Paper - WANFANG MED ONLINE

You Position: Home > Paper

Preliminary evaluation of magnetic resonance fresh blood imaging for diagnosis of Budd-Chiari syndrome

( views:80, downloads:8 )

Author:: No author available

Journal Title:: CHINESE MEDICAL JOURNAL

Issue:: 2

DOI:: No doi available

Key Word:: Budd-Chiari syndrome;hepatic vein thrombosis;magnetic resonance;angiography;fresh blood imaging

Abstract： Background Budd-Chiari syndrome (BCS) is a rare disease with portal hypertension caused by the blockage of the hepatic vein and/or the inferior vena cava (IVC). Angiography is the "golden standard" for diagnosis, but it is an invasive examination. To assess the diagnostic value of a fresh blood imaging (FBI) relative to BCS, we used a magnetic resonance angiography (MRA) with an FBI sequence for a preoperative evaluation of the BCS patients in this study. Methods Fifty patients who were suspected of having BCS after they had been checked by a B-ultrasound were studied. 2D and 3D FBI were performed on a 1.5T superconductive MR scanner. Original images were rebuilt using a maximal intensity projection (MIP) method on the console. Two doctors reviewed all images before they learned of the angiography results. We then compared the diagnoses obtained from the FBI and angiography results to evaluate the diagnostic value of the FBI.Results Forty-one patients were diagnosed as BCS and 9 as non-BCS based on an angiography. The FBI correctly diagnosed 38 patients, incorrectly diagnosed 1 patient, and missed diagnosis in 3 patients. Thus, the diagnostic sensitivity of the FBI is 93% (38/41), the specificity is 89% (8/9) and the accuracy is 92% (46/50). The FBI images of the 13 membranous stenoses of the IVC showed a sudden stenosis of the post-liver segment of the IVC. The Images of the 5 patients with a membranous obstruction of the IVC showed IVC thickening and an absence of blood signals in the post-hepatic segment of the IVC. The images of the 4 patients with the segmental thrombosis of the IVC showed abnormal and intermittent signals in the IVC. The images of the 6 patients with a simple hepatic vein obstruction showed obstructive hepatic veins. The images of the 6 patients with the stenosis of both the IVC and the hepatic veins showed the stenosis of the IVC, the thickening of the hepatic veins and the formation of a compensatory circulation within the liver. Lastly, the images of the 7 patients showed a combination of the IVC thrombosis with stenosis or with the obstruction of one or two hepatic veins.Conclusions An FBI can show a membranous stenosis, and an obstruction and thrombosis of the IVC. In addition, it can also demonstrate the thickening of the flexural hepatic vein and the development of intra-hepatic compensatory branches with slow blood flow. Thus, it can guide the puncturing and opening of the hepatic vein involved in an interventional therapy for BCS patients.

Reference

[1]杨建勇,张翎,余深平,等.Reestablishment of second hepatic hilum: a new technique for the treatment of Budd-Chiari syndrome[J].2003,(1).
[2]LIN Jiang,CHEN Bin,WANG Jian-hua.Diagnosis of systemic arterial diseases with whole-body 3D contrast-enhanced magnetic resonance angiography[J].2006,(21).
[3]程留芳,王志强,李长政,等.食管胃静脉曲张出血硬化治疗经验回顾[J].2002,(6).
[4]Ferral H,Gamboa P,Postoak DW,etc.Survival after elective transjugular intrahepatic portosystemic shunt creation: prediction with model for end-stage liver disease score.[J].2004,231(1).
[5]Urata J,Miyazaki M,Yamashita Y,etc.Clinical evaluation of aortic diseases using nonenhanced MRA with ECG-triggered 3D half-Fourier FSE.[J].2001,14(2).
[6]Rossi M,Marcelli G,Passariello R,etc.Polytetrafluoroethylene-covered Nitinol Stent-Graft for Transjugular Intrahepatic Portosystemic Shunt Creation: 3-year Experience.[J].2004,231(3).
[7]Yin Y,Elsayes KM,Mukundan G,etc.Focal hepatic lesions: diagnostic value of enhancement pattern approach with contrast-enhanced 3D gradient-echo MR imaging.[J].2005,25(5).
[8]Maetani Y,Hiraoka M,Itoh K,etc.Outcome of percutaneous transhepatic venoplasty for hepatic venous outflow obstruction after living donor liver transplantation.[J].2006,239(1).
[9]Konda D,Gandini R,Simonetti G.Transjugular intrahepatic portosystemic shunt patency and clinical outcome in patients with Budd-Chiari syndrome: covered versus uncovered stents.[J].2006,241(1).
[10]M, Miyazaki,S, Sugiura,F, Tateishi,etc.Non-contrast-enhanced MR angiography using 3D ECG-synchronized half-Fourier fast spin echo.[J].2000,12(5).
[11]K, Yokoyama,T, Nitatori,S, Inaoka,etc.Non-contrast enhanced MR venography using 3D fresh blood imaging (FBI): initial experience.[J].1900,19(5).
[12]Clark TW,Scott M,Soulen MC,etc.Dacron-covered stent-grafts in transjugular intrahepatic portosystemic shunts: initial experience.[J].2005,236(2).
[13]Patrick S, Kamath.Budd-Chiari syndrome: Radiologic findings.[J].2006,12(11 Suppl 2).
[14]Helmberger TK,Semelka RC.Contrast agents for MR imaging of the liver.[J].2001,218(1).
[15]Razavi MK,Frisoli JK,Sze DY,etc.Treatment of hepatic venous outflow obstruction after piggyback liver transplantation.[J].2005,236(1).
[16]Brancatelli G,Golfieri R,Grazioli L,etc.Benign regenerative nodules in budd-Chiari syndrome and other vascular disorders of the liver: radiologic-pathologic and clinical correlation.[J].2002,22(4).
[17]W Kenneth, Washburn,Robert G, Gish,Patrick S, Kamath.Model for end-stage liver disease (MELD) exception for Budd-Chiari syndrome.[J].2006,12(12 Suppl 3).