吡咯生物碱相关肝窦阻塞综合征患者数字减影血管造影图像特征

The digital subtraction angiography image characteristics of patients with pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome

目的:观察吡咯生物碱相关肝窦阻塞综合征(PA-HSOS)患者的数字减影血管造影(DSA)图像特征,为PA-HSOS的早期诊断提供依据。方法:选取5例PA-HSOS予以经颈静脉肝内门体分流术(TIPS)治疗的患者作为研究组,选取同期肝硬化门静脉高压行TIPS治疗的10例患者作为对照组,分析和比较两组患者临床资料、腹部增强CT影像DSA下门静脉系统图像,明确PAHSOS患者的DSA图像特征。结果:PA-HSOS患者均存在不同程度的肝损伤,但是肝损伤程度较轻;PA-HSOS患者增强CT多见肝脏肿大、密度不均一、实质强化不均匀,脾脏不肿大,腹水,门静脉不宽,胃冠状静脉未见明显显示或纤细。而肝硬化患者肝脏多见体积明显缩小,肝脏实质强化均匀,门静脉明显增宽,胃冠状静脉可见。PA-HSOS患者DSA下门静脉未见明显增宽,门静脉呈枯树枝样改变,细小末梢未见明显显示,肝内门静脉未见节段性扩张,胃冠状静脉未见显示或者纤细。而肝硬化患者门静脉显著增宽,肝内门静脉节段性扩张,门静脉末梢可见显影,胃冠状静脉明显可见,脾静脉迂曲。结论:PA-HSOS患者DSA下门静脉未见明显增宽,细小末梢未见明显显示,肝内门静脉呈枯树枝样改变,门静脉未见节段性扩张,胃冠状静脉未见显示或者纤细,是PA-HSOS患者的一个特异征象,DSA下门静脉系统图像特征将为PA-HSOS的诊断提供重要依据。

Objective:The purpose of uor study was to observe the digital subtraction angiography(DSA)image features of pyrrolizidine alkalozid-induced hepatic sinusiolal obstruction syndrome(PA-HSOS),and to provide a help for the diagnosis of PA-HSOS.Methods:We selected 5 PA-HSOS patients treated with transjugular intrahepatic portosystemic shunt(TIPS)in our hospital as the study group,10 patients with portal hypertension due to cirrhosis and received TIPS treatment during the same period were selected as the control group.We collected clinical data,enhanced CT images of the abdomen,image of portal vein system under(DSA).DSA image characteristics of PA-HSOS patients were defined.Results:All patients with PA-HSOS had different degrees of liver injury,but the degree of liver injury was mild.Enhanced CT of patients with PA-HSOS showed hepatomegaly,ascites,uneven liver density,uneven liver parenchymal enhancement and no splenomegaly.The portal vein was not wide and the gastric coronary vein was not obvious or slender.In patients with cirrhosis,liver volume was significantly reduced,liver parenchyma was strengthened evenly,portal vein was significantly widened,gastric coronary vein was visible.In the DSA image of PA-HSOS patients,the portal vein was not significantly enlarged.The portal vein was similar to a dead branches in winter,because the tiny tips were not clearly visible.The intrahepatic portal vein did not show segmental dilatation.Gastric coronary veins were not visible or slender.The portal vein of patients with liver cirrhosis was significantly widened,the portal vein appeared as a segmental dilation,the fine tip of the portal vein could be displayed,the gastric coronary veins were clearly visible,and the splenic veins were tortuous.Conclusion:In the DSA image of PA-HSOS patients,the portal vein is not significantly enlarged.The portal vein is similar to a dead branches in winter,because the tiny tips are not clearly visible.The intrahepatic portal vein do not show segmental dilatation.Gastric coronary veins are not visible or slender.The above phenomenon is a specific sign in patients with PA-HSOS.The DSA image features of portal vein system provide an important basis for the diagnosis of PA-HSOS.