Comparative Imaging Research Of Budd-Chiari Syndrome

Background and ObjectiveBudd-Chiari Syndrome(BCS) is a clinical syndrome which has portal vein and inferior vena cava hypertension resulted from hepatic vein and(or) the inferior vena cava blood flow obstruction.The liver appears pathological changes such as sinusoid hemorrhagic necrosis,eventually leading to a group of clinical syndromes of posterior sinus portal hypertension,including hepatomegaly,abdominal distension, portal hypertension and ascites by obstruction of hepatic venous,as well as varicose veins of the chest wall,lower limb edema for obstruction of inferior vena cava reflux. The early diagnosis of BCS is difficult,misdiagnosis is high,relapse rate is high after conservative treatment or improved self-compensatory symptoms,these are related to the unclear causes and pathogenesis of BCS.With the deepening aknowlege of BCS and developing of medical imaging technology,non-invasive imaging played a key role on the evaluation of preoperative diagnosis and the guidance of interventional therapy of BCS,and which also made it possible for BCS for early diagnosis and treatment.In recent years,the imaging of vascular disease and the level of interventional treatment has rapid development,but up to now,it has no unified program.In this study,the objective of this study was to do comparative imageology reserch on different examination methods and different types of lesions imaging of BCS,the results of Digital substraction angiography as the gold standard,and probe into the optimal examination route of BCS,in order to better guide clinical interventional therapy work. Materials and MethodsFrom January 2005 to February 2009,100 patients of suspected BCS,they are examined by CDFI in one week before DSA,in the First Affiliated Hospital of China Medical University.100 patients of suspected BCS,a total of 421 vein,83 BCS patients were confirmed by angiography,239 affected vein,47 left hepatic veins,52 middle hepatic veins,63 right hepatic veins,11 assistant hepatic veins,66 inferior vena cava.DSA as the gold standard,to calculate the sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ultrasound diagnostic,then to compare the US with DSA for clinical relevance ratio of BCS by X² test,and to evaluate there is no statistical difference or not.DSA as the gold standard,the results of the ultrasound diagnosis of venous obstruction of BCS were controlled,to assess the overall sensitivity,specificity,positive predictive value,negative predictive value and accuracy of stenosis or occlusion of venous obstruction BCS by the ultrasound.The right hepatic vein,middle hepatic vein,left hepatic vein,assistant hepatic vein,inferior vena cava vein are analysed separately.Ultrasound examinations showed the sensitivity, specificity,positive predictive value,negative predictive value and accuracy of venous stenosis or occlusion of above veins.By Kappa test,to analyse consistency of lesion classification for hepatic vein, inferior vena cava about US and DSA respectively.According to Xu Ke type,the results of ultrasonography were contrasted,and were analysed the consistency of both.Data was processed by SPSS 13.0 software,Kappa test for consistency,p＜0.05 as statistical standard.Results1.As gold standard of DSA,the sensitivity,specificity positive predictive value, negative predictive value and accuracy for ultrasound in BCS is 90.4%,64.7%,92.6%, 57.9%and 86.0%respectively,relevance rate was not statistically different from two methods(p＞0.75). 2.As gold standard of DSA,ultrasound showed that the overall correct rate of venous obstruction were 88.6%.Ultrasound showed the better consistency both hepatic veins and inferior vena cava aboat the classification of lesions with DSA,hepatic vein lesions grade showed better than the inferior vena cava(Kappa_HVs＞0.75＞Kappa_IVC＞0.7).3.According to Xu Ke BCS type,compared the results with ultrasound and DSA,two methods can be integrated on the Xu Ke BCS type,and have a good consistency with each other(Kappa=0.771,p＜0.01).Conclusions1.Ultrasonography,as a non-invasive examination method,can be much accurately to diagnose BCS,ultrasonography and DSA examination have no statistically different in the relevance rate of BCS.Therefore,as a preferred methods of clinical examination, ultrasound will become an important non-invasive examination on BCS and more suitable for screening job in high risk group.2.The accurate rates for classification of different veins are very high by ultrasonography,and they have a good consistency with DSA,and the hepatic vein lesion classification is superior to the inferior vena cava.3.Ultrasonography has a better consistency with DSA about Professor Xu Ke BCS type, can be a good guidance of the interventional treatment in BCS.