非对比剂增强 MR 血管成像技术在门静脉成像中的应用

摘要

目的：探讨非对比剂增强磁共振血管成像（NCE-MRA）在评估肝脏门静脉解剖中的临床价值，并与 MSCT门静脉成像（MSCTP）进行对照。方法：选择30例受试者分别行 SLEEK 序列 NCE-MRA 和 MSCTA 门静脉成像检查，其中肝硬化10例，肝癌10例，健康体检者10例。由两位医师分别对所有患者的 NCE-MRA 和 MSCTP 门静脉成像质量进行评分（4级评分法）并进行统计学分析。结果：NCE-MRA 组和 MSCTP 组中，门静脉成像质量评分在2分以上者分别占93．3％（28／30）和96．7％（29／30）。两种方法均能显示所有受试者的3级及3级以下的肝内门静脉，符合率为100％（30／30）。2例（6．7％）健康志愿者的门静脉第6级分支在 NCE-MRA 上未显示，而在 CTP 上可以显示；3例（10％）肝硬化门静脉高压患者的门静脉第5级分支在 CTP 上未显示，而在 NCE-MRA 上可以显示；2例（6．7％）肝肿瘤患者门静脉的部分第4级分支在 CTP 上未显示，而在 NCE-MRA 上可以显示。两种方法的门静脉图像质量评分的差异无统计学意义（P ＜0．05），两位诊断医师对 NCE-MRA 门静脉成像质量评分的一致性较高，Kappa 值为0．95。结论：SLEEK 序列 NCE-MRA是一种无需使用对比剂的非侵入性血管成像方法，能有效地对肝脏门静脉进行评估。%Objectire:To explore the diagnostic performance of non-contrast-enhanced MR angiography (NCE-MRA) in the anatomic assessment of hepatic portal vein (PV ) using comparative study with multi-slice CT portography (MSCTP).Methods:Thirty patients including ten patients with hepatic cirrhosis without ascites and ten patients with hepa-tocellular carcinoma and ten healthy volunteers underwent MSCTP and NCE-MRA with SLEEK (spatial labeling with mul-tiple inversion pulses)technique.Imaging quality of hepatic portal veins on NCE-MRA and MSCTP was evaluated and gra-ded with a four-point scale by two radiologists respectively,and the difference of scores between two imaging methods was analyzed with chi-square test.Results:There were 28 cases (28/30,93.3%)with score of image quality more than 2 in NCE-MRA group,and 29 cases (29/30,96.7%)in MSCTP group,respectively.All the segments of PV with grade 1 ~3 were clearly showed both on NCE-MRA and CTP images.Only 2 segments with grade 6 were missed in NCE-MRA group, but were showed in CTP group;and 3 segments with grade 5 and 2 segments with grade 4 were missed in CTP group.There was no statistic difference between the scores of portography in NCE-MRA and CTP group.The agreement of the scores of portography by two radiologist in NCE-MRA group was high with Kappa value (0.95)larger than 0.75.Conclusion:NCE-MRA with SLEEK technique is a non-invasive and effective method which could provide comprehensive assessment of the hepatic portal vein without using contrast medium .