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目的评价三维对比动态增强磁共振血管成像(3D DCE MRA)在诊断Budd-Chiari综合征(BCS)中的价值。方法8例BCS术前接受了常规MRI和3D DCE MRA检查,着重于回顾性分析其3D DCE MRA表现。结果8例3D DCE MRA检查显示下腔静脉阻塞3例,下腔静脉和肝静脉阻塞5例。下腔静脉阻塞部位在肝段5例、膈段1例及膈上段2例,阻塞表现形式包括膜性1例及节段性7例。伴有肝静脉阻塞的5例中肝静脉开口处阻塞3例,肝静脉分支阻塞2例。8例中有5例显示肝内侧枝循环,包括肝包膜下静脉侧枝循环、叶间静脉侧枝循环及肝内未定型侧枝循环。8例均显示肝外侧枝循环,包括深层静脉侧枝循环、中层静脉侧枝循环、浅层静脉侧枝循环及门静脉侧枝循环。8例BCS的其他征象包括肝实质信号异常、肝脏形态改变、下腔静脉内血栓形成、脾大、腹水及胸水。结论3D DCE MRA在诊断BCS中具有很高的价值,是诊断和治疗前后全面评价BCS的无创性血管成像技术。
Objective To evaluate the value of three-dimensional contrast enhanced dynamic MR angiography (3D DCE MRA) in the diagnosis of Budd-Chiari syndrome (BCS). Methods Eight cases of BCS underwent routine MRI and 3D DCE MRA before surgery, with a focus on the retrospective analysis of 3D DCE MRA findings. Results 8 cases of 3D DCE MRA showed inferior vena cava occlusion in 3 cases, inferior vena cava and hepatic vein occlusion in 5 cases. Inferior vena cava obstruction in the liver segment in 5 cases, 1 case of phrenic and upper diaphragm in 2 cases, the manifestations of obstruction, including membranous in 1 case and segmental in 7 cases. In 5 cases with occlusion of hepatic vein occlusion in 3 cases, hepatic vein occlusion in 2 cases. Five of the eight cases showed intrahepatic collateral circulation, including the subcapsular subcortical vein collateral circulation, the interlobar vein collateral circulation, and the intrahepatic unscheduled collateral circulation. 8 cases showed extrahepatic collateral circulation, including deep venous collateral circulation, middle venous collateral circulation, superficial vein collateral circulation and portal vein collateral circulation. Other signs of BCS in 8 cases included abnormal hepatic parenchymal signals, altered liver morphology, inferior vena cava thrombosis, splenomegaly, ascites and pleural effusion. Conclusion 3D DCE MRA is of great value in the diagnosis of BCS. It is a noninvasive vascular imaging technique for the comprehensive evaluation of BCS before and after diagnosis and treatment.