| Objective:Formation of portosystemic collateral vessels is an important pathophysiological symptom in liver cirrhosis. Esophagus and gastric fundus varices is a main collateral vessel. Hemorrhage caused by esophagus and gastric fundus varices is the reason for death. Left gastric vein (LGV) plays an important role in the formation of esophageal and gastric fundus varices. Caliber of LGV gradually are widen with the increase of portal hypertension. For the past few years, Multi-detector Row Computed Tomography (MDCT), which has the virtues of fast scanning, stenotic scanning collimation, accurate temporal and spatial resolution, has acquired rapid development. Abdominal scanning can be executed in the best time of portal venous phase. The reconstructed image is limpid and super-ordinary by using varied three and two-dimensional post-processing technique. All portosystemic collateral vessels can be displayed by one scanning. It is also the groundwork for quantitative analysis of the varicose degree. Therefore, Multi—detector Row Spiral CT Portal Venography (MDCTPV) has been widely used in clinical medicine. The purposes of this study are as follows. 1) To use MDCT to study LGV imaging technique; 2) to compare differences of infusing pylic locality of LGV between cirrhotic patients of portal hypertension and normal group; 3) to assess the correlation between the level of liver cirrhosis and the dilated degree of LGV, and the relationship between dilated degree of LGV and postcavale shunt; 4) to study the application of selective devascularization in the treatment of portal hypertension.Materials and methodologies:64-dectectors row spiral CT scanner was used to perform contrast—enhanced abdominal scanning in 42 patients of liver cirrhosis,30 healthy volunteers (controls) and 21 patients of selective devascularization three months later. The initial data of portal vein phase has been reconstructed in ADW4.4 workstation. Both reconstructed slice thickness and interval were 0.6 millimeter. Image post-processing techniques (MIP, MPR and VR) were applied to depict LGV and vessels of portal venous system. Diameters of PV, SV and LGV were measured. According to Child-Pugh classification, the 42 patients were divided into Child-Pugh A and Child-Pugh B, C two groups,the third group consisted of 30 healthy volunteers. Based on the location where LGV infuses into portal vein system, all cases can be divided into 3 groups: portal vein trunk, splenic vein and the junction between portal vein trunk and splenic vein. The 42 patients with portal hypertension can also be divided into 2 groups based on whether they have inferior venous shunt.Results1 Excellent image quality of LGV was obtained in all patients of liver cirrhosis and healthy volunteers. The diameters of LGV, PV and SV in all patients are significantly widened. There was statistically significant difference of LGV, PV and SV between patients and volunteers (P = 0.00).2 Among the total 72 cases, there were 33 cases that LGV infusing into portal vein trunk, 29 cases that LGV infusing into splenic vein, 10 cases that LGV infusing into the junction between portal vein trunk and splenic vein. There was no statistically significant difference between patients and volunteers (P = 0.795).3 There was no statistically significant difference between Child-Pugh classification and the correlation of PV and SV. There was statistically significant difference between Child-Pugh classification and LGV (P = 0.795). It is clear that Child-Pugh classification is closely related with change of LGV (P = 0.002).4 There was no statistically significant difference between caliber of PV, SV, GLV and inferior venous shunt (P = 0.93,0.50 and 0.09).5 The statistic difference of postoperative data between PV, SV and LGV was statistically significant (P = 0.000). Selective devascularization has a large influence on postoperative diameter of SV.Conclusions1 MDCT portal venography and post-processing is a powerful technique for studying LGV in cirrhotic patients with portal hypertension.2 For LGV infusing location, there was no statistically significant between patient group and volunteer group.3 The degree of LGV varicose reflects degree of liver cirrhosis to some extent. The diameter of LGV measured by MSCPV could be used to evaluate liver function and the degree of portal hypertension of cirrhosis patients.4 The degree of LGV varicose has no relationship with inferior vena cava shunt. 5 MDCT portal venography of LGV may play an important role in evaluating the surgical efficacy of selective devascularization in the treatment of portal hypertension。... |
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