4D flow MRI评估部分脾栓塞与门体分流封堵对门静脉血流动力学的影响
本研究回顾性纳入2019至2025年间30例手术（16例部分脾栓塞PSE、14例门体分流封堵PSO），用4D flow MRI测量术前术后门静脉主干、脾静脉、肠系膜上静脉及门体分流道血流。PSE后门静脉主干和脾静脉血流下降且变化强相关，PSO后两者均升高，且全部分流道被封堵时门静脉主干血流增加更显著。
要点
- PSE后门静脉主干与脾静脉血流下降，肠系膜上静脉血流不变。
- PSO后门静脉主干与脾静脉血流升高，肠系膜上静脉血流无显著变化。
- 全部分流道被封堵时门静脉主干血流增加幅度大于未全部封堵者。
核心结论
- 4D flow MRI显示PSE降低门静脉和脾静脉血流，而PSO使两者升高。
- 这些发现为门静脉系统治疗相关复杂血流动力学变化提供了定量依据。
研究设计与样本
- 回顾性队列研究，纳入2019至2025年间30例手术（16例PSE、14例PSO）。
- 使用4D flow MRI测量术前术后门静脉主干、脾静脉、肠系膜上静脉及门体分流道血流。
诊断标准与关键数值
- PSE后门静脉主干血流中位数从751.0降至441.5 mL/min（p=0.025），脾静脉从482.5降至323.0 mL/min（p=0.001）。
- PSE后门静脉主干与脾静脉血流变化强相关（ρ=0.726，p=0.002），栓塞体积比与脾静脉血流变化率中度相关（ρ=0.563，p=0.036）。
- PSO后门静脉主干血流从544.5升至692.5 mL/min（p<0.001），脾静脉从63.0升至231.5 mL/min（p=0.001）。
- 全部分流道被封堵时门静脉主干血流增加140.0 mL/min，未全部封堵时增加17.0 mL/min（p=0.019）。
临床应用与阅片要点
- 4D flow MRI可定量评估PSE和PSO前后门静脉系统血流动力学变化。
- PSE后应关注门静脉主干与脾静脉血流的同步下降，PSO后应关注两者升高。
- PSO疗效评估时需注意是否全部门体分流道被封堵，全部封堵者门静脉主干血流增加更明显。
局限性
- 回顾性研究设计。
- 样本量较小（共30例手术）。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
PURPOSE: To quantitatively evaluate changes in portal venous hemodynamics after partial splenic embolization (PSE) and portosystemic shunt occlusion (PSO) using four-dimensional (4D) flow magnetic resonance imaging (MRI).
METHODS: This retrospective cohort study included 30 procedures (16 PSE and 14 PSO) performed between 2019 and 2025. Flow rates were measured in the main portal vein (MPV), splenic vein (SpV), superior mesenteric vein (SMV), and portosystemic shunts (PSS) using pre- and post-procedural 4D flow MRI. For PSE, correlations were assessed between changes in MPV and SpV flow, and between vessel-specific flow change ratios and the embolic volume ratio. For PSO, changes in MPV flow were compared based on whether all PSS were treated, and correlation was assessed between flow changes in MPV and PSS flow.
RESULTS: After PSE, MPV flow decreased (median, 751.0 to 441.5 mL/min; p = 0.025) as did SpV flow (482.5 to 323.0 mL/min; p = 0.001), whereas SMV flow remained unchanged. Changes in MPV and SpV flow were strongly correlated (ρ = 0.726, p = 0.002). The embolic volume ratio showed a moderate correlation with the SpV flow change ratio (ρ = 0.563, p = 0.036), but not with the MPV flow change ratio. After PSO, MPV flow increased (544.5 to 692.5 mL/min; p < 0.001), along with SpV flow (63.0 to 231.5 mL/min; p = 0.001), while SMV flow did not change significantly. The increase in MPV flow was greater when all PSS were treated than when they were not (140.0 vs. 17.0 mL/min; p = 0.019), and was not correlated with PSS flow.
CONCLUSION: 4D flow MRI demonstrates that PSE decreases portal and splenic venous flow, whereas PSO increases both. These findings provide quantitative insight into complex treatment-related hemodynamic changes in the portal venous system.
引用
- Kato D, Kinota N, Abo D, et al. Effects of partial splenic embolization and portosystemic shunt occlusion on portal venous hemodynamics using 4D flow MRI. Abdom Radiol (NY). 2026. PMID: 42089988. doi:10.1007/s00261-026-05528-8
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。