MRI肝脏加速容积采集成像在评估布-加综合征侧支循环中的价值

The value of MRI LAVA imaging in the evaluation of collateral circulation in Budd-Chiari syndrome

目的:探讨3.0 T MRI肝脏加速容积采集(LAVA)技术在评估布-加综合征(BCS)患者侧支循环中的价值。方法:搜集经数字减影血管造影(DSA)确诊的40例BCS患者,回顾性分析其MRI LAVA影像资料,计算LAVA对BCS分型的诊断符合率;分析LAVA对常见肝内外侧支循环的检出率及侧支循环与BCS分型的相关性;采用Kappa检验评估LAVA与DSA对直径≥3.0 mm副肝静脉的检出一致性。结果:LAVA诊断下腔静脉阻塞型18例,肝静脉阻塞型13例,混合型9例;DSA证实下腔静脉阻塞型18例,肝静脉阻塞型15例,混合型7例;MRI LAVA对BCS分型的诊断符合率为95.0%(38/40)。LAVA显示奇/半奇静脉扩张33例(82.5%),副肝静脉扩张22例(55.0%),腹壁浅静脉扩张19例(47.5%),肝内交通支静脉扩张17例(42.5%),膈下静脉扩张9例(22.5%)。奇/半奇静脉侧支主要存在于下腔静脉梗阻型和混合型BCS(P<0.01,相关程度为0.595),而副肝静脉侧支主要存在于混合型BCS(P<0.01,相关程度为0.426)。LAVA检出副肝静脉31支,平均管径为(7.1±3.4)mm,LAVA与DSA对副肝静脉检出的一致性较好(Kappa值=0.767)。结论:MRI LAVA扫描技术在BCS分型诊断、侧支循环评估中具有重要价值,能为临床BCS的诊疗提供有用信息。

Objective:To investigate the value of 3.0T MRI liver accelerated volume acquisition(LAVA)in the evaluation of collateral circulation in patients with Budd-Chiari syndrome(BCS).Methods:The 40 patients with BCS diagnosed by DSA were retrospectively collected.The MRI LAVA images and the diagnostic value of MRI LAVA in BCS classification were analyzed.The detection rate of common collateral circulation inside and outside the liver by MRI LAVA and the correlation between collateral circulation and BCS classifications was analyzed.Consistency of MRI LAVA and DSA in the diagnosis of hepatic veins(≥3.0mm in diameter)was analyzed by Kappa test.Results:18 cases of inferior vena cava obstruction,13 cases of hepatic vein obstruction,9 cases of mixed type were diagnosed by MRI LAVA;18 cases of inferior vena cava obstruction,15 cases of hepatic vein obstruction,7 cases of mixed type were diagnosed by DSA;The diagnostic accuracy of MRI LAVA for BCS classification was 95.0%(38/40).The MRI LAVA showed odd/semi-singular vein dilatation in 33 cases(82.5%),parahepatic vein dilatation in 22 cases(55.0%),abdominal wall superficial vein dilatation in 19 cases(47.5%),intrahepatic traffic branch vein expansion in 17 cases(42.5%),and infraorbital vein dilatation in 9 cases(22.5%).The odd/semi-singular collateral vein mainly existed in the inferior vena cava obstruction type and mixed type BCS(P<0.01,V=0.595),while the accessory hepatic vein mainly existed in mixed type BCS(P<0.01,V=0.426).MRI LAVA detected 31 branches of the accessory hepatic vein with an average diameter of(7.1±3.4)mm.MRI LAVA and DSA had a good agreement on the detection of accessory hepatic vein(Kappa value=0.767).Conclusion:MRI LAVA scanning technology is of great value in the diagnosis of BCS classification and collateral circulation,and can provide useful information for the diagnosis and treatment of BCS.