MR对乙型肝炎肝硬化患者门脉海绵样变胆管病的诊断价值

摘要

Objective To investigate the diagnostic value of MR for portal cavernoma cholangiopathy(PCC)in patients with hepatitis B virus(HBV)-related cirrhosis.Methods Dynamic contrast-enhanced MR imaging for 33 patients clinically diagnosed of HBV-related cirrhosis with PCC from 2010 to 2016 in our hospital were retrospectively analyzed.MR signs including bile duct dilatation,terminal biliary strictures,marginal vascular dilatation and others were observed. Results All the 33 cases showed wavy bile duct dilation and irregular biliary wall,including 3 cases with tumor-like bile duct wall thickening.Among these patients,7 cases showed involvement of intrahepatic bile duct in left lobe,4 cases showed involvement of intrahepatic bile duct in right lobe,14 cases showed involvement of intrahepatic bile duct in both lobes and 8 cases showed involvement of both intrahepatic and extrahepatic bile ducts.Marginal vasculars of common bile duct(CBD)were tortuous in all cases.Furthermore,21 cases showed terminal biliary strictures and 12 cases showed obstruction,with homogeneously delayed reinforcement mass in 4 cases and portal vein embolus in 8 cases.Conclusion MR imaging plays an important role in diagnosis of PCC patients with HBV-related cirrhosis,which is characterized by bile duct dilatation,tortuous marginal vascular of CBD and homogeneously delayed reinforcement mass in terminal bile duct.%目的 通过分析乙型肝炎肝硬化患者门脉海绵样变胆管病的MR表现,提高本病的诊断准确率.方法 回顾性分析2010年至2016年解放军第三○二医院M R动态增强扫描及临床诊断的33例乙型肝炎肝硬化门脉海绵样变胆管病患者,观察胆管扩张范围、末端狭窄程度、胆管边缘血管扩张情况等M R征象.结果 33例患者均可见胆管迂曲扩张、管壁不规则,3例可见胆管壁呈"假瘤状"增厚;7例累及肝左叶肝内胆管,4例累及肝右叶肝内胆管,14例累及肝左右叶肝内胆管,8例累及肝内、外胆管;胆总管边缘均可见迂曲扩张血管影;另外,胆管末端狭窄21例,梗阻12例,末端见均匀延迟强化结节4例,末端与门脉栓子关系密切8例.结论 MR对于乙型肝炎肝硬化门脉海绵样变胆管病具有重要的诊断价值,典型表现为胆管扩张和胆管周边血管曲张及胆管末端均匀延迟强化结节.