腹部器官移植术后并发症的磁共振检查

MRI and MRA evaluation of postoperative complications after abdominal organ transplantation

目的 探讨磁共振在腹部器官移植并发症中的诊断价值。方法 对 4例肝移植、5例胰肾联合移植及 2例肾移植患者进行磁共振检查 ,检查时间在术后 2 8d至 2年 ,采用GE1.5TMR机型 ,成像技术包括常规平扫及增强扫描。结果 4例肝移植 ,1例发生肝动脉狭窄伴肝坏死 ,1例发生下腔静脉血栓形成 ,1例为肝静脉与下腔静脉吻合口明显狭窄 ,1例为左右肝管明显狭窄 ;5例胰、肾联合移植中 ,1例并发急性排斥反应 ,1例为移植胰慢性排斥反应伴纤维化 ,1例为迟发性胰腺炎 ,移植肾 4例正常 ,1例并发急性排斥反应伴肾梗死 ;2例单纯肾移植者 ,1例为肾动脉局限性中度狭窄 ,1例为肾动脉与髂内动脉吻合口处动脉瘤形成。上述病理改变均经组织病理检查和数字减影血管造影证实。结论 磁共振可作为腹部器官移植并发症的一种无损伤检查手段 ,对于血管并发症 ,有其独有的优势。

Objective To evaluate the value of MRI and three dimensional (3D) contrast magnetic resonance angiography (MRA) for the diagnosis of complications of abdominal organ transplantation, as confirmed by biopsy and DSA.Methods Eleven patients (including 4 cases of liver transplantation, 5 cases of pancreaticorenal transplantation and 2 cases of renal transplantation) were subjected to MRI examination within 28 days-2 years after surgery on GE 1.5T MR system. Imaging techniques included traditional plain scanning and enhanced T 1WI. 3D contrast MRA was performed with smartprep technique.Results In 5 cases of liver transplantation, MRI and MRA revealed one case of hepatic artery stenosis and liver necrosis, one case of ICV occlusion, and one case of narrowing at the site of ICV anastomosis, and MRCP displayed one case of hepatic bile tube stricture. In 5 cases of pancreaticorenal transplantation, MRI found two normal pancreas grafts, one case of acute rejection, one case of chronic rejection with 70 % fibrosis and one case of late pancreatitis. In 5 transplant kidneys of SPKT, MRI detected 4 normal kidney grafts and one case of acute rejection with infarction. In 2 cases of single renal transplantation, MRA found renal artery stenosis in one case and aneurysm formation of anastomosis in another patient. 3D contrast MRA could display vascular complications, such as stenosis or occlusion, aneurysm formation of transplanted vessels and narrowing at the site of anastomosis, as confirmed by DSA. Pancreatic tube and urinary tract could be demonstrated well by MRCP and MRU. Conclusion With combined application of MRI and 3D contrast MRA, complications of abdominal organ transplantation can be clearly identified.