Erden Ayşe, Erden Ilhan, Yurdaydin Cihan, Karayalçin Selim
Department of Radiology and Gastroenterology, Ankara University, Medical School, Sihhiye, 06100 Ankara, Turkey.
Eur J Radiol. 2003 Nov;48(2):203-8. doi: 10.1016/S0720-048X(02)00229-2.
Our purpose was to present the enhancement patterns of the liver on MR angiography in patients with hepatic outflow obstruction. Twenty-three patients with Budd-Chiari syndrome (4 in acute stage and 19 in chronic stage of the disease) were examined with 3D contrast-enhanced MR angiography. During early and late portal venous phase of MR angiography the pattern of parenchymal enhancement was assessed on source images. The enhancement patterns were evaluated under 4 groups as following: (a) central (b) peripheral (c) patchy and (d) homogeneous enhancement. The morphologic changes in the liver (lobar hypertrophy or atrophy, hepatic surface irregularities) were also recorded. In the acute stage global liver enlargement (75%) with caudate hypertrophy (100%) and central enhancement of the liver (75%) were suggestive findings of the hepatic outflow obstruction. The left lobe hypertrophy (53%) associated with the caudate lobe hypertrophy (72%) and irregular surface (26%) were predominant in the chronic stage of the disease. The enhancement patterns seen in chronic disease were variable and reflected the persistent stasis of the portal blood flow (patchy enhancement in 32% of the patients) or the altered hemodynamics of the liver due to the development of subcapsular collaterals (peripheral enhancement in 21% of the patients). Homogeneous enhancement of the liver in Budd-Chiari syndrome may indicate the chronicity of the outflow obstruction (37%) and shows a more stable hepatic perfusion that occurs after the formation of intra and extrahepatic collateral veins. The morphological and perfusional features on multiphase contrast-enhanced MR angiography are valuable in understanding the effects of the hepatic outflow obstruction on the liver parenchyma.
我们的目的是呈现肝静脉流出道梗阻患者肝脏在磁共振血管造影（MR angiography）上的强化模式。对23例布加综合征患者（4例急性期和19例慢性期）进行了三维对比增强磁共振血管造影检查。在MR血管造影的门静脉早期和晚期，在原始图像上评估实质强化模式。强化模式分为以下4组进行评估：（a）中央型（b）周边型（c）斑片状和（d）均匀强化型。还记录了肝脏的形态学变化（叶肥大或萎缩、肝表面不规则）。在急性期，肝脏整体增大（75%）、尾状叶肥大（100%）和肝脏中央强化（75%）是肝静脉流出道梗阻的提示性表现。在疾病慢性期，左叶肥大（53%）与尾状叶肥大（72%）及表面不规则（26%）较为常见。慢性病中所见的强化模式各不相同，反映了门静脉血流的持续淤滞（32%的患者为斑片状强化）或由于包膜下侧支循环形成导致的肝脏血流动力学改变（21%的患者为周边强化）。布加综合征中肝脏的均匀强化可能提示流出道梗阻的慢性化（37%），并显示出在肝内和肝外侧支静脉形成后出现的更稳定的肝脏灌注。多期对比增强MR血管造影上的形态学和灌注特征对于理解肝静脉流出道梗阻对肝实质的影响具有重要价值。
