CT和MR三维血管成像技术对于TIPSS的价值

CT Angiography and MR Angiography to Transjugular Intrahepatic Portosystemic Stent Shunt

目的 探讨CT血管造影及MR血管造影对门脉高压患者TIPSS治疗的价值。方法 TIPSS术前 10例患者进行了三维MR血管造影 ,2例用MR团注技术测量门脉血流速度。 6 0例进行了三维CT血管造影。所有病例经临床和DSA证实为肝硬化门脉高压 ,其中 ,6 8例行TIPSS治疗。MR血管造影使用西门子 1.5TMR机 ,CT血管造影使用GEHighSpeedCT/i扫描机。结果 MR血管造影 :10例患者均可见门静脉主干及其肝内分支扩张 ,但其中 2例有布加综合征的表现。 3例患者可见侧支循环及静脉曲张 ,表现为胃左静脉丛和左肾静脉曲张、脾肾分流。应用MR“团块追踪”技术测量了 2例门脉主干的血流速度 ,分别为 11.8cm/s和 10 .6cm/s。CT血管造影 :准确地显示了 6 0例患者的肝动静脉解剖、门脉主干扩张及其小血管分支 ,以及 19例侧支循环及曲张血管。结论 CT血管造影和MR血管造影是一种无创性的检查方法 ,可充分显示肝静脉和门静脉解剖及变异 ,为TIPSS术前提供了重要信息。CT血管造影的空间分辨率优于MR血管造影。

Objective To evaluate the value of CT angiography and MR angiography for transjugular intrahepatic portosystemic stent shunt (TIPSS) in treating patients with portal venous hypertention.Methods Prior to TIPSS, 3D MR venography and 3D CT angiography of abdomen were performed in 10 patients and in 60 patients respectively, MR bolus tracking technique was used in two cases to measure velocity of portal vein. All cases were confirmed as liver cirrhosis associated with portal venous hypertetion by clinical and DSA study, 68 cases underwent TIPSS. MR venography were done with a 1.5T system (Siemens), and CT angiography with single slice spiral CT.Results MR angiography: The dilatation of main portal vein and its intrahepatic branches were shown in 10 patients among them Budd-Chiari syndrome were found in 2 cases.The large varices including dilatation of the left gastic venous plexus and the left renal vein suggesting splenorenal shunting were revealed in 3 cases, the flow velocity of main portal vein were measured in two cases as 11.8cm/s and 10.6cm/s. CT angiography: The anatomy of hepatic artery and vein ,and the dilatation of main portal vein and its intrahepatic branches were demonstrated in 60 patients, the large varices in 19 cases.Conclusion As excellent non-invasive techniques,CT angiography and MR venography can fully show hepatic and portal venous anatomy for TIPSS. The spatial resolution of CTA is better than that of MRI for detecting smaller branches of hepatic blood vessel.