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目的　评价磁共振技术对门静脉系统全方位三维成像在门静脉高压症中的应用价值。方法　 2 0 0 2年 9月至 2 0 0 3年 10月通过规范扫描时相、增加采集块厚及减影后处理等成像优化技术 ,对 5 1例肝硬化病人作磁共振血管三维成像 (three dimensionalMRangiography ,3DMRA) ,以整体地、全角度地三维显示门静脉系统及其侧支循环 ,结合临床手术进行对比、分析。结果　 5 1例病人中有 4 6例门静脉主干清晰成像 ,其余 5例为门静脉海绵样变或癌栓。食管下段及胃底静脉、前腹壁静脉、左性腺静脉、直肠上静脉曲张及自发性胃肾 /脾肾分流的比例分别为 73 3% ,2 8 9% ,2 0 % ,2 0 % ,8%。减影技术能提高侧支曲张静脉的成像评分 (P <0 0 5 )。接受手术者共 39例 ,结合其MRA影像制定方案 ,均取得预期手术效果。结论　 3DMRA全方位显示门静脉系统及侧支循环 ,具有准确全面、直观无创等优点 ,对门静脉高压症的手术决策有重要指导作用。

Three-dimensional MRA's totally imaging portal venous system in portal hypertensive surgery

Objective To evaluate the availability of 3D MRA's imaging the whole portal venous system in portal hypertensive surgery. Methods With normative timing of sequences,enhancive slab thickness and subtraction,3D MRA was performed in 51 patients with liver cirrhosis from Sept. 2002 to Oct. 2003 to display portal venous system and its collaterals totally and three-dimensionally.Combined with operations of the patients,the data was compared and analyzed. Results Forty-six of 51 cases showed clear graphs of portal veins while other 5 cases showed cavernous transformation or cancerous emboli in portal vein. The lower esophageal vein,gastric fundus vein,anterior abdominal wall,left gonad vein,superior rectal veins,spontaneous gastrorenal or splenorenal shunt accounted for the proportion by 73.3%,28.9%,20%,20%,8%. Subtraction demonstrated porto-collaterals more clearly than non-subtraction did ( P<0.05). All 39 cases received procedures based on MRA and got expected effects. Conclusion Three dimensional MRA's imaging the whole portal system with its collaterals is an accurate,comprehensive,invasive method and is important to surgical decision of portal hypertension.