The Clinical Application Of MDCTP In Esophageal And Gastric Varices With Cirrhosis

Objective:To study the clinical application of MDCTP assess the extent of esophageal gastric variceal with cirrhosis and bleeding related risk factors of them.Materials and methods:The subjects were patients with clinical diagnosis of cirrhosis, who had endoscopy and 64-detector spiral CT portography examination done in 4 weeks, in the First Affiliated Hospital of Guangxi Medical University from October 2009 to December 2010. Endoscopic observations were the esophageal and gastric varices and their types, classifications, the red sign and other diseases, such as hypertensive gastropathy, ulcers. MDCTP observed collateral vessels of portal vein system; the esophageal and gastric varices and their types, classifications. The 53 patients with esophageal varices, whoes classification in MDCTP consistent with the endoscopic diagnosis, were observed the maximum diameter of esophageal varices, grades and types, the diameter and opening types of the left gastric vein, the diameter portal vein and splenic vein, spleen index.SPSS 13.0 statistical software package was used for the study. P<0.05 was the standard for the results, which involved the difference was statistically significant. Kappa consistency test was used for the classifications, grades of esophageal and gastric varices. The sensitivity, specificity, the same rate, Youden index, positive predictive value, negative predictive value of esophageal and gastric varices the MDCTP diagnosised were calculated. According to whether a history of esophageal variceal bleeding, the indicators of MDCTP that MDCTP classification were consistent with the endoscopic diagnosis esophageal varices were analyzed.Results:1. There were 67 cases with portal hypertension detection in 92 patients with cirrhosis in MDCT and MDCTP, including 64 of the esophagus and paraesophageal varices,21 of gastric varices, including 3 of isolation varices; 62 of left gastric varices.2. Esophageal and gastric varices were diagnosed in MDCTP:25 were negative, 67 cases were positive. The types of the positive cases included:46 of GOV1, 18 of GOV2,3 of IGV1.2 patients of IGV1 varicose veins were found in MDCTP not found in endoscopy, which performance existed in isolation under the gastric mucosa in MDCTP. The grades of esophageal varices were diagnosed in MDCTP:9 of Ⅰ,15 of Ⅱ,40 of Ⅲ; including 4 of false positive and 4 of false negative.3. The diagnosis results of esophageal and gastric varices in endoscopy were:27 were negative,65 were positive. The types of the positive cases included:45 of GOV1,19 of GOV2,1 of IGV1. The degrees of esophageal varices were diagnosed in MDCTP:9 of Ⅰ,17 of Ⅱ,38 of Ⅲ.29 of red signs,39 of portal hypertensive gastropathy,24 of chronic superficial gastritis, and 4 of gastric ulcer were also detected in endoscopy.4. The exists, types, classifications of esophageal and gastric varices diagnosing in MDCTP and digestive endoscopy were compared, and their Kappa values were 0.756,0.743,0.763.5. The correlation analysis results of the indicators in MDCTP diagnosing esophageal variceal bleeding group and non-bleeding group:the largest diameter and grade of esophageal varices, the diameter of left gastric vein were statistically significant differences (P<0.05). In the bleeding group and not-bleeding group:the maximum diameters of esophageal varices were 6.9 ± 2.2mm,4.9 ± 2.2mm, the 95% confidence interval were 6.1～7.8mm,4.0 5.9mm; the diameters of LGV were 6.4 ± 1.3mm,5.3 ± 1.2mm,95% confidence interval was 5.9～6.4mm,4.7～5.8mm. The types of esophageal varices, the opening types of left gastric vein, the diameters of portal vein and splenic vein, and the spleen index were no significant differences between bleeding group and non-bleeding group (P> 0.05).Conclusions:1. MDCTP can be clearly demonstrated collateral circulation of portal vein system.2. For patients with cirrhosis diagnosis of esophageal and gastric varices, MDCTP and digestive endoscopy compared with high consistency.3. The diameter of left gastric vein, the diameter and degrees of esophageal varices, these indicators of MDCTP associated with esophageal variceal bleeding, which is important to predict the bleeding.