肝硬化门静脉血栓的MRI特征及其与Child-Pugh分级相关性研究
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摘要
目的用MRI评价肝硬化门静脉血栓(Portal vein thrombus,PVT)数量、解剖位置、信号特征及其与Child-Pugh分级的相关性。方法回顾性分析2011年3月~2015年10月经临床随访、CT或超声诊断的肝硬化门静脉血栓(PVT)的住院病人27例,以及同期肝硬化患者中未发生PVT患者222例,所有患者均有门静脉高压表现,均行常规MRI平扫及三维容积超快速多期动态增强扫描(LAVA),采用MRI观察门静脉血栓的数量、位置、信号特征,并与肝硬化Child-Pugh分级做对照分析。结果肝硬化PVT发生率为10.84%(27/249)。在27例血栓患者中共发现34个血栓,其解剖分布,位于门静脉主干22个,同时累及其左支或右支或者两支9个;位于门静脉右支3个,位于肠系膜上静脉7个,位于脾静脉2个。MRI均能显示门静脉内血栓,血栓在T1WI平扫上呈现两种不同的信号,信号值为(1134.17±35.28)和(291.33±58.20),分别代表新鲜血栓和陈旧性血栓。血栓的数量、解剖分布、信号强度差异与Child-Pugh分级间的相关性无统计学差异(P>0.05)。结论 MRI能准确显示肝硬化PVT的数量、解剖部位及新鲜血栓或陈旧血栓。
Objective To explore the features of portal vein thrombosis(PVT)secondary to liver cirrhosis including the number,anatomic distribution and signal intensity on magnetic resonance imaging(MRI),and determine whether the PVT is associated with Child-Pugh classification.Methods Between March 2011 and October 2015,27 inpatients with liver cirrhosis in our hospital were confirmed by clinical data,and Doppler ultrasonography or computed tomography.During this period,222 cirrhotic patients without PVT were also enrolled in this study to calculate the incidence of PVT.All patients had the clinical appearances of portal hypertension and underwent routine MRI scan and a three-dimensional volume of the ultra-fast multi-phase dynamic contrast-enhanced scans(LAVA).On MRI,the number,anatomic distribution and signal intensity of PVT were reviewed,and the correlation of the occurrence of PVT with ChildPugh class of cirrhosis was assessed.Results The incidence of PVT in patients with portal hypertension secondary to liver cirrhosis was 10.84%(27/249).34 thrombi were found in 27 patients,22thrombi were located in the main branch of portal vein including 9thrombi involving the left branch or right branch or the two,3thrombi were located in right branch of portal vein,7thrombi were located in the superior mesenteric vein,and 2thrombi were located in splenic vein.All thrombi in the portal vein were well depicted on MRI.On T1-weighted imaging,thrombus presented as two different signals representing fresh thrombus and old thrombus,and signal intensity was 1134.17±35.28 and 291.33±58.20,respectively.The number,anatomic distribution and signal intensity of PVT on MRI were not correlated with Child-Pugh class of cirrhosis(P>0.05).Conclusion MRI can well show the number,anatomic distribution PVT and determine whether it is old or fresh thrombus.
Objective To explore the features of portal vein thrombosis(PVT)secondary to liver cirrhosis including the number,anatomic distribution and signal intensity on magnetic resonance imaging(MRI),and determine whether the PVT is associated with Child-Pugh classification.Methods Between March 2011 and October 2015,27 inpatients with liver cirrhosis in our hospital were confirmed by clinical data,and Doppler ultrasonography or computed tomography.During this period,222 cirrhotic patients without PVT were also enrolled in this study to calculate the incidence of PVT.All patients had the clinical appearances of portal hypertension and underwent routine MRI scan and a three-dimensional volume of the ultra-fast multi-phase dynamic contrast-enhanced scans(LAVA).On MRI,the number,anatomic distribution and signal intensity of PVT were reviewed,and the correlation of the occurrence of PVT with ChildPugh class of cirrhosis was assessed.Results The incidence of PVT in patients with portal hypertension secondary to liver cirrhosis was 10.84%(27/249).34 thrombi were found in 27 patients,22thrombi were located in the main branch of portal vein including 9thrombi involving the left branch or right branch or the two,3thrombi were located in right branch of portal vein,7thrombi were located in the superior mesenteric vein,and 2thrombi were located in splenic vein.All thrombi in the portal vein were well depicted on MRI.On T1-weighted imaging,thrombus presented as two different signals representing fresh thrombus and old thrombus,and signal intensity was 1134.17±35.28 and 291.33±58.20,respectively.The number,anatomic distribution and signal intensity of PVT on MRI were not correlated with Child-Pugh class of cirrhosis(P>0.05).Conclusion MRI can well show the number,anatomic distribution PVT and determine whether it is old or fresh thrombus.
