Budd-Chiari综合征的MRI诊断及其与血管造影的比较

Diagnosis of Budd-Chiari syndrome in MRI and comparison with venography

目的 :探讨MRI对Budd Chiari综合征 (BCS)的诊断价值。方法 :对 1 2例BCS患者先后行MRI和血管造影检查 ,然后将两种检查结果进行比较。结果 :1 2支下腔静脉中 ,MRI及血管造影均清晰显示 1 0支有阻塞 ,并能判断其阻塞类型 (节段性阻塞 7例 ,膜性阻塞 3例 ) ;36支肝静脉中 ,MRI清楚显示 1 8支肝静脉阻塞 (肝右静脉 8支 ,肝中静脉 5支 ,肝左静脉 5支 ) ,1 8支通畅 (肝右静脉 4支 ,肝中静脉 7支 ,肝左静脉 7支 ) ,而血管造影见 31支肝静脉未显影 (肝右静脉 7支 ,肝中静脉 1 2支 ,肝左静脉 1 2支 ) ,5支显影 (肝右静脉 5支 )。根据检查结果的BCS分型 ,MRI为单纯下腔静脉阻塞 4例 ,单纯肝静脉阻塞 2例 ,并有两者阻塞者 6例 ;而血管造影因肝静脉分支多不能显影 ,难以作出分型诊断。结论 :MRI对Budd Chiari综合征的分型、梗阻的定位、定性较血管造影有明显优势 。

Objective:To evaluate the value of MRI in diagnosing Budd Chiari syndrome(BCS) and its clinical application.Methods:SE sequence transversal T 1WI,TSE sequence transversal and sagittal T 2WI were performed on all of the 12 patients,and 2D TOF MRA were performed on 8 of them.All patients were examined also with inferior venocavography and jugular venography simultaneously.Results:The BCS were divided into three types on MRI.TypeⅠ:occlusion of inferior vena cava in 4 cases.One is membranous and the other three are segmental.TypeⅡ:obstruction of hepatic veins in 2 cases.TypeⅢ:blockade of both hepatic veins and inferior vena cava in 6 cases.The appearances of BCS on venography were segmental occlusion of inferior vena cava in 7 cases,stenosis in 2 cases,membranous occlusion in 2 cases,membranous stenosis in 1 case,only 4 patients' inferior right hepatic vein and 1 patient's right hepatic vein were demonstrated at the same time.Conclusion:MRI has significant advantages than angiography in determining the type of BCS,the position and quality of the occlusion.It should be taken as the routine examination before interventional therapy.