Comparative Study Of3D-DCE MRA And DSA In The Diagnostic Classification Of Primary Budd-Chiari Syndrome

Objective:To investigate the clinical value of three-dimensional dynamic contrast-enhanced magnetic resonance angiography (3D DCE MRA) in the diagnosis of primary Budd-Chiari syndrome (BCS) and the Diagnostic Classification.Methods:The study enrolled46patients with a clinical suspicion of primary BCS; all patients underwent MRI and DSA. MRI scanning used GE1.5T magnetic resonance scanners and Torsopa8-channel phased array coil, with the plain and vascular enhanced scan, including the sequences of T1WI, T2WI, FIESTA, and LAVA sequence. M3D/TOF/FSPGR is the vascular enhanced scanning sequence. After transmitted the obtained data to GE AW4.2workstation, we reconstruct the blood vessel images with the MIP and MPR. All3D DCE MRA images were evaluated respectively by2physicians who have worked more than5years in vascular diagnostic imaging department, they evaluated the diseases of veins and the typing of the primary BCS patients. Comparing with the DSA data, we evaluated the ability of3D DCE MRA in diagnosing primary BCS; evaluated the sensitivity and specificity of finding all intravenous lesions (including inferior vena cava and hepatic veins), the sensitivity of finding lesions of inferior vena cava and hepatic vein and the sensitivity of showing accessory hepatic veins; Kappa coefficient testing was adopted to evaluate the consistency of two methods in diagnosing the type of primary BCS.Results:1. the average image quality score of46patients was (3.6±0.5).46cases were all BCS patients confirmed by the DSA.45patients were diagnosed correctly by3D DCE MRA; one case with poor image quality was misdiagnosed as normal.2.46patients were found151venous lesions in DSA (including inferior vena cava and three hepatic veins),39venous lesions of inferior vena cava; Right, middle and left hepatic venous lesions were34,39, and39respectively. Using the3D DCE MRA, we found that a total of143venous diseases,39venous lesions of inferior vena cava disease; Right hepatic, middle and left hepatic venous lesions were32,36and36respectively. The sensitivity and specificity of3D DCE MRA in detecting the total intravenous lesions (inferior vena cava and hepatic veins) was93.4%and94.0%. The sensitivity of3D DCE MRA in detecting the lesions of the inferior vena cava was94.9%, the sensitivity in diagnosing lesions of right, middle and left hepatic veins was94.1%,92.3%and92.3%respectively.3D DCE MRA misdiagnosed2inferior vena venous lesions, missed2inferior vena venous lesions, missed2,3and3lesions of right, middle and left hepatic veins respectively.3. DSA found30BCS patients with vice hepatic vein dilation, while25cases’accessory hepatic vein were seen by3D DCE MRA, the sensitivity was83.3%in detecting the accessory hepatic vein.4.3D DCE MRA correctly diagnosed45cases of BCS while missed one case, making the classification of the45BCS patients by DSA and3D DCE MRA.3patients of type I,5cases of type Ⅱ,31cases of type Ⅲ were diagnosed correctly by3D DCE of MRA, with86.7%of the total coincidence rate. The consistency between the two way of examination was relatively high (κ=0.667). Conclusion:3D DCE MRA can accurately diagnose primary Budd-Chiari syndrome and is able to make the right typing.