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目的探讨三维动态对比增强磁共振门脉血管造影(3D DCE MRP)在肝硬化门脉高压症门静脉系统及门体侧支循环显像中的应用价值。方法对19例肝硬化门脉高压症组病人及51例非肝硬化对照组行3D DCE MRP 检查,测量门脉系统各主要干支的径线并比较两者差异;于3D DCEMRP 检查前后10d内,对所有肝硬化症组病人行门脉间接造影,以其结果为标准,分析侧支循环发生的部位和分布范围,评价两者的符合情况。结果肝硬化门脉高压症组 MPV、SPV 及 SMV 直径明显大于对照组(P<0.05),门脉分支级数明显减少;但 Child A、B 级病人间 MPV 直径及门脉分支级数的减少无明显差别(P>0.05)。同时,3D DCE MRP 显示2例门脉主干海绵样变并检出48条肝外侧支血管,与 DSA 结果相对照,除1例脐静脉开放及1例自发性脾肾分流未见显示外,其余侧支循环在3D DCE MRP 上均清楚显影,总符合率为96.0%(48/50)。结论 3D DCE MRP 能较好显示门脉系统的解剖影像,并对曲张静脉、侧支循环显影良好,也是诊断门脉海绵样变的有效方法,对于门脉高压症的诊断及手术治疗有重要指导意义。
Objective To investigate the value of three-dimensional contrast enhanced MR angiography (3D DCE MRP) in the portal vein system and collateral circulation in cirrhotic patients with portal hypertension. Methods Nineteen patients with cirrhosis and 51 non-cirrhotic patients underwent 3D DCE MRP. The diameter of each major branch of the portal system was measured and compared between them. Within 10 days before and after 3D DCEMRP, Indirect portal angiography was performed on all patients with cirrhosis. Based on the results, the location and distribution of collateral circulation were analyzed to evaluate their compliance. Results The diameters of MPV, SPV and SMV in cirrhotic patients with portal hypertension were significantly larger than those in the control group (P <0.05), and the numbers of portal branches were significantly decreased. However, the reduction of MPV diameter and portal vein branches between Child A and B patients No significant difference (P> 0.05). At the same time, 3D DCE MRP showed two cases of portal vein sponge-like changes and detected 48 extrahepatic collateral vessels. In contrast to DSA results, except for 1 case of umbilical vein opening and 1 case of spontaneous splenorenal shunt, Collateral circulation was clearly developed on the 3D DCE MRP with a total coincidence rate of 96.0% (48/50). Conclusion 3D DCE MRP can better display the anatomical images of portal system and develop well for varicose veins and collateral circulation. It is also an effective method to diagnose portal sponge-like changes and is an important guide to the diagnosis and surgical treatment of portal hypertension significance.