Correlation Study On Evaluation Of Portal Hypertension Between MDCT And Endoscopy

Objective In this study,we use Multi-Detector Row Computer Tomography(MDCT) to measure the diameter of esophageal varices and observe the presence of palisade veins dilatation in patients with portal hypertension,use upper digestive tract endoscopy to evaluate the degree of esophageal varices and red color sign,then study the correlation between MDCT findings and endoscopic findings,determine its diagnostic significance of the red color sign,expand the application value of MDCT in portal hypertension,and strive to find a non-invasive method superior to upper gastrointestinal endoscopy,predict esophageal variceal bleeding,and evaluate before operation.Methods1.62 suspicious esophageal varices cases of portal hypertension was selected in this study.They was not performed endoscopy screening within two weeks.2.To scan esophagus and the portal vein system from the trachea to the symphysis pubis with Multi-Detector Row Computer Tomography (64 row)and enhance with contrast agent,to observe the presence of palisade veins dilatation and measure the largest diameter of esophageal varices.3.All the patients were underwent conventional endoscopy screening to exclude gastric varices,and finally a total of 55 cases were selected.The location,form,color and red color sign,and grade of varices were described.4.We viewed the endoscopy findings as gold standard,evaluated the accuracy,the sensitivity,specificity,positive predictive value,negative predictive value in the diagnosis of esophageal varices.5.We used Spearman's correlation analysis to study the correlation between esophageal variceal grade,diameter,presence of palisade veins dilatation screened by MDCT and esophageal variceal grade,the degree of red color sign screened by endoscopy.We used Mann-Whitney's U test to compare the red color sign with esophageal variceal grade,diameter screened by MDCT,used Fisher's test to compare the red color sign with presence of palisade veins dilatation screened by MDCT.Make the largest diameter of esophageal varices with red color sign and without red color sign fit to receiver operating characteristic curve(ROC) data analysis, select cut-off point to determine the diameter of esophageal varices on the diagnostic value of the red sign.P <0.05 was considered to be statistically significant difference.All statistics completed by the Statistical Package of SPSS13.0.Results1.The diagnosis of esophageal varices of MDCT:sensitivity 98.0%, specificity 83.3%,accuracy 96.4%,positive predictive value 98.0%, negative predictive value83.3%.2.The esophageal variceal grade,diameter,presence of palisade veins dilatation screened by MDCT and presence of palisade veins dilatation screened by endoscopy was positively correlated classification. (p <0.05)3.The esophageal variceal grade,diameter,presence of palisade veins dilatation screened by MDCT and the degree of red color sign screened by endoscopy was positively correlated classification.(P <0.05)4.In the red color sign group,the diameters of variceal veins measured by MDCT were 0-9.8mm(average 5.4mm),significantly larger than the group without the red color sign 0-4.8mm(average 2.4mm) (P<0.05),the difference was statistically significant.When the diameter of 4.1mm,the area under the receiver operating characteristic curve(ROC) up to maximum,the sum of sensitivity and specificity up to maximum, diagnostic accuracy of red color sign up to the maximum.MDCT classification of esophageal varices and the extent of the red color sign was a positive correlation(P <0.05).Conclusion1.MDCTcan replace upper gastrointestinal endoscopy to some extent to diagnose and monitor regularly. 2.The evaluation of the degree of esophageal varices between MDCT and upper digestive tract endoscopy was positively correlated classification.The former can replace the latter to some degree.3.When the diameter measured by MDCT > 4.1mm,the preventive treatment should be performed.4.The esophageal wall shows more contrast agent screened by MDCT may hint hemorrhage,be good for judging the degree of esophageal varices.5.CTA has the ability of showing collateral circulation of the portal vein system,superior to endoscopy.