CT血管三维重建鉴别布加综合征与乙型肝炎肝硬化价值分析*

doi:10.3969/j.issn.1672-5069.2020.06.027

摘要/Abstract

摘要： 目的研究CT血管三维重建对鉴别布加综合征(BCS)与乙型肝炎肝硬化的临床价值。方法 2017年3月～2020年3月我院诊治的BCS患者28例,乙型肝炎肝硬化患者46例,接受CT血管三维重建检查,记录两组CT三维重建检查影像学特点。采用Logistic多因素回归分析探讨各征象对诊断BCS的价值,并建立回归方程。采用受试者工作特征曲线(ROC)分析回归方程诊断BCS的应用价值。结果 BCS组肝内静脉侧支开放发生率为82.1%,显著高于肝硬化组的15.2%(P<0.05),奇静脉与腰升静脉交通发生率为46.4%,显著高于肝硬化组的10.9%(P<0.05),下腔静脉和肝静脉充盈缺损为85.7%和92.9%,显著高于肝硬化组的10.9%和8.7%(P<0.05);腹膜后静脉丛曲张为35.7%,显著高于肝硬化组的10.9%(P<0.05),尾状叶增大为64.3%,显著高于肝硬化组的6.5%(P<0.05),地图状/雪花样强化为82.1%,显著高于肝硬化组的6.5%(P<0.05),门脉期不均匀强化为85.7%,显著高于肝硬化组的13.0%(P<0.05);Logistic多因素分析显示肝内静脉侧支开放(95%CI=1.035～3.332,P=0.038)、奇静脉与腰升静脉交通(95%CI=1.203～2.296,P=0.002)、下腔静脉充盈缺损(95%CI=1.694～4.893,P=0.000)、肝静脉充盈缺损(95%CI=1.695～3.156,P=0.000)、尾状叶增大(95%CI=1.012～1.901,P=0.042)和门脉期不均匀强化(95%CI=1.234～2.916,P=0.004)是诊断BCS的独立指标;ROC分析结果显示我们建立的回归方程诊断BCS的AUC为0.888(95%CI=0.812～0.965,P=0.000),显著高于其他各征象诊断。结论 CT血管三维重建检查有助于鉴别BCS与乙型肝炎肝硬化,综合CT三维重建征象建立预测模型有助于对BCS患者的早期筛查和诊断。

关键词: 布加综合征, 肝硬化, CT血管三维重建, 诊断

Abstract: Objective To study the diagnostic value of three-dimensional reconstruction of blood vessels in differential diagnosis of patients with Budd-Chiari syndrome (BCS) and liver cirrhosis after hepatitis B infecton. Methods 28 patients with BCS and 46 patients with liver cirrhosis after hepatitis B viral infection were enrolled between March 2017 and March 2020, and All patients underwent three-dimensional reconstruction of blood vessels by CT imaging. The imaging features of three-dimensional reconstruction of blood vessels were recorded. The Logistic regression analysis was applied to explore the value of each sign in the diagnosis of BCS, and a regression equation was established. The receiver operating characteristic curve (ROC) was used to analyze the value of this regression equation in the diagnosis of BCS. Results The collateral opening of intrahepatic vein in patients with BCS was 82.1%, which was significantly higher than that in patients with cirrhosis(15.2%, P<0.05), the communication between azygos vein and ascending lumbar vein was 46.4%, which was significantly higher than that in cirrhosis group (10.9%, P<0.05), the filling defects of inferior vena cava and hepatic vein in BCS group were 85.7% and 92.9%, respectively, which were significantly higher than those in cirrhosis group (10.9% and 8.7%,P<0.05), the retroperitoneal varicosity in BCS group were 35.7%, which was significantly higher than that in cirrhosis group (10.9%,P<0.05), the caudate lobe enlargement in BCS group was 64.3%, which was significantly higher than that in cirrhosisgroup (6.5%,P<0.05), the map snow pattern enhancement was 82.1% in BCS group, which was significantly higher than in the cirrhosis group(6.5%,P<0.05), the uneven enhancement of portal phase in BCS group was 85.7%, which was significantly higher than that in cirrhosis group (13.0%,P<0.05); the multivariate Logistic analysis showed that the collateral opening of intrahepatic vein (95%CI=1.035-3.332,P=0.038), the communication between azygos vein and ascending lumbar vein (95%CI=1.203-2.296,P=0.002), the filling defect of inferior vena cava (95% CI=1.694-4.893,P=0.000),the filling defect of hepatic vein (95%CI=1.695-3.156,P=0.000),the caudate lobe enlargement (95%CI=1.012-1.901, P=0.042), and the uneven enhancement of portal phase (95%CI=1.234-2.916,P=0.004) were the independent indicator in the diagnosis of BCS; the regression equation was established,and the ROC analysis showed that the AUC of the regression equation we established in diagnosis of BCS was 0.888 (95%CI=0.812～0.965,P=0.000), which were highest among any other signs. Conclusion The three dimensional reconstruction of blood vessels by CT scan is helpful to distinguish between BCS and the hepatitis B liver cirrhosis, which might be used for early screening and diagnosis of patients with BCS.

Key words: Budd-Chiari syndrome, Liver cirrhosis, Three dimensional reconstruction of blood vessels, Diagnosis

宋丽俊, 鲁雪红, 薛志伟, 张梅, 王伟. CT血管三维重建鉴别布加综合征与乙型肝炎肝硬化价值分析^*[J]. 实用肝脏病杂志, 2020, 23(6): 865-868.

Song Lijun, Lu Xuehong, Xue Zhiwei, et al. Diagnostic value of three-dimensional reconstruction of blood vessels by CT scan in differential diagnosis of patients with Budd Chiari syndrome and liver cirrhosis[J]. Journal of Practical Hepatology, 2020, 23(6): 865-868.

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CT血管三维重建鉴别布加综合征与乙型肝炎肝硬化价值分析^*

Diagnostic value of three-dimensional reconstruction of blood vessels by CT scan in differential diagnosis of patients with Budd Chiari syndrome and liver cirrhosis

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