝静脉血栓和肝内、外侧支循环的能力并进行统计学分析,比较它们的诊断效能。结果 55例中17例患者最终经DSA或手术诊断为BCS。17例BCS中,DSA诊断肝静脉型4例,下腔静脉型7例,混合型6例;SLEEK诊断肝静脉型4例,下腔静脉型6例,混合型7例;US诊断肝静脉型5例,下腔静脉型5例,混合型7例。SLEEK、US在BCS诊断与分型方面与DSA比较没有统计学意义(P>0.05);SLEEK对BCS分型的敏感度为94.12%(16/17),US对BCS分型敏感度为82.35%(14/17),二者不具有统计学差异(P>0.05)。以DSA作为金标准,SLEEK对肝内、外侧支循环及下腔静脉血栓的显示较US更直观、清晰。结论 SLEEK序列诊断BCS敏感性优于US,同时具有直观、诊断符合率较高、无需对比剂的优点,可作为US之外诊断BCS的另一选择。

To explore the value of unenhanced MR angiography （MRA） using spatial labeling with multiple inversion pulses （SLEEK） in the assessment of Budd-Chiari syndrome （BCS）. Methods 55 patients with clinically suspected BCSunderwent MRA using the SLEEK sequence. The demonstration of hepatic vein, inferior vena cava （IVC） , hepatic vein thrombosis,and intrahepatic and lateral branch circulation by MRA, Doppler ultrasound （US） , and digital subtraction angiography （DSA） wascompared and the diagnostic efficacy was analyzed. Results 17/55 patients were confirmed to have BCS by DSA and surgery involving the hepatic vein （4）, IVC （7）, or mixed （6）. BCS was suspected on SLEEK MRA in the hepatic vein （4）, IVC （6）, or mixed（7） whereas Doppler US suggested lesions of hepatic vein （5）, IVC （5）, or mixed （7）. There was no statistical significant difference inthe diagnosis and classification of BCS（P〉0.05） on SLEEK MRA, Doppler US and DSA. The BCS classification sensitivity of SLEEKMRA （94.12%, 16/17） was not significantly different（P〉0.05） from that of Doppler US （82.35%, 14/17） . Using DSA as the goldstandard, SLEEK MRI demonstrated thrombus in the intrahepatic and lateral branch circulation, and IVC more clearly and directlythan Doppler US. Conclusion SLEEK MRA is superior to Doppler US in the diagnosis of BCS.