Application Of The Portal Hypertension In Cirrhosis With Muti-slice CT Portography

Part 1 A anlysis of hepatic portal vein anatomy and variants with multi-slice CT angiographyObjective: A prospective multi-slice CT Portography (MSCTP) study was undertaken to determine the anatomy and variations of the intrahepatic portal vein.Methods: A 16-detector row spiral CT scanner was used to perform plain and muti-phase contrast enhanced abdominal scanning. The intrahepatic portal systems of 200 healthy volunteers were analyzed and various image post-processing techniques such as MPR,MIP ,VR,were applied to depict the portal systems.The normal anatomy of these venous systems were determined. Variants of the intrahepatic portal veins were classified. The percentage of each variation was calculated. The parameters of portal system(Dpv,Lpv,Dsv and Dsmv) were measured and compared with different sexes and ages groups.The data were analyzed with statistics .Results: Of the 200 healthy volunteers examined , 163 (81.5%) patients were normal distribution of the intrahepatic portal vein.23 (11.5%) inⅠvariation, 13(6.5%) inⅡvariation, 1(0.5%)inⅢvariation and the absence of the horizontal segment of the left portal vein or absence of the right portal vein was not demonstrated. There are significant difference between sexes groups in Dpv,Dsv and Dsmv (1.33±0.12cmVS1.23±0.12 cm,0.82±0.10cm VS 0.75±0.12cm,1.21±0.16cm VS1.08±0.15cm , P<0.05).There are no sigificant difference between sexes groups in Lpv(4.84±1.02ccmVS4.64±0.93cm, P>0.05). Except Lpv of≥50 ages group is longer than <50 ages group in man(5.11±1.17cmVS4.64±0.85cm,P<0.05),There are no significant difference in the rest parameters of portal system in different ages group in men and women(P>0.05).Conclusions: The anatomy and variations of the portal veins can objectively recognized with MSCTP. Part 2 Evaluation of the portal hypertension in cirrhosis with muti-slice CT portographyObjective:To investigate the parameters of portal system in cirrhosis with portal hypertension and its correlation with esophageal variceal bleeding (EVB)and evaluate the clinic value in cirrhotic gradeing and esphgeal variceal bleeding with multi-slice CT portography.Method: 200 healthy controls, 94 males and 104 females, with mean age 48.5years old. 63 cirrhosis, 33males, 30females, with mean age 51.82 years old, 31 cases in esophageal variceal bleeding and 32 cases in non esophageal variceal bleeding group. A 16-detector row spiral CT scanner was used to perform plain and muti-phase contrast enhanced abdominal scanning in all 63 cirrhosis patients and 200 cases control group. Various image post-processing techniques such as MPR,MIP ,VR,were applied to depict the portal systems. The Dpv,Dsv,Dsmv and Lpv, the blood vessel parameter of portal system were measured and were compared with control group and cirrhotic group,different cirrhotic grades and were compared with EVB and non EVB.Result: The Dpv,Dsv,Dsmv and Lpv are higher in cirrhotic group than control group(1.57±0.29 cmVS1.28±0.13 cm,1.16±0.30cmVS0.79±0. 12cm,1.29±0.24cm VS1.15±0.17 cm,5.66±1.05cmVS4.73±0.98cm respectively,P<0.01), except the diameter of super mesenteric vein in Child-Pugh C grade is larger than Child-Pugh A and B grade ,the rest parameters are not statistic significance in different cirrhotic grade(P>0.05).the portal diameter of EVB group is larger than that of non EVB group(P<0.05).Conclusion: MSCTP can clearly demonstrate the portal trunk and its branches and can not reflect the extent of cirrhotic portal hypertension and are of great clinic value in the estimation of EVB. Part 3 Evaluation of esophageal varices in cirrhotic patients with muti-slice row CT portographyObjective:To retrospectively investgate MSCTP in the detection and grading of esophageal varices(EV) in cirrhotic patients compared with endoscopy and to evaluate esophageal changes in EV and the relation of esophageal varices with variceal hemorrhage.Methods: All 70 cirrhosis patients were underwent a 16-detector row spiral CT(GE LightSpeedPro16 /CT,GE company) and endoscopy within one week,the results with MSCTP were compared with endoscopy. 56 patients with esophageal varices were divided into two groups: esophageal varice bleeding group(28cases) and non esophageal varice bleeding group(28cases), both groups were compared in the diameter of EV,the thickness of esophagus and the numer of blood transverse sections .Result: MSCTP had high consistency with endoscopy (Kappa value=0.823);The sensitivity, specificity and accuracy of mediate and severe (≥3mm) esophageal varices of MSCTP were 97.78%,88%,94.29%; The vessel diameter,wall thickness and the numbers of varice section of esophageal varices in the bleeding group had satistical significance compared with non bleeding group(6.54±2.16mm VS 4.32± 1.45mm,9.44±2.59mm VS7.96±1.89mm,and3.79±0.57VS 2.50±1.04,respectively,P<0.05).Conclusion: MSCTP can objectvely show EV and accurately demonstrate the scope and grading of esophageal varices and can be better accepted for patients. The thicker wall thickness , the more numbers of varice section and the thickener vessel diameter of esophageal varices in the bleeding group suggest that bleeding possibility is greater.