Study On The Risk Of EGVB In Cirrhotic Portal Hypertension By CT Perfusion Imaging

Objective: To explore the value of CT perfusion imaging in the prediction of esophageal variceal bleeding(EGVB)in patients with cirrhosis and portal hypertension.Materials and methods: CT perfusion images of 55 patients in our hospital from December 2018 to December 2019 were analyzed,including 37 patients with cirrhosis and portal hypertension,19 patients with EGVB,18 patients without EGVB and 18 patients with normal liver.Transfer the original image to the creative workstation for image post-processing.The specific steps are as follows:The first step is to obtain the time-density curve(TDC)of aorta,portal vein and spleen at the level near the main portal vein.Step 2: the regions of interest(ROI)of the left outer lobe,the left inner lobe,the right anterior lobe and the right posterior lobe of the liver were divided at the better display level.Three ROIs were selected for each liver lobe,totaling 12 ROIs.Step 3: calculate the hepatic arterial perfusion(HAP),portal vein perfusion(PVP),total liver perfusion(TLP),hepatic arterial perfusion index(HPI),and take the average value of 12 ROIs as the perfusion parameters of the whole liver.The differences of the general data and perfusion parameters among the three groups were compared.R×c2 test and one-way ANOVA were used respectively.LSD method or tamhane T2 method were used for comparison between the two groups.The sensitivity and specificity of EGVB were calculated according to the diagnostic test method,and the working curve of the subjects was drawn,the area under the curve was calculated,and the sensitivity and specificity of various parameters(HAP,PVP,TLP,HPI)were evaluated to predict the EGVB in cirrhotic portal hypertension.Results: 1.There was no significant difference in general data of bleeding group,non bleeding group and normal group(P > 0.05).2.There was no significant difference between the three groups(P > 0.05).PVP:the difference was statistically significant(P < 0.05).TLP: the difference was statistically significant(P < 0.05).HPI: the difference was statistically significant(P < 0.05).3.ROC curve analysis showed that AUC of PVP was higher than that of TLP and HPI.The threshold,sensitivity and specificity of PVP were 41.55ml/min/100 ml,86.1% and 90%,respectively.The threshold,sensitivity and specificity of TLP were 67.89ml/min/100 ml,86.1% and 90%,respectively.The threshold,sensitivity and specificity of HPI in detecting EGVB in cirrhotic portal hypertension were 35.28%,89.5% and 80.6%,respectively.Conclusion: CT perfusion imaging has clinical guiding value in predicting the occurrence of EGVB in cirrhotic portal hypertension,PVP is an ideal parameter.