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目的 评价无创性三维造影剂增强磁共振血管成像 (3DCEMRA)用于诊断肝癌门脉受侵的准确性。方法 90例肝癌患者在肝脏手术或介入治疗前接受门脉 3DCEMRA检查,所用仪器为高场强 1 5T磁共振机和体线圈,所用造影剂为磁显葡胺。扫描所获的原始图像经计算机重建成类似血管造影的 3DCEMRA图,用于诊断门脉主干、左支和右支的开放性。对总共 270条门脉做图像分析,门脉开放性分为正常和受累两种,门脉受累又分成包埋、闭塞和癌栓形成。3DCEMRA的诊断结果同手术 病理、术中超声X线门脉造影所见相对照。结果 根据手术或X线门脉造影, 3DCEMRA检出 75支受侵门脉中的 74支和 195支正常门脉中的 188支,其总体敏感性为 99%。特异性为96%,阳性预测值为 91%,阴性预测值为 99%。该法显示门脉主干的准确性达 100%。3DCEMRA有 7例假阳性, 6例发生在门脉左支, 1例发生在右支, 1例假阴性发生在右支。结论 3DCEMRA能相当准确地判断肝癌患者门脉受累的情况。
Objective To evaluate the accuracy of noninvasive three-dimensional contrast enhanced MR angiography (3DCEMRA) in the diagnosis of hepatic portal vein invasion. Methods Ninety patients with liver cancer underwent portal vein 3DCEMRA examination before liver surgery or interventional therapy. The instruments used were high field intensity 1 5T magnetic resonance machine and body coil. The contrast agent used was magnetic meglumine. The original images obtained by scanning were reconstructed into angiography-like 3DCEMRA images by computer to diagnose the openness of the main branches of the portal vein, left and right branches. Image analysis of a total of 270 portal venous, portal openness is divided into two types of normal and involvement, portal involvement is divided into embedding, occlusion and thrombosis. 3DCEMRA diagnostic results with surgical pathology, intraoperative ultrasound X-ray portal angiography contrast. Results According to surgery or X-ray portal angiography, 3DCEMRA detected 74 out of 75 invaded portal vessels and 188 out of 195 normal portal vessels with an overall sensitivity of 99%. The specificity was 96%, the positive predictive value was 91%, and the negative predictive value was 99%. The method shows portal vein accuracy of 100%. There were 7 false positives in 3DCEMRA, 6 in the left branch of the portal, 1 in the right branch and 1 in the right branch. Conclusion 3DCEMRA can fairly accurately determine the involvement of portal vein in patients with liver cancer.