急性亚急性门静脉血栓形成

来源：双语学影像；病例选自《MayoClinicBodyMRICaseReview》

83-year-oldmanbeingevaluatedintheemergencydepartmentforabdominalpain

88岁男性，腹痛。

Fig2.16.1

Fig2.16.2

Axialpostgadoliniumportalvenousphaseimages(Figure2.16.1)demonstratenearlyocclusivethrombusthroughoutthemainportalvein.Reformattedobliqueimages(Figure2.16.2)showthrombusextensionintotherightandleftportalveinsandthesuperiormesentericvein.

横断位增强扫描门静脉期(Figure2.16.1)示门静脉主干内血栓形成，管腔几乎完全闭塞。斜位重建图像(Figure2.16.2)示血栓延伸至门脉左支、右支及肠系膜上静脉。

Diagnosis

Acute-subacuteportalveinthrombosis

急性-亚急性门静脉血栓形成

Comment

Portalveinthrombosis,whenasextensiveasinthiscase,isaneasydiagnosistomakewithMRI,particularlyonpostgadoliniumimages,wherethethrombusappearsasadarkfillingdefectwithinthevein.Ifgadoliniumcannotbeadministered,2Dor3DSSFPimagesareoftenhelpful,demonstratingfillingdefectswithdecreasedsignalintensityrelativetoadjacentblood.NoncontrastSSFPacquisitionsareprobablyslightlylesssensitivefordetectionofthrombusthanpostgadolinium3DSPGRimages:Afewcasereportshavedescribedsubacutethrombusofexactlytherightagetohavesignalintensityverysimilartotheadjacentbloodpool.Inourexperience,however,thisisarareoccurrence,andSSFPimagesareingeneralmuchmorereliableindicatorsofthrombusthanFSEacquisitions,wheretheabsenceofavenousflowvoidcanbeseennotonlyinthepresenceofthrombus,butalsowithslowflowandin-planeflow.Likewise,diffusion-weightedimagesareverysensitivefordetectionoftumorthrombus,whichappearsasahyperintenselesionwithintheportalvein,butmaybelesssuccessfulinthesettingofsubacute-chronicblandthrombus,whichfrequentlyhaslowsignalintensityandmaybedifficulttodistinguishfromanormalflowvoid.

类似本例病变范围广泛的门静脉血栓形成MR诊断并不难，特别是增强扫描表现为管腔内低信号充盈缺损。如果不进行增强扫描，2D或3DSSFP序列表现为管腔内相对低信号，也可有助于诊断。SSFP平扫对血栓形成的发现不如SSFP增强扫描，部分病例报道亚急性期血栓信号有时与血池信号相仿，但根据我们的经验，这一情况很少发生，而且SSFP序列对血栓的诊断优于FSE序列，管腔内血液没有流空，不仅可以显示血栓，也能显示缓慢流动的血流和平面内血流。DWI序列中瘤栓表现为门静脉内高信号，诊断有一定敏感性，但亚急性-慢性血栓在DWI序列呈低信号，与流空的血液信号相仿，诊断有一定难度。

Occlusiveportalveinthrombosisthatisnotquicklyrecanalizedwillinevitablyleadtoportalhypertensionandsubsequentdevelopmentofvarices.Cavernoustransformationoftheportalveinoccurswhenthereisin

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