CT静脉成像技术在布加综合征诊断中的应用价值  

Application of CT venography imaging in the diagnosis of Budd-Chiari syndrome

作　　者：施彪[1] 陈世远[2] 王孝高[2] 高涌[2] 魏建筑[3] 乔晓春[1] 葛健康 李文明 Shi Biao;Chen Shiyuan;Wang Xiaogao;Gao Yong;Wei Jianzhu;Qiao Xiaochun;Ge Jiankang;Li Wenming(Department of Medical Imaging,Bengbu First People's Hospital,Bengbu 233000,China;Department of Vascular Surgery,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Department of Interventional Radiology,the First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,China;Department of General Surgery,Guangde People's Hospital,Guangde 242200,China)

机构地区：[1]蚌埠市第一人民医院医学影像科,蚌埠233000 [2]蚌埠医学院第一附属医院血管外科,蚌埠233004 [3]蚌埠医学院第一附属医院介入科,蚌埠233004 [4]广德市人民医院普外科,广德242200

出　　处：《中华解剖与临床杂志》2022年第11期758-762,共5页Chinese Journal of Anatomy and Clinics

基　　金：安徽省高校自然科学研究项目(KJ2020A0558)。

摘　　要：目的探讨CT静脉成像(CTV)在布加综合征(BCS)诊断中的应用价值。方法回顾性研究。纳入2017年5月—2021年11月蚌埠市第一人民医院和蚌埠医学院第一附属医院BCS患者136例。其中男78例、女58例,年龄24~82岁。患者均经CTV和数字减影血管造影(DSA)检查,对下腔静脉、肝静脉及侧支血管进行三维重建分析。观察项目:(1)观察BCS患者的CTV影像学表现;(2)比较CTV与DSA在评估和诊断阻塞血管及BCS合并血栓、肝癌等的差异。结果(1)BCS患者的CTV影像学表现:肝硬化,脾肿大,腹水,尾状叶明显增大,增强早期见尾状叶及肝左叶中央部分迅速强化,呈斑片状不均匀强化(中心扇样强化),延迟强化密度趋于均匀,并可见侧枝循环形成。(2)CTV与DSA在诊断肝静脉节段性阻塞、肝静脉膜性阻塞、肝静脉广泛性阻塞、下腔静脉节段性阻塞、下腔静脉膜性阻塞、下腔静脉膜性带孔阻塞及肝静脉和下腔静脉阻塞的差异均无统计学意义(χ^(2)=0.13、0.00、0.00、0.44、0.13、0.25、0.80,P值均>0.05)。CTV诊断BCS合并肝癌(5例)优于DSA(0例),差异有统计学意义(χ^(2)=4.00,P=0.046)。两者诊断BCS合并血栓,差异无统计学意义(χ^(2)=2.45,P=0.118)。结论CTV可准确显示BCS患者的血管病变,具有与DSA相当的准确性,而且对合并肝癌的诊断优于DSA,可为BCS的术前诊断和临床治疗方案制定提供指导意见。Objective This paper discusses the application value of CT venography(CTV)in the preoperative diagnosis of Budd-Chiari syndrome(BCS).Methods A total of 136 patients with BCS,78 males and 58 females aged 24-82,were included in a retrospective study conducted in the First People's Hospital of Bengbu and the First Affiliated Hospital of Bengbu Medical College from May 2017 to November 2021.The patients were examined with CTV and digital subtraction angiography(DSA),and the three-dimensional structures of the inferior vena cava,hepatic vein,and collateral vessels were reconstructed and analyzed.The following items were observed:(1)The CTV imaging findings of the patients;(2)Differences between CTV and DSA in assessing and diagnosing obstructed vessels,BCS complicated with thrombus,and liver cancer.Results(1)The CTV imaging findings were as follows:liver cirrhosis,splenomegaly,ascites,and significantly enlarged caudate lobe;in the early stage of enhancement,the caudate lobe and the central part of the left hepatic lobe was rapidly enhanced,and the liver parenchyma showed patchy heterogeneous enhancement(central fan-like enhancement),the density of delayed enhancement tended to be uniform,and the formation of collateral circulation is visible.(2)There were no significant differences between CTV and DSA in the diagnosis of segmatic hepatic vein occlusion,membranous hepatic vein occlusion,extensive hepatic vein occlusion,segmatic inferior vena cava occlusion,membranous inferior vena cava occlusion,membranous perforated inferior vena cava occlusion,hepatic vein occlusion and inferior vena cava occlusion(χ^(2)=0.13,0.00,0.00,0.44,0.13,0.25,0.80;all P values>0.05).The proportion of liver cancer diagnosed with CTV was higher than that with DSA(5 vs.0),and the difference was statistically significant(χ^(2)=4.00,P=0.046).There was no significant difference in the diagnosis of BCS complicated with thrombosis between CTV and DSA.Conclusions CTV technology can accurately display the vascular lesions of patients with BCS.Its acc

关 键 词：布加综合征 计算机体层摄影静脉成像 数字减影血管造影 诊断 

分 类 号：R575[医药卫生—消化系统]