下腔静脉梗阻的CT/MR特征与介入治疗相关危险因素评估

The effect of CT/MR in evaluating obstructive characteristics and interventional therapy related risk factors in patients with inferior vena cava obstruction

目的探讨术前影像学评估梗阻特征、危险侧支及下腔静脉内飘浮血栓,在布加综合征腔内治疗中的作用。方法回顾性研究112例在我院行腔内治疗的下腔静脉梗阻患者的临床资料。两名影像学专家评价患者的影像资料,采用Likert五分法评估诊断精确度、一致性。采用Spearman’s相关系数评估影像特征与介入手术操作的相关性。结果两名阅片者对各梗阻特征的诊断敏感度为81.25%～100%。对于评价下腔静脉内飘浮血栓,ROC曲线下面积分别为0.87～0.975;诊断精确度的一致性为0.745～0.927。对于危险侧支的评价,两名阅片者共报告了20例(20/112),一致性为1,共9例在血管造影中显示。Spearman’s检验显示术前影像学特征与介入手术操作之间的相关性有统计学意义。结论术前CT/MR可精确判断下腔静脉梗阻患者的特征且预测介入手术的穿刺路径与操作方法 ,并可显示与介入手术相关的一些危险因素,有助于制定介入手术方案及减少并发症。

Objective The purpose of this study was to determine the role of preoperative imaging for endovascular procedures in Budd-Chiari patients.Methods 112 BCS patients from 2009 to 2017 in our hospital were included in this retrospective study.Two radiologists assessed the imaging data to evaluate diagnostic accuracy on a 5-point Likert scale.Correlation between imaging presentation and interventional procedures was identified by Spearman’s coefficient analysis.Results Diagnostic sensitivities of obstructive characteristics for two readers ranged from 81.25%to 100%.AUROCs for diagnosing floating thrombus of these two readers ranged from 0.87 to 0.975.Inter-reader agreement(κvalue)ranged from 0.745 to 0.927.20 dangerous collateral vessels were reported by two readers,and nine of them were shown on DSV imaging.Spearman’s coefficient showed a statistical correlation between obstructive characteristics and interventional access route and modus operandi.Conclusion MSCT/MR are important and preoperative method to accurately reveal risk factors in BCS patients and may guide interventional planning to minimize complications.