Multi-slice CT Portal Venography In Evaluation Of The Collateral Circulation In Portal Hypertension

Background Esophagogastric variceal bleeding is one of the most seriouscomplications in portal hypertension after liver cirrhosis. the higher the bleeding rateis,the higher the mortality is. To make early diagnosis and prevention can beeffectively reduce the generation of the complications. At present, the endoscopicexamination was still the gold standard to diagnose the esophaogastric varices. It canobserve whether the esophaogastric varices is, judge the degree of varices and reflectthe tension of vessel walls. Because of its traumatic and painfulness, some patientscannot be tolerated. In recent years, with the rapidly development of MDCT, someadvantages such as fast scan speed, high temporal and spatial resolution, narrowedCollimation and powerful post-processing workstations. especially as a non-invasion,were to be paid attention more and more. The technology of imaging in the portal veinhas quite mature at present, it can be through a large scan scale to display thecollateral vessels clearly. Consequently, MSCTP has been applicable to evaluate thecollateral circulation widely.Objective To evaluate technique and observe the imaging of esophagogastricvarices of SCTP by64-slice spiral CT and Gemstone spectral CT; To discuss theexpand of the vessels and its correlation with esophagealgastric varicealbleeding(EVB) and its correlation with cirrhotic grade by the measurement of portalsystem vessel diameter. To investigate the diagnosis of the extend and scope inesophagealgastric varices between multi-slice spiral CT portography and endoscopy.The study aim is how to effectively predict the esophagealgastric variceal bleedingand to make a proper pre-operative evaluation. Methods64-slice spiral CT and Gemstone spectral CT were used to performmulti-slice spiral CT portography imaging in50patients with liver cirrhosiscompanied by portal hypertension and15healthy volunteers (controls).10cases withliver cirrhosis ware undergone with Gemstone spectral CT. The original data has beentransferred to ADW4.4and ADW4.5workstations. The reconstructed slice thicknessan interval were1.25and0.6millimeter. Image post-processing techniques such asMIP, VR and MPR were applied to measured the diameters of portal venous systemvessels and depict the portosystemic collaterals of portal venous system. Accordingto Child-Pugh classification,60patients were divided into Child-Pugh group A、Band C，15volunteers were group D. According to the patients whether theesophagealgastric bleeding is or not, it divided into two groups that esophagealgastricbleeding(EVB) and no esophagealgastric bleeding(NEVB).32cases among60patients were performed with endoscopic, that were finding Type Ⅰ（4）,ypeⅡ（14）,type Ⅲ（11）.but3cases had no seen the esophagealgastric varices.Results1The diameters of remote/proximal of portal vein, right branch of portalvein and super mesenteric vein were no statistic significance between bleeding groupand no bleeding group(P＞0.05). The rest parameters of portal system in EVB groupwere all larger than those of no EVB group(P＜0.05). Age and gender in two groupswas no statistic significance (P＞0.05).2All diameters of portal system in cirrhotic group were larger than those of controlgroup(P＜0.05). The diameter of remote vessel, right branch of portal vein and leftgastric vein in grade Child-Pugh A and B were shorter than that in grade Child C (P＜0.05). those above parameters were no statistic significance in grade Child-Pugh Aand B (P＞0.05). The diameter of proximal vessel and left branch of portal vein, leftgastric vein in grade Child-Pugh A were shorter than that in grade Child-Pugh C (P＜0.05). those above parameters were no statistic significance in grade Child A-Pughand B, grade Child-Pugh B and C (P＞0.05). Compared the diameter of supermesenteric vein in grade Child-Pugh A and B, Child-Pugh A and C,the difference has statistics significance(P＜0.05), there was no statistic significance in gradeChild-Pugh B and C (P＞0.05).3The bleeding rate in different groups according to hepatic function showedstatistic significance(P＜0.05).4More than16mm and6mm of Heportal vein and left gastic in diameter asstandard as predict the esophagealgastric bleeding risk lamination target, bleeds inportal vein diameter＞16mm to compare the existence remarkable difference with noEVB group(P＜0.05). there was no statistic significance in diameter of left gastricvein between the two sets(P＞0.05).5More than16mm and6mm of Heportal vein and left gastic in diameter as alamination target to predict the esophagealgastric bleeding risk in different hepaticfunction. bleeds in portal vein diameter≥16mm and left gastric vein diameter≥6mm to compare the existence no statistic significance with no EVB group(P＞0.05).6The correlation between64-slice CT portal venography(CTPV) and endoscopichas statistic significance in the diagnosis and classification of esophagealgastricvarices (Κ=0.520,P=0.003).764-slice CT portal venography(CTPV) can clearly and comprehensivedemonstrate the collateral vessels.Conclusions1The portal vein, right branch of portal vein, spleen vein and leftgastric vein diameter of EVB group was larger than those of no EVB group. there wasno statistic significance in diameter of left branch of portal vein and supermesenteric vein between the two sets.2All diameters of portal system in cirrhotic group were larger than those of controlgroup. There was difference the diameter of vascular in different hepatic function.3Esophagealgastric bleeding is related to the degree of liver cirrhosis. With theclassification level increases, the risk of bleeding also raise.4There were remarkable difference between the portal vein Diameter of EVBAnd the Diameter of no EVB. The larger the diameter of portal vein, higher the bleeding rate. there was no statistic significance in diameter of left gastric veinbetween the two sets.5Take the portal vein and left gastric vein were more than16mm and6mm as alamination target to predict the esophagealgastric bleeding risk in different hepaticfunction. there was no statistic significance between the EVB and no EVB group inabove the diameter.6There was hight consistence between64-slice CT portal venography(CTPV) andthe endoscopic in the diagnosis and classification of esophagealgastric varices werediagnosed764row helical CT and Gemstone spectral CT are of great diagnostic value andadvantages for the portal hypertension in cirrhosis imaging.