肝内门静脉周围水肿MR征象及潜在临床意义

MRI signs and potential clinical significance of intrahepatic periportal edema

目的 探讨肝内门静脉周围水肿(periportal edema, PPE)MR征象及其潜在临床意义。方法 收集2019年3月—2022年4月期间在上海市静安区市北医院行上腹部MRI平扫及增强检查病例的影像及临床资料,共计522例,回顾性分析病例是否存在肝内PPE的MR征象以及各主要序列上该征象的影像表现,同时根据病变范围将其分为肝叶型及全肝型,并结合肝内PPE征象阳性病例的临床资料,评价PPE征象的潜在临床意义。结果 522例中有104例存在肝内PPE征象,阳性率为19.9%。低b值DWI序列显示肝内PPE征象较T2WI脂肪抑制像及T1WI脂肪抑制像增强序列更敏感,显示阳性率达100%。104例肝内PPE阳性病例中,肝源性疾病61例(58.6%),其中全肝型58例,肝叶型3例,以病毒性肝炎、肝硬化、肝转移瘤及药物性肝损伤为主,肝源性占比明显高于其它疾病(P<0.05),全肝型明显多于肝叶型(P<0.01);胆源性疾病26例(25.0%),其中全肝型23例,肝叶型3例,包括胆囊炎、胆总管梗阻;心源性疾病1例(0.9%),表现为全肝型;其他疾病16例(15.4%),表现为全肝型。结论 肝内PPE是一种临床常见的影像征象,低b值DWI有利于其检出及分型,且该征象可能有助于判断其潜在病因及病情程度。

Objective To investigate the MRI signs and potential clinical significance of intrahepatic periportal edema(PPE).Methods The clinical data and imaging findings of 522 patients who underwent upper abdominal MRI plain scan and enhanced examination from March 2019 to April 2022 at Shanghai Jing an District Shibei Hospital were retrospectively collected.The MR signs of intrahepatic PPE and the related imaging manifestations on each major sequence were analyzed.The intrahepatic PPE was divided into liver lobe type and whole liver type according to the lesion range.The potential clinical significance of PPE signs and classification was evaluated.Results Intrahepatic PPE signs were found in 104 of 522 cases,with a positive rate of 19.9%.DWI sequences with low B-value showed more sensitive intrahepatic PPE signs than T2WI and T1WI fat suppression images,with a positive rate of 100%.Among 104 cases with positive PPE signs,61(58.6%)were hepatogenic diseases,including 58 cases of whole liver type and 3 cases of liver lobe type,which were mainly viral hepatitis,cirrhosis,liver metastases and drug-induced liver injury.The proportion of liver origin was significantly higher than other diseases(P<0.05),and whole liver type was significantly higher than liver lobe type(P<0.01).There were 26 cases of biliary diseases(25.0%),including cholecystitis and bile duct obstruction,among which 23 cases were whole liver type and 3 cases were liver lobe type.One case(0.9%)of cardiogenic disease presented as whole liver type,and 16 cases(15.4%)of other diseases also showed whole liver type.Conclusion Intrahepatic PPE is a common imaging sign,and low B-value DWI is conducive to its diagnosis and classification.Different types of intrahepatic PPE signs may help to determine the latent etiology and severity of the symptoms.