布加综合征：CT 和 MRI 上的“下腔静脉逆流”征和“射血”征。

Radiology Department of Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.

Emergency Department of Second Medical Center of Chinese PLA General Hospital, Beijing, China.

Eur J Radiol. 2020 Nov;132:109288. doi: 10.1016/j.ejrad.2020.109288. Epub 2020 Sep 19.

OBJECTIVE

To investigate the CT and MR features of "inferior vena cava(IVC) reverse-flow" sign and "jet-blood" sign in Budd-Chiari Syndrome (BCS).

METHODS

The liver CT and/or MRI plain scan and dynamic enhancement of 107 cases of BCS diagnosed by DSA and/or clinic were collected, including 17 patients with hepatic vein obstruction type, 79 patients with IVC obstruction type, and 11 patients with mixed type. The manifestations of IVC reverse-flow sign and jet-blood sign in the latter two type BCS (90cases) imaging were analyzed.

RESULTS

The incidence of IVC reverse-flow sign in the IVC obstruction type and mixed type was 93.3 %(83/90), which was manifested as: The contrast agent was shown below the level of renal veins in the hepatic arterial phase enhancement, while no contrast agent was shown above it at the same time. 2) The incidence of jet-blood sign in membrane-perforated subtype was 100 %(15/15) or 16.7 %(15/90), which was manifested as: The low density/signal dots appeared within full of contrast agent at the superior liver segment IVC on axial slices in arterial phase of CT/MRI enhancement, or the low signal line within agent presented above the IVC membrane on coronal image in equilibrium phase of MR enhancement. 3) Other imaging findings: 75 cases of membrane, 18 cases of membrane calcification, 27 cases of abnormal hepatic vein, 76 cases of abnormal structure of IVC, 18 cases of thrombus/cancer embolus in hepatic vein and/or IVC. There were 65 cases of abnormal liver appearance; 71 cases of abnormal liver enhancement; 21 cases of hepatic vein unsynchronous enhancement. Anastomotic branches among the hepatic veins open with comma sign in 54 cases; dilatation of intraspinal and paravertebral veins, azygos and hemiazygos veins in 90 cases(100 %, 90/90) or 96 cases(89.7 %, 96/107).

CONCLUSIONS

The "IVC reverse-flow" sign is a specific CT and MR sign of IVC type and mixed type BCS, and the "jet-blood" sign is a characteristic CT and MR sign of membrane-perforated subtype BCS.

目的

探讨布加综合征（BCS）下腔静脉（IVC）逆向血流（IVC 逆流血）征和“射流-血流”征的 CT 和 MR 特征。

方法

收集经 DSA 和/或临床诊断为 BCS 的 107 例患者的肝脏 CT 和/或 MRI 平扫及动态增强资料，其中肝静脉阻塞型 17 例，IVC 阻塞型 79 例，混合型 11 例。分析后两种类型 BCS（90 例）影像中 IVC 逆流血征和射流-血流征的表现。

结果

1）IVC 阻塞型和混合型 IVC 逆流血征的发生率分别为 93.3%（83/90）和 93.3%（83/90），表现为：肝动脉期增强时造影剂位于肾静脉水平以下，同时其上无造影剂。2）膜孔型射流-血流征的发生率为 100%（15/15）或 16.7%（15/90），表现为：CT/MRI 增强动脉期轴位上 IVC 上段肝内充满造影剂时出现低密度/信号点，或 MR 增强平衡期冠状位上 IVC 膜内出现低信号线。3）其他影像学表现：膜 75 例，膜钙化 18 例，肝静脉异常 27 例，IVC 结构异常 76 例，肝静脉和/或 IVC 内血栓/癌栓 18 例。异常肝脏表现 65 例，异常肝增强 71 例，肝静脉不同步增强 21 例。54 例肝静脉吻合支呈逗号征开放，90 例（100%，90/90）或 96 例（89.7%，96/107）椎间静脉、椎旁静脉、奇静脉和半奇静脉扩张。