| PART 1 STUDY OF COMPENSATORY CIRCULATION OF PORTAL HYPERTENSION WITH 64 CHANNEL MULTIDECTOR ROW CT VENOGRAPHYObjective: to discuss the imaging appearance and relative clinical application of portal system and compensatory circulation in portal hypertension through portal venography and postprocessing technique with 64 channel multidector row CT.Materials and methods: Retrospective analysis was carried out on 106 cases of 64 channel multidector row CT venography, 56 of patient group, 50 of the control group. The scan range was from 1 cm above diaphragm to the superior border of iliac ala. Plain scanning was first carried out, following with enhancement scanning of three phrases and postprocessing with the reconstruction techniques of volume rendering(VR), maximum intensity projection(MIP), multi-planar reconstruction(MPR), in order to display the main portal vein, principal branches and collateral circulation, especially the enthesis, courser and expansion extent of the collateral vessels.Results: In the patient group, there were 53 cases of left gastric varices(94.6%), 51 of gastroesophageal varices (91.1%), 35 of n periesophagus varices 62.5%), 47 of lateroesophagus varices s(83.9%), 19 of short and posterior gastric varices (33.9%),22 of paraumbilical varices and subcutaneous varicos of abdominal wall(39.3%), 16 of spontaneous splenic/gastric-renal vein shunt(28.6%), 24 of posterior peritoneum and laterovertebral varices (42.9%), 6 of cavernous tranformation of portal vein(10.7%). There was expansion of different degree in the main portal vein, left and right branches, and splenic vein in the patient group. The diameter of main portal vein was 14.3±2.6mm, that of left gastric vein was 5.6±1.5mm. In the control group, the diameter of main portal vein was 10.8±1.4mm, that of left gastric vein was 2.8±0.7mm.Conclusions: 1 64 channel multidector row CT venography can display noninvasively, clearly and three-dimensionally the open position, range and extent of portal system and collateral circulation to achieve high quality images of CT portal venography, which has advantages over color ultrasound, conventional digital subtraction angiography and traditional multislice CT, helps to select treatment prescription and follow up for patients of portal hypertension, as a noninvasive portal venography with important clinical value. 2 There is significant difference in displaying expansion of the main portal vein and branches with 64 channel multidector row CT venography for patients