三维动态增强MRA与DSA对原发性Budd-Chiari综合征分型诊断的对照研究  

Diagnosis of the type of primary Budd-Chiari syndrome with 3D DCE MRA:a comparative study with Digital subtraction angiography

作　　者：翟蕊[1] 翟冬枝[1] 冯广森[1] 丁鹏绪[2] 顾志强[1] 杜焱[1] 

机构地区：[1]郑州大学第二附属医院核磁共振室,郑州450014 [2]郑州大学第一附属医院,450052

出　　处：《放射学实践》2012年第3期329-332,共4页Radiologic Practice

摘　　要：目的:探讨3DDCE MRA和DSA对原发性Budd-Chiari综合征的分型诊断能力。方法:回顾性分析46例行3DDCE MRA和DSA检查的原发性Budd-Chiari综合征患者的病例资料,所有患者经DSA证实至少有一支肝静脉或入右心房段及肝后段下腔静脉存在病变且无肿瘤、血栓等基础疾病。对所有患者的3DDCE MRA图像质量进行评价(1～4分,依次为优、良、中和差),以DSA检查作为金标准,评估3DDCE MRA诊断BCS的能力,包括检出静脉病变的总敏感度、特异度及诊断准确度,显示下腔静脉及肝静脉(肝左、肝右及肝中静脉)病变各自的敏感度以及发现副肝静脉的敏感度,采用Kappa检验评估这两种检查方法对BCS分型诊断的一致性。结果:46例中44例的3DDCE MRA图像质量评分为3～4分,仅2例图像质量为2分。3DDCE MRA正确诊断BCS 45例。46例患者共184支血管段中DSA共检出151支静脉病变,3DDCE MRA正确诊断141支、误诊2支,MRA发现静脉病变的总敏感度为93.4%(141/151),特异度为94.0%(31/33);发现下腔静脉病变的敏感度为94.9%(37/39),发现肝右、肝中及肝左静脉的敏感度分别为94.1%(32/34)、92.3%(36/39)和92.3%(36/39);显示副肝静脉的敏感度为83.3%(25/30)。3DDCE MRA对所有患者的分型诊断符合率为86.7%(39/45),且与DSA之间存在高度一致性(Kappa=0.667,P<0.05)。结论:3DDCE MRA可较准确地对原发性BCS进行诊断和分型,能够对患者的介入治疗方案的制订和导管入路的选择提供帮助。Objective：To evaluate the ability of 3D DCE MRA in diagnosing the type of primary Budd-Chiari syndrome（BCS） by comparing it with DSA.Methods：Patients having undergone 3D DCE MRA in our hospital from March 2007 to January 2010 were recruited in the study according to following requirements：patients underwent DSA after 3D DCE MRA;at least one lesion of the hepatic vein or inferior vena cava（from the segment of right atrium to the post-hepatic segment） was confirmed by DSA,but without tumor,thrombosis or other basic diseases.The quality of imges from 3D DCE MRA was evaluated to ensure the veracity of the condition of the patient.Then,taking DSA examination as the gold standard,the ability of 3D DCE MRA to diagnose BCS was assessed,especially the sensibility,specificity and accuracy in finding all the vascular lesion（including inferior vena cava and hepatic veins）.Kappa coefficient testing was adopted to evaluate the consistency of these two methods in diagnosng the type of BCS.Results：Among the 46 patients in our study,the images of 44 patients were useful for diagnosis.From 184 blood vessel segments of the 46 patients,151 vein leions were found by DSA,and 141 vein lesions by 3D DCE MRA.The sensitivity and specificity of 3D DCE MRA in detecting the total lesions（inferior vena cava and hepatic veins） were 93.4%（141/151） and 94.0%（31/33）,respectively.The sensitivity of 3D DCE MRA in detecting the lesions of the inferior vena cava was 94.9%（37/39）,the sensitivity in diagnosing right hepatic veins,middle hepatic veins and the left hepatic veins were 94.1%（32/34）,92.3%（36/39） and 92.3%（36/39） respectively.3D DCE MRA showed a sensitivity of 83.3%（25/30） in detecting the accessory hepatic veins.DSA and 3D DCE MRA were both used in determining the type of all patients,the total coincidence rate was 86.7%（39/45）,and the consistency of the two ways of examination was relatively high（Kappa=0.667,P0.05）.Conclusion：3D DCE MRA can accurately diagnose and determine the

关 键 词：血管病变 下腔静脉 肝静脉 磁共振成像 血管成像 数字减影血管造影术 

分 类 号：R445.2[医药卫生—影像医学与核医学] R816.5[医药卫生—诊断学]