肝移植术后血管和胆系并发症的MRI诊断价值  

MR imaging of vascular and biliary complications after liver transplantation

作　　者：郭友[1] 陈曌[1] 郑晓林[1] 王金林[2] 何惜金[1] 宁永见[1] 张善譔[1] 胡道予[3] 

机构地区：[1]广东省东莞市人民医院放射科MR室,523018 [2]广东省东莞市人民医院肝胆外科,523018 [3]华中科技大学同济医学院附属同济医院放射科

出　　处：《中华放射学杂志》2005年第7期718-721,共4页Chinese Journal of Radiology

摘　　要：目的探讨磁共振血管造影(MRA)和MR胰胆管成像(MRCP)对诊断肝移植术后血管及胆管并发症的价值。方法7例原位肝移植术后患者均用磁共振(MR)快速自旋回波(TSE)序列及快速小角度激发梯度回波(FLASH)序列常规扫描、MRCP、钆喷替酸葡甲胺(Gd-DTPA)动态增强3DMRA检查,分析各序列图像特点。结果术后正常2例,主要表现少量腹水,积血和轻度淋巴结增大。血管并发症4例:肝动脉过长迂曲1例,肝动脉供体端瘤样轻度扩张2例;门静脉轻度狭窄2例,位于吻合口;肝静脉末梢分支杵状扩张2例。胆系并发症3例:吻合口胆管狭窄3例;在吻合口以外的胆管狭窄2例,位于肝门及肝内;胆总管在吻合口扭曲2例;胆囊管残端黏液囊肿2例;胆漏1例。结论MRA和胆管造影作为1种非侵袭性影像检查方法,可准确、快速诊断肝移植术后出现的血管和胆管并发症,对指导临床诊断及治疗具有重要意义。Objective To evaluate the value of MR angiography and cholangiopancreatography on the diagnosis of vascular and biliary complications after liver transplantation. Methods Seven consecutive adult patients underwent 16 MR imaging examinations after orthotopic liver transplantation using a breath-hold 2D TSE and FLASH. MR cholangiopancreatography and triphasic contrast-enhanced 3D imaging (average dose, 0.30 mmol/kg of Gd-DTPA) was performed and imaging findings after liver transplantation was analyzed. Results Two normal cases showed a small amount of ascites or fluid in the perihepatic region or the intersegmental fissure of the transplanted liver, as well as transient right-sided pleural effusion and mild lymph swelling. Four cases had vascular complication including elongation and kinking of hepatic artery, aneurysm formation of donor′s hepatic artery, narrowing of the portal vein at the anastomosis and clubbed dilataltion of hepatic veins. Three cases had biliary complications including anastomotic and nonanastomotic strictures, mucocele and bile leakage. Conclusion Dynamic enhanced 3D MR angiography imaging combined with MR cholangiopancreatography can provide a comprehensive assessment of vascular and biliary complications in most recipients of liver transplants. MR imaging after liver transplants is significative to guide the diagnosis and treatment.

关 键 词：肝移植术后 胆系并发症 诊断价值 MRI MR胰胆管成像 磁共振血管造影 钆喷替酸葡甲胺 胆管并发症 快速自旋回波 影像检查方法 胆管狭窄 原位肝移植 MRA检查 淋巴结增大 血管并发症 胆囊管残端 诊断及治疗 吻合口 常规扫描 

分 类 号：R445.2[医药卫生—影像医学与核医学]