CAJ | 학술논문

目的研究急、慢性布加综合征(BCS) MRI特征,探讨MRI对急、慢性BCS的诊断价值.方法以11例急性BCS患者作为急性组,以同期连续收治的42例慢性BCS患者作为慢性组.回顾性分析两组患者MR检查结果.腹水量两组间比较采用Wilcoxon W秩和检验;肝内外交通支形成比例两组间比较采用Fisher确切概率法.结果急性组MR检查均发现T2WI高信号的肝静脉血栓,其中3例患者合并下腔静脉血栓;与肝脏中央区相比,肝脏外周带T1WI均呈稍低信号,T2WI均为稍高信号,动态增强扫描时动脉期及静脉期强化程度均相对较低.慢性组中单纯下腔静脉阻塞3例,单纯肝静脉阻塞9例,肝静脉和下腔静脉联合受累30例,仅有3例患者下腔静脉内可发现T2 WI高信号的静脉血栓.慢性组患者均示淤血性肝硬化征象.MR平扫及增强扫描时,慢性BCS患者肝脏外周带与中央区信号无明显差异.急性组均有腹水形成(中等量腹水2例、大量腹水9例),慢性组中22例(52.4％)患者腹水形成(少量腹水15例、中等量腹水2例、大量腹水5例),急性组腹水发生率高于慢性组(Z=4.15,P＜0.01);急性组肝内交通支形成2例、肝外交通支1例,慢性组肝内交通支形成37例、肝外交通支形成34例,急性组中肝内及肝外交通支形成患者比例均低于慢性组(P均＜0.01),以上各指标组间差异均有统计学意义.结论 MRI能准确显示BCS的各种直接征象及间接征象,能够对急、慢性BCS做出准确诊断.
목적 연구급、만성포가종합정(BCS) MRI특정,탐토MRI대급、만성BCS적진단개치.방법 이11례급성BCS환자작위급성조,이동기련속수치적42례만성BCS환자작위만성조.회고성분석량조환자MR검사결과.복수량량조간비교채용Wilcoxon W질화검험;간내외교통지형성비례량조간비교채용Fisher학절개솔법.결과 급성조MR검사균발현T2WI고신호적간정맥혈전,기중3례환자합병하강정맥혈전;여간장중앙구상비,간장외주대T1WI균정초저신호,T2WI균위초고신호,동태증강소묘시동맥기급정맥기강화정도균상대교저.만성조중단순하강정맥조새3례,단순간정맥조새9례,간정맥화하강정맥연합수루30례,부유3례환자하강정맥내가발현T2 WI고신호적정맥혈전.만성조환자균시어혈성간경화정상.MR평소급증강소묘시,만성BCS환자간장외주대여중앙구신호무명현차이.급성조균유복수형성(중등량복수2례、대량복수9례),만성조중22례(52.4％)환자복수형성(소량복수15례、중등량복수2례、대량복수5례),급성조복수발생솔고우만성조(Z=4.15,P＜0.01);급성조간내교통지형성2례、간외교통지1례,만성조간내교통지형성37례、간외교통지형성34례,급성조중간내급간외교통지형성환자비례균저우만성조(P균＜0.01),이상각지표조간차이균유통계학의의.결론 MRI능준학현시BCS적각충직접정상급간접정상,능구대급、만성BCS주출준학진단.
Objective To investigate the features of Magnetic resonance imaging (MRI) and analyze the diagnostic value of MRI on acute and chronic Budd-Chiari syndrome(BCS).Methods Eleven patients with acute BCS who were treated,while other 42 patients with proven chronic BCS were taken as chronic group.All patients in our study underwent MRI examinations.MRI findings were retrospectively studied.Comparison between groups was made by Wilcoxon W rank sum test for frequency of ascites and Fisher Exact Test for the percentage of intrahepatic venous collaterals and extrahepatic venous collaterals.Results Hepatic venous thrombosis with high signal on T2WI was demonstrated in 11 patients with acute BCS,and 3 of them also had inferior vena cava thrombosis.Compared with the central liver,the periphery of the liver of all patients were moderately hypointensive on T1 WI and slightly hyperintensive on T2WI,and the enhancement degree of liver periphery in venous phase and arterial phase was relatively low.In chronic group,9 of them had hepatic venous obstruction,3 had inferior vena cava obstruction,and 30 had both.All chronic BCS patients had the features of stasis cirrhosis.There was no signal difference between the periphery and the central of the liver on precontrast and postcontrast images.In acute group,all of them suffered from ascites (2 patients with a moderate amount of ascites,and 9 patients with massive ascites),2 of them had intrahepatic venous collaterals,one had extrahepatic venous collaterals.But in chronic group,22 of them suffered from ascites (A small anount of ascites in 15 patients,2 patients had a moderate amount of ascites,and 5 patients had massive ascites),and 37 of them were found with intrahepatic venous collaterals,34 of them were with extrahepatic venous collaterals.The incidence of ascites in the acute group was higher than that in the chronic group (Z =4.15,P ＜ 0.01),and the percentage of intrahepatic venous collaterals and extrahepatic venous collaterals in the acute group were lower than the chronic group (P ＜ 0.01).Conclusion MRI can show the direct and indirect features of BCS,which is not only helpful to diagnose BCS,but also to judge the stage of BCS.