Debatin J F, Zahner B, Meyenberger C, Romanowski B, Schöpke W, Marincek B, Fuchs W A
Department of Radiology, Zurich University Hospital, Switzerland.
Hepatology. 1996 Nov;24(5):1109-15. doi: 10.1002/hep.510240522.
Flow volume in the azygos venous system was quantitated with Cine-phase contrast (PC) velocity mapping in volunteers and compared with patients with known portal hypertension, who were referred for transjugular intrahepatic portosystemic shunt (TIPS) placement. Subsequently, the TIPS-induced hemodynamic effects on portal and azygos flow were analyzed. To assess intra- and intersubject variability, flow in the azygos veins was measured in each of 10 normal subjects at three different times. Subsequently, portal and azygos flow was quantitated in 20 patients with portal hypertension, before and after TIPS placement. All imaging was performed on a 1.5-tesla magnetic resonance imaging (MRI) system. Azygos flow was measured transaxially at the midthoracic level. Cine-PC flow measurements of the main portal vein followed morphological evaluation of the portal venous system with axial and coronal breath-held magnet resonance angiogram. Azygos flow in normal subjects was characterized by high inter- and low intrasubject variability. Azygos flow in patients with portal hypertension was significantly higher (P < .001). Following successful TIPS placement in 18 patients, Cine-PC revealed a mean decrease in azygos flow of 46.3% (P < .001) and a 134% (P < .001) increase of portal flow. Reflecting the complexity of portal hemodynamics, there was no correlation between the changes in the portal and azygos systems. In 2 patients with early occlusion of TIPS, documented invasively, portal and azygos flow values remained largely unchanged. Cine-PC enables the noninvasive, quantitative assessment of flow within the azygos venous system. Azygos flow was found to be markedly elevated in patients with portal hypertension. Combined portal and azygos PC flow measurements quantitate the therapeutic effect of TIPS placement.
在志愿者中，采用电影相位对比（PC）速度成像技术对奇静脉系统的血流量进行定量分析，并与因行经颈静脉肝内门体分流术（TIPS）而就诊的已知门静脉高压患者进行比较。随后，分析TIPS对门静脉和奇静脉血流的血流动力学影响。为评估个体内和个体间的变异性，在10名正常受试者的三个不同时间点分别测量奇静脉的血流。随后，在20名门静脉高压患者TIPS植入前后对门静脉和奇静脉血流进行定量分析。所有成像均在1.5特斯拉磁共振成像（MRI）系统上进行。在胸中段水平经轴位测量奇静脉血流。在对门静脉系统进行轴位和冠状位屏气磁共振血管造影进行形态学评估后，对门静脉主干进行电影PC血流测量。正常受试者的奇静脉血流具有较高的个体间变异性和较低的个体内变异性。门静脉高压患者的奇静脉血流显著更高（P <.001）。18例患者成功植入TIPS后，电影PC显示奇静脉血流平均减少46.3%（P <.001），门静脉血流增加134%（P <.001）。反映门静脉血流动力学的复杂性，门静脉和奇静脉系统的变化之间无相关性。在2例经有创记录为TIPS早期闭塞的患者中，门静脉和奇静脉血流值基本保持不变。电影PC能够对奇静脉系统内的血流进行无创定量评估。发现门静脉高压患者的奇静脉血流明显升高。联合门静脉和奇静脉PC血流测量可定量TIPS植入的治疗效果。
