目的 探讨3.0T MRI肝脏容积加速采集序列(LAVA)在Budd-Chiari综合征(BCS)肝内、外侧支的显示及其分型中的价值.方法 18例经数字减影血管造影(DSA)证实的原发性BCS,均行MRI LAVA扫描,原始图像行多平面重建(MPR)、最大密度投影(MIP)和容积再现(VR)方法重建三维图像,分析下腔静脉、肝静脉和肝内、外侧支循环的显示.结果 18例BCS中,下腔静脉阻塞型12例,肝静脉型3例,混合型3例,LAVA清楚显示了全部的下腔静脉和肝静脉改变.肝内见4类侧支:①肝静脉-副肝静脉引流型15例,②肝静脉-(副肝静脉+肝静脉)引流型6例,③肝静脉-肝静脉引流型6 例,④肝包膜下静脉引流型及肝静脉-左膈下静脉型5例.肝外共见5类侧支:①腰静脉-腰升静脉-奇静脉及半奇静脉侧支18例,②左肾静脉-左腰升静脉-半奇静脉通道和左肾静脉-左膈下静脉侧支8例,③肾静脉-肾包膜下静脉-腹壁浅静脉侧支4例,④腹壁浅静脉侧支7例,⑤脊柱静脉丛侧支18例.肝内及肝外门-体交通各1例.结论 LAVA可清楚显示BCS的肝静脉和下腔静脉病变,结合MIP及MPR可以更直观、准确地显示肝内、外侧支循环.%Objective To evaluate liver acquisition with volume acceleration( LAVA ) in the demonstration and typing of collateral circulation in Budd-Chiari syndrome( BCS ). Methods Eighteen patients with primary BCS confirmed by DSA underwent MR imaging( MRI ), the sequence of LAVA was performed. The demonstration of inferior vena cava ( IVC ), hepatic vein ( HV ) and collaterals were evaluated. Results Of the 18 patients. intrahepatic collaterals were classified as four types:① HV-accessor HV( AHV ) pathway ( n = 15 ).② HV-AHV/HV pathway ( n = 6 ) ,③ HV-HV pathway ( n = 6 ) ,④ HV-hepatic subcapsular vein/left inferior phrenic vein pathway ( n = 5 ). Extrahepatic collaterals included five types :① ascending lumbar-azygos/hemiazygos pathway ( n = 18 ) ,② left renal-ascending lumbar-hemiazygos/left renal-left inferior phrenic vein pathway ( n = 8 ) ,③ renal vein-renal subcapsular vein-superficial collaterals of the abdominal wall pathway ( n = 4 ) ,④ superficial abdominal wall pathway ( n = 7 ),⑤ perispinal vein pathway ( n = 18 ). Intrahepatic and extrahepatic portal vein-systemic vein communication had one type, respectively. Conclusion 3D thin section dynamic enhanced MRI with LAVA technique can clearly depict lesions of HV and IVC. and combining with MIP and MPR. can more explicitly display the collateral circulations in BCS.
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