A Preliminary Study On The Morphology, Hemodynamics And Pathogenesis Of IVC In Budd-Chiari Syndrome By Magnetic Resonance Angiography Without Contrast Agent

Part ?Study on the Value of Rapid Quantitative Phase Contrast Method in the Diagnosis of Budd-Chiari Syndrome of Inferior Vena Cava ObstructionBackground:Non-CE MRA techniques(true steady-state free-precession,SSFP)have been used effectively for the selective visualization of the portal venous system and inferior vena cava.The Budd-Chiari Syndrome(BCS)encompasses a number of conditions that cause obstruction of the hepatic outflow tract from the small hepatic veins to the junction of the inferior vena cava(IVC)and right atriumPurpose:The purpose of this study was to analyze inferior vena cava(IVC)obstruction in Budd-Chiari syndrome(BCS)using rapid quantitative phase-contrast(PC)magnetic resonance(MR)imaging and compare the diagnostic efficacy of PC and MR venography(MRV)to explore the clinical prospects of applying PC quantitative diagnosis in IVC obstruction in BCSMaterials and Methods:PC quantitative data and MRV qualitative data obtained in 35 DSA-recognized inferior vena cava obstruction BCS patients and 35 patients with liver focal lesions found in physical examination were analyzed and comparedResults:The areas under the ROC curve for diagnostic parameters related to PC quantitative parameters,including stroke volume,forward flow volume,absolute stroke volume,mean flux,stroke distance,mean velocity(MV),and peak velocity,were 0.7767,0.7788,0.7747,0.7665,0.9143,0.9159,and 0.8947,respectively.The sensitivity,specificity and accuracy of MV in the diagnosis of IVC obstruction were 88.57%,85.71%and 87.14%,respectively.For IVC obstruction in BCS,there was no significant difference between the diagnostic efficacy of MV(one of the quantitative parameters of PC)and that of MRV(P=0.0768)Conclusion:PC can be used to diagnose IVC obstruction BCS and improve understanding hemodynamics of IVC obstruction BCSPart ?Preliminary study on the diagnostic value of non-enhanced MRA in vena cava of Budd-Chiari syndromePurpose:The purpose of this study was to diagnose BCS with IVC obstruction using respiratory triggered three-dimensional(3D)true SSFP with T-SLIP,and compare with digital subtraction angiography(DSA)Materials and methods:The image of 3D true SSFP scans acquisition was being successfully performed in 108 patients((?)2 score).Institutional review board approval and informed consent from all patients were attained before this research Non-contrast-enhanced MR angiography and DSA were completed within one week All patients have not gone through any treatment before this study.Interobserver agreement for the detection of 4 types IVC obstruction with Time-SLIP between the two readers was determined by calculating the ? values using a simple kappa test Intergroup agreement for the detection of 4 types IVC obstruction between the Time-SLIP(Reader 1)and the DSA was determined by calculating the ? values using a simple kappa testResults:The mean and SDs of the relative SNR and CNR are 55.96 ±2.32,and 30.72± 1.56,respectively.Intergroup agreement for the detection of the 4 types(membranous obstruction,segmental occlusion,and membranous obstruction with a holes and segmental stenosis)IVC obstruction BCS between the Time-SLIP and the DSA was an excellent agreement with a kappa value 0.897Conclusion:In conclusion,utilizing the Time-SLIP technology without contrast could be used to detect of IVC obstruction BCS.It can achieve high success rate,high accuracy with fine image quality for diagnosis of IVC obstruction BCSPart ?The MRV Comparation of the Angle between the Right Hepatic Vein and the Inferior Vena Cava for Patients with Membranous Obstruction of the Inferior Vena CavaPurpose:By observing both the right hepatic vein morphology and the size of the angle between the inferior vena cava and RHV in the group of MOVC patients,the group of normal people and the group of patients with cirrhosis,the aims to find out whether there is a difference among them and guide interventional treatment program developmentMaterials and methods:we collected consecutive 248 subjects sequentially and divided them into 3 groups:Group A(control ones,94 cases),Group B(MOVC patients,68 cases),and Group C(HLC patients,86 cases),respectively.The angle between the hepatic vein and inferior vena cava of the three groups,which is defined as value T were measured.The morphology of the right hepatic vein is divided into three types as N,U,I.The differences of the constituent ratio among the three groups of the T value and the angle type were compared.Measurement data were recorded as mean ±SD,the difference of T value among the groups were compared with one-way ANOVA,count data were used as relative number,the difference of the angle type among the groups were compared with the chi-square testResults:Average T value of group B[(56.1 ± 13.7)]was significantly higher than that in group A[(49.3 ± 7.8),P=0.010]and group C[(51.5 ± 10.0),P<0.001];the difference has statistic significance(F=8.750,P<0.001),no significant difference between the group A and C was found N-type proportion of the group B is greater than that of the group A,and C Meanwhile,U-type proportion of the group B is less than that of the group A,and C and the differences among the groups were statistically significant(P<0.001).There was no statistical difference between the group A and C for the proportion of N and U-typesConclusion:The angle between right hepatic vein and the inferior vena cava of MOVC patients has morphological differences compared with the other subjects,and the angle value of MOVC patients is significantly larger than those of the others Such difference is irrelevant to the patients with cirrhosis.