引文
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[22]施伦波.肝硬化患者肝功能Child-Pugh分级与血小板参数及凝血指标变化的临床相关性探究[J].中国全科医学,2015,13(6):941-943.
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[2]祁兴顺,韩国宏,樊代明.经颈静脉肝内门体分流术治疗门静脉血栓的现状[J].介入放射学杂志,2010,19(11):916-920.
[3]姚戈冰,鲁建国.门静脉血栓的发病机制及诊治[J].肝胆外科杂志,2009,17(2):151-154.
[4]覃智颖,张应和,范真真,等.门静脉血栓的MRI诊断[J].中国CT和MRI杂志,2012,10(10):51-53.
[5]刘晓云,仲炜,易正湘,等.门静脉三维动态增强在3.0T高场磁共振成像技术的应用[J].中国CT和MRI杂志,2009,7(2):53-55.
[6]王丽萍,刘战丛,史永涛.脾切除贲门周围血管离断术后门静脉血栓形成的危险因素分析[J].医学信息(内外科版),2009,22(5):406-407.
[7]Winslow ER,Brunt LM,Drebin JA,et al.Portal vein thrombosis after splenectomy[J].AM J Surg,2002,184(6):63.
[8]Ibrahim E,SeyfettinK,merB,et al.Thrombosis of the portal venous system aprospective study[J].Clin Gastroenterol,2008,42(7):835.
[9]吴刚,刘永锋,陈旭春,等.肝移植门静脉血栓形成的预防和治疗[J].中华器官移植杂志,2006,27(10):612-614.
[10]Handa P,Crowther M,Douketis JD.Portal vein thrombosis:a Clinician-Oriented and practical review[J].J Clin Appl Thromb Hemost,2014,20(5):498-506.
[11]Belli L,Romani F,Sansalone CV,et al.Portal thrombosis in cirrhotics.A retrospective analysis[J].Ann Surg,1986,203(3):286-291.
[12]Nonami T,Yokoyama I,Iwatsuki S,et al.The incidence of portal vein thrombosis at liver transplantation[J].Hepatology,1992,16(5):1195-1198.
[13]Amitrano L,Guardascione MA,Brancaccio V,et al.Risk factors and clinical presentation of Portal vein thrombosis in patients with liver cirrhosis[J].J Hepatol,2004,40(5):736-741.
[14]张冬磊,杨宁.肝硬化患者门静脉血栓形成的相关危险因素[J].世界华人消化杂志,2008,16(27):3106-3109.
[15]Boyer TD,Haskal ZJ.American Association for the study of liver diseases practice guidelines:the role of transjugular intrahepatic portosystemic shunt creation in the management of portal hypertension[J].J Vasc Interv Radiol,2005,16(5):615-629.
[16]容鹏飞,王维,刘晟,等.螺旋CT多期扫描在肠系膜上静脉梗塞中的诊断价值[J].临床放射学杂志,2008,27(6):814-816.
[17]叶慧义,于平年,马林,等.MRI诊断门静脉血栓的价值[J].中国医学影像学杂志,2005,13(4):251-254.
[18]Kreft B,Strunk H,Flacke S,et al.Detection of thrombosis in the portal venous system:comparison of contrast-enhanced MR angiography with in-traarterial digital subtraction angiography[J].Radiology,2000,216(1):86.
[19]Bradbury MS,Kavanagh PV,ChenMY,et al.Noninvasive assessment ofportomensenteric veinous thrombosis:current concepts and imagingstrategies[J].J Comput Assist Tomogr,2002,26(3):392.
[20]吕敦召,杨志宏,万严,等.急性门静脉和肠系膜上静脉血栓形成的MRI诊断[J].临床放射学杂志,2009,28(10):1472-1474.
[21]莫友发,张雪林,张礼鹃,等.门静脉和肠系膜上静脉血栓形成的MRI诊断[J].中华放射学杂志,2007,41(2):180-183.
[22]施伦波.肝硬化患者肝功能Child-Pugh分级与血小板参数及凝血指标变化的临床相关性探究[J].中国全科医学,2015,13(6):941-943.
[23]李树武.成人肝硬化门静脉血栓形成[J].中国厂矿医学,2008,21(5):610-612.
[24]叶慧义,汪伟,李永才.实用腹部综合影像诊断学肝脏分册[M].北京.人民军医出版社,2004:173.