肝移植术后磁共振propeller LAVA薄层动态增强技术及MRCP的诊断价值  

Application of MR Imaging with LAVA and Cholangiopancreatography Technology in the Diagnosis of Complications Following Liver Transplantation

作　　者：王劲[1] 何炳均[1] 张亚琴[1] 肖茹[1] 姜在波[1] 于春鹏[1] 谢斯栋[1] 单鸿[1] 

机构地区：[1]中山大学附属第三医院放射科,510630

出　　处：《临床放射学杂志》2009年第3期347-351,共5页Journal of Clinical Radiology

基　　金：广东省自然科学基金研究团队项目(编号:05200177);广东省科技计划项目(编号:2008B060600034)

摘　　要：目的探讨磁共振propeller LAVA和MR胰胆管成像(MRCP)对原位肝移植术后移植肝及其血管、胆管并发症、门静脉高压血液动力学变化的诊断价值。资料与方法11例原位肝移植术后患者均用MRI常规序列扫描(Fiesta、Dual-Echo、FSPGR,FS FSE RT,DWI)及propeller LAVA薄层动态增强、MRCP检查,利用图像工作站对MRCP及propeller LAVA原始图像进行多平面重组(MPR),最大密度投影(MIP)等图像后处理。结果(1)移植肝:肝实质动脉期异常灌注5例;肝淋巴回流受阻3例,肝局灶性坏死、肝包膜下少许积血、炎性病变、胆汁瘤形成各1例;(2)血管并发症:肝动脉吻合口狭窄3例,肝动脉略迂曲2例,移植动脉迂曲、节段性管腔狭窄2例,移植血管、门静脉吻合口狭窄各1例;(3)门静脉高压血流动力学变化:脾大5例,肝脾包膜下少量积液3例,合并脾包膜下灶性梗死1例,脾静脉、食管胃底静脉轻度曲张4例,脾肾分流1例,胃-肾静脉分流1例;(4)胆管并发症:缺血性胆管炎4例,胆总管吻合口狭窄7例,合并肝内胆管炎6例,胆囊管残端囊性扩张3例,胆总管多发小结石1例。结论结合常规MRI,propeller LAVA和MRCP作为无创性"一站式"影像检查方法,在肝移植术后临床诊断及治疗方案的制定中具有重要价值。Objective To evaluate the value of propeller LAVA and cholangiopancreatography in the diagnosis of liver grafts, complications of vascular or biliary and hemodynamics changes after orthotopie liver transplantation. Materials and Methods After orthotopic liver transplantation, 11 adult patients underwent convertional MRI examinations （ including Fiesta, Dual - Echo, FSPGR, FS FSE RT and DWI）, MR cholangiopancreatography and triphasic contrast - enhanced propel- ler LAVA. The original images were reconstructed with MPR and MIP. Results MRI revealed ： （ 1 ） liver grafts. Hepatic including hyperperfusion in arterial phase （ n = 5 ）, lymphatic circulation stasis （ n = 3 ） , localized liver necrosis （ n = 1 ）, focal infla mmatory foei （ n = 1 ） , hepatic subeapsule hematoma （ n = 1 ） and biloma （ n = 1 ） ; （2） complications of vessles including anastomotic stenosis of hepatic artery（ n = 7 ）, elongation and kinking of hepatic artery（ n = 2 ）, arterial anastomoses stenosis of aortoheptic interposition grafts（ n = 1 ） and portal vein anastomotic stenosis（ n = 1 ）; （3）Portal and sys- temic hemodynamic changes including splenomegaly（ n = 5 ）, hepatic and spleen perihepatic effusion（ n = 3 ）, splenic infarc- tion （ n = 1 ） , splenic and gastro - esophageal variees （ n = 4 ） , splenorenal shunts （ n = 1 ） , gastrorenal shunts （ n = 1 ） ; （ 4 ） biliary complications including biliary nonanastomotic stenosis （n = 4 ） , biliary anastomotie stenosis （n = 7 ）, and with eholangitis （ n = 6） ,long and cystoid cystic duct stump （ n = 3 ）, sludge or stone in the bile duct （ n = 1 ）. Conclusion Combined with conventional MRI, propeller LAVA and MRCP provided a noninvasive methods for guiding the diagnosis and play an important role in formulating treatment plan after orthotopic liver transplantation.

关 键 词：原位肝移植 磁共振成像 动态增强 磁共振胆胰管成像 

分 类 号：R657.3[医药卫生—外科学] R445.2[医药卫生—临床医学]