A Preliminary Study Of The Assessment Of 320-Slice CT Angiography Simulation Puncture Path Before Intrahepatic Portosystemic Shunt

Objective:To evaluate the value of 320-slice CT angiography in the evaluation of preoperative simulated puncture pathways in liver cirrhosis patients with portal hypertension for intrahepatic portosystemic shunt,and to provide imaging basis for the preparation of intrahepatic portosystemic shunt.Methods:A retrospective analysis was made on the imaging images of 30 patients with cirrhotic portal hypertension under the 320-slice CT angiography at the Fourth Affiliated Hospital of Kunming Medical University from November 2014 to January 2017.Compared with the control group.The width of RPV,PV and LPV of the study group and the contol group were measured.The distance and angle parameters between HV and PV were measured,and the differences between the parameters of the study group and the control group were measured.According to hemodynamics,via the portal vein puncture hepatic vein is defined as anterograde puncture,via the hepatic vein puncture portal vein defined as retrograde puncture.To analyze the difference between the anterograde puncture angle and the retrograde puncture angle of the study group.To analyze the difference between the distance and angle of the simulated puncture path before intrahepatic portosystemic shunt by Multi-slice spiral CT angiography and the distance and angle of the intraoperative puncture path by DSA.SPSS 21.0 software was used for statistical analysis.Metrological data are expressed as x±s,Independent sample comparison using independent sample t test,Comparison of the relevant samples using paired t test,Evaluator consistency of Image Quality with Weight Kappa Tests,The kappa coefficients are five groups to represent different levels of consistency:0.0 to 0.20 is slight,0.21 to 0.40 is fair,0.41 to 0.60 is moderate,0.61 to 0.80 is substantial,0.81 to 1 is almost perfect.Groups with a frequency of 0 are represented by crosstabs and percentages.Surveyor consistency of data measurement is using ICC test(intra-group correlation coefficient test),the reliability coefficient is less than 0.4 indicates poor reliability,greater than 0.75 indicates good reliability.P<0.05 was statistically significant.Results:(1)There were significant differences between the study group and the control group.The diameter of RPV,PV,and LPV of the study group were higher than those of the control group,while the distance from the RHV to the RPV(AR),the distance from the RHV to the PV(AM),the distance from the RHV to the LPV(AL),the distance from the MHV to the RPV(BR),the distance from the MHV to the PV(BM),the distance from the MHV to the LPV(BL),the distance from the LHV to the RPV(CR),the distance from the LHV to the PV(CM),the distance from the LHV to the LPV(CL),the angle of the LHV retrograde puncture LPV(∠ZHCL)of the study group were smaller than those in the control group(P<0.05).There were no significant differences between the study group and the control group with the angle of the RPV anterograde puncture the RHV(∠PRA),the angle of the RPV anterograde puncture the MHV(∠PRB),the angle of the RPV anterograde puncture the LHV(∠PRC),the the angle of the PV anterograde puncture the RHV(∠PMA),the angle of the PV anterograde puncture the MHV(∠PMB),the angle of the PV anterograde puncture the LHV(∠PMC),the angle of the LPV anterograde puncture the RHV(∠PLA),the angle of the LPV anterograde puncture the MHV(∠PLB),the angle of the LPV anterograde puncture the LHV(∠PLC),the angle of the RHV retrograde puncture the RPV(∠HAR),the angle of the RHV retrograde puncture the PV(∠HAM),the angle of the RHV retrograde puncture the LPV(∠HAL),the angle of the MHV retrograde puncture the RPV(∠HBR),the angle of the MHV retrograde puncture the PV(∠HBM),the angle of the MHV retrograde puncture the LPV(∠HBL),the angle of the LHV retrograde puncture the RPV(∠HCR),the angle of the LHV retrograde puncture the PV(∠HCM)(P>0.05).(2)There was a significant differences between the angle of anterograde puncture of intrahepatic portosystemic shunt and the angle of retrograde puncture of intrahepatic portosystemic shunt except the differences betwee∠PLB and∠HBL.The angle which was via the RPV,the PV anterograde puncture the RHV,the MHV,the LHV were smaller than the angle which was via the RHV,the MHV,the LHV retrograde puncture the RPV and the PV.The angle which was via the LPV anterograde puncture the RHV,the MHV,the LHV were greater than the angle which was via the RHV,the MHV,the LHV retrograde puncture the LPV(P<0.05).There was no significant difference between ∠PLB and ∠HBL(P>0.05),the difference was not statistically significant.(3)There were no significant differences betweenthe distance and angle of the simulated puncture path before intrahepatic portosystemic shunt by Multi-slice spiral CT angiography and the distance and angle of the intraoperative puncture path by DSA(P>0.05).Conclusions:(1)The portal vein and its branch diameter in the portal hypertension group were larger than those in the control group.The distance between the hepatic vein and the portal vein and its branch was smaller than that of the control group.(2)CTA simulation of intrahepatic portosystemic shunt at anterograde puncture angle and retrograde puncture angle were statistically different from the right portal vein,portal vein of the anterograde puncture angle is better than the right portal vein portal vein,portal vein Retrograde puncture of the trunk.(3)The distance and angle of the simulated puncture path between the CTA intrahepatic portosystemic shunt and the distance and angle of the DSA in the portal vein shunt were not statistically different.CTA was helpful for the portal vein The puncture path was evaluated before shunt.