Budd-Chiari综合征肝尾状叶的形态学变化

Morphological Changes of Hepatic Caudate Lobe in Budd-Chiari Syndrome

目的利用增强MRI检查观察Budd-Chiari综合征(BCS)患者肝尾状叶的变化及其诊断价值。资料与方法回顾性分析2014年4月—2017年4月太和县人民医院收治的43例BCS患者、36例乙肝肝硬化患者和31例肝脏正常者(对照组)的上腹部MRI增强扫描资料,比较3组研究对象的肝尾状叶横径和尾状叶静脉显示率,比较不同病程、病变类型BCS患者的肝尾状叶静脉管径,绘制肝尾状叶横径诊断BCS的受试者工作特性(ROC)曲线。结果 BCS组肝尾状叶横径大于对照组和乙肝肝硬化组,差异均有统计学意义(P<0.01);对照组和乙肝肝硬化组肝尾状叶横径差异无统计学意义(P>0.05)。BCS组肝尾状叶静脉显示率均高于对照组和乙肝肝硬化组,差异均有统计学意义(χ~2=21.278、21.070,P<0.01);对照组和乙肝肝硬化组肝尾状叶静脉显示率比较,差异无统计学意义(χ~2=0.054,P>0.05)。BCS组中,33例患者可见肝尾状叶静脉,尾状叶静脉管径1.60～7.90mm,平均(4.40±1.59)mm。慢性BCS患者尾状叶静脉管径大于急性BCS,差异有统计学意义(t=-5.001,P<0.05)。下腔静脉型或混合型BCS患者尾状叶静脉管径大于肝静脉型(t=-3.781,P<0.05)。ROC曲线下面积为0.861(95%CI0.777-0.946)。当尾状叶横径取43.49 mm时,敏感度为76.74%、特异度为90.32%。与超声相比,采用尾状叶横径诊断BCS的特异度较高(χ~2=4.757,P=0.033)。结论肝尾状叶体积增大、尾状叶静脉扩张是BCS患者的特征性改变,具有一定的诊断和病情评估价值。

Purpose To observe the changes of hepatic caudate lobe in patients with Budd-Chiari syndrome （BCS） through contractenhanced MRI and explore its significance in clinical practice. Materials and Methods Retrospective analysis of epigastric MRI enhanced imaging data concerning 43 patients with BCS, 36 patients with hepatitis B cirrhosis and 31 cases of normal liver （control group） admitted to Taihe County People＇s Hospital from April 2014 to April 2017 was performed. The transverse diameter of hepatic caudate lobe and caudate lobe veins display rate of research subjects in the 3 groups were measured and compared. Hepatic caudate lobe vein diameters of patients with varied disease courses and lesion types of BCS were compared. ROC curve of BCS diagnosed via hepatic caudate lobe transverse diameter was plotted. Results The transverse diameter of hepatic caudate lobe in the BCS group was larger than that in the control group and the hepatitis B cirrhosis group （P〈0.01）, with difference in transverse diameter of hepatic caudate lobe between the control group and the hepatitis B cirrhosis group demonstrating no statistical significance （P〉0.05）. The display rate of hepatic caudate lobe vein in the BCS group was higher than that in the control group and the hepatitis B cirrhosis group, the difference of which was statistically significant （χ2=21.278, 21.070, P〈0.01）, with difference in display rate of hepatic caudate lobe vein in the control group and the hepatitis B cirrhosis group showing no statistical significance （χ2=0.054, P〉0.05）. 33 patients were detected hepatic caudate lobe vein in the BCS group, with the vein diameter ranging between 1.60-7.90 mm, and average vein diameter （4.40±1.59） mm. The vein diameter of hepatic caudate lobe in patients with chronic BCS was larger than that of acute BCS, the difference of which was statistically significant （t=-5.001, P〈0.05）. The vein diameter of hepatic caudate lobe of patients with inferior vena cava type or mixed BCS was larger than that with hepatic vein type （t=-3.781, P〈0.05）. The area under the ROC curve was 0.861 （95% CI 0.777-0.946）. When the transverse diameter of caudate lobe was set at 43.49 ram, the sensitivity and specificity were 76.74% and 90.32%, respectively. Compared with ultrasound, BCS diagnosis drawing on transverse diameter of caudate lobe displayed higher specificity （χ2=4.757, P=0.033）. Conclusion The increase of hepatic caudate lobe volume and the expansion of caudate lobe vein are the characteristic changes of BCS patients, featuring certain value in disease diagnosis and evaluation.