双源CT动脉期增强图像上肝静脉和下腔静脉返流的影响因素分析  

Analysis of influencing factors of inferior vena cava and hepatic vein reflux on arterial phase enhanced images on dual source CT

作　　者：王笑 乔建兰 龚建中 刘新疆 WANG Xiao;QIAO Jian-lan;GONG Jian-zhong(Department of Ra-diology,Shanghai Pudong Hospital,Fudan University Pudong Medical Center,Shanghai 201399,China)

机构地区：[1]上海市浦东医院,复旦大学附属浦东医院放射科,上海201399

出　　处：《放射学实践》2021年第12期1548-1552,共5页Radiologic Practice

基　　金：上海市浦东新区卫生健康委员会2020年卫生科技项目(PW2020A-35);复旦大学附属浦东医院院级课题项目(YJRCJJ201901);复旦大学附属浦东医院院级人才项目(PY2020003)。

摘　　要：目的:探讨双源CT动脉期增强图像上出现下腔静脉及肝静脉返流(IVCHVR)的影响因素。方法:回顾性分析2019年12月-2020年2月在本院同时行腹部CT增强扫描和多普勒超声心动图检查的459例患者的临床和影像资料。出现返流者246例,无返流者213例。比较返流组和无返流组的临床和影像资料,并采用Logistic回归分析筛选IVCHCR的危险因素。结果:最终入组459例患者,其中返流组共计246例,无返流组213例。下腔静脉返流组中,Ⅰ型187例、Ⅱ型34例、Ⅲ型25例;下腔静脉返流合并肝静脉返流48例;伴有二尖瓣返流71例、三尖瓣返流115例、主动脉瓣返流64例、肺动脉瓣返流108例、肺动脉高压118例、右心室收缩功能降低181例、室壁瘤1例及心包积液9例。无返流组中,伴有二尖瓣返流32例、三尖瓣返流30例、主动脉瓣返流34例、肺动脉瓣返流30例、肺动脉高压44例、右心室收缩功能降低111例和心包积液4例。返流组和无返流组中下腔静脉直径分别为(30.06±4.31)和(21.28±3.97)mm,差异具有统计学意义(t=0.12,P<0.05)。单因素分析显示二尖瓣返流、三尖瓣返流(a)、主动脉瓣返流、肺动脉瓣返流(b)、肺动脉高压(c)、右心室收缩功能降低(d)及右心疾病(a~d中任意1项)这7个危险因素与肝静脉和下腔静脉返流具有相关性(P<0.05)。Logistic回归分析显示三尖瓣返流、肺动脉高压、右心室收缩功能降低和右心疾病是出现肝静脉和下腔静脉返流的独立危险因素(P<0.05)。结论:三尖瓣返流、肺动脉高压、右心室收缩功能降低和右心疾病是IVCHVR的独立危险因素,提示右心功能不全可能是导致IVCHVR的原因。Objective:The purpse of this study was to investigate the influencing factors of inferior vena cava(IVC)and hepatic vein(HV)reflux(IVCHVR)on abdominal enhanced images at arterial phase scanned by dual source CT.Methods:459 patients who underwent abdominal contrast enhanced CT and Doppler echocardiography were retrospectively analyzed.The clinical and imaging data of the reflux group and non-reflux group were recorded and compared,and Logistic regression analysis was used to select out the risk factors of IVCHVR.Results:Of the 459 patients,there were 246 cases with reflux and 213 cases without reflux.In the IVC reflux group,there were 187 cases of typeⅠreflux,34 cases of typeⅡ,25 cases of typeⅢ;48 cases IVC reflux combined with HV reflux;71 cases with mitral regurgitation(MR),115 with tricuspid regurgitation(TR),64 with aortic regurgitation(AR),108 with pulmonary valve regurgitation(PVR),118 with pulmonary hypertension(PH),181 with right ventricular systolic dysfunction(RVSD),1 with ventricular aneurysm and 9 with pericardial effusion.In the non-reflux group,32 cases with MR,30 with TR,34 with AR,30 with PVR,44 with PH,111 with RVSD,4 with pericardial effusion.The average IVC diameter of the reflux group and non-reflux group were(30.06±4.31)and(21.28±3.97)mm,respectively,with statistical significance(t=0.12,P<0.05).The univariate analysis showed that 7 risk factors including MR,TR,AR,PVR,PH,RVSD and right-sided heart disease(one of TR,PVR,PH and RVSD was found)were correlated with reflux(P<0.05).Logistic multivariate regression analysis showed that TR,PH,RVSD and right-sided heart disease were independent risk factors of reflux(P<0.05).Conclusion:TR,PH,RVSD,Right-sided heart disease are the independent risk factors of IVCHVR,and it suggests that right-sided heart dysfunction may be the cause of IVCHVR.

关 键 词：下腔静脉 返流 三尖瓣返流 体层摄影术 X线计算机 

分 类 号：R445.1[医药卫生—影像医学与核医学] R445.3[医药卫生—诊断学]