增强磁共振血管造影对布加综合征副肝静脉开口方向及夹角检测的应用价值  

CE-MRA in detecting the opening direction and measuring the angle of accessory hepatic vein with the inferior vena ca-ca in Budd-Chiari syndrome

作　　者：徐慧婷 徐凯[1] 何鹏[3] 张庆桥[2] 代岳[1] 路莉[1] 李曾[1] 孙景敏[2] 

机构地区：[1]徐州医学院附属医院放射科,江苏221002 [2]徐州医学院附属医院介入放射科,江苏221002 [3]江苏恩华药业股份有限公司临床医学部

出　　处：《中华肝胆外科杂志》2015年第9期596-599,共4页Chinese Journal of Hepatobiliary Surgery

基　　金：江苏省临床医学科技专项-新型临床诊疗技术攻关项目（BL2012044）

摘　　要：目的探讨增强磁共振血管造影（CE-MRA）对布加综合征副肝静脉（AHV）开口方向及AHV与下腔静脉长轴远端夹角检测的临床价值。方法对本院就诊的202例布加综合征患者分别用CE-MRA和数字减影血管造影（DSA）观察直径≥5mmAHV开口方向并测量AHV与下腔静脉长轴远端夹角。采用Kappa检验分析两种检查方法显示AHV开口方向的一致性。以DSA为金标准，采用混合线性模型评估两种检查方法测量夹角的差异性。结果202例患者中，139例患者MRA测出直径≥5mmAHV199支，123例患者DSA测出152支。MRA显示AHV开口在下腔静脉右侧、前方、左侧分别为135、51、13支，DSA显示AHV开口在下腔静脉右侧、前方、左侧分别为108、34、10支，Kappa值为0．6。拟合AHV与下腔静脉远端夹角空模型得到截距项的方差（σ2μ0）为166．6，残差的方差（σ2ε）为377．1，P值皆小于0．05，组内相关系数为0．3。混合线性模型得出两种检查测量AHV夹角差异无统计学意义（t=1．24，P〉0．05）。结论CE-MRA可清楚显示布加综合征AHV开口方向，准确测量AHV与下腔静脉长轴远端夹角，对制定介入治疗方案具有实用价值。Objective To investigate the clinical value of the opening direction and the angle of the accessory hepatic vein （AHV） with the inferior vena eava （IVC） in Budd-Chiari syndrome using CE-MRA. Methods Two hundred and two patients with Budd-Chiari syndrome confirmed by DSA underwent CE-MRA examination with a 3.0 T scanner. The opening direction of the AHV （ diameter ≥5 mm） was measured by CE-MRA and DSA, respectively. The variation in these two methods was correlated using the Kappa coeffi- cient test. The angle of the AHV （diameter ≥ 5 mm） with the IVC was also measured by CE-MRA and DSA, respectively. Using DSA examination as the gold standard, a mixed model was used to detect the difference in the angle between the two methods. Results Among the 202 patients, MRA demonstrated 199 AHVs （diameter≥5 ram） in 139 patients, while DSA demonstrated 152 AHVs in 123 patients. The opening directions at the right, anterior and left were 135, 51, 13 on MRA and 108, 34, 10 on DSA, respectively. These two methods in determining the opening directions of AHV were relatively consistent （ Kappa = 0. 6）. The variance of the intercept term （ σ2μ0 = 166. 6） and residual variance （ σ2ε = 77.1 ） were obtained by fitting the empty model of the angle （ P 〈 0. 05 ）. The intraelass correlation coefficient was 0. 3. The angle measured by CE-MRA was not significantly different from that by DSA （ t = 1.24, P 〉 0. 05 ）. Conclusions CE MRA could accurately measure the opening direction and the angle of the AHV with the IVC. CE MRA could be used to preoperatively evaluate AHVs and it may become an accurate way to guide interventional treatment.

关 键 词：副肝静脉 磁共振成像 数字减影血管造影术 

分 类 号：R541.1[医药卫生—心血管疾病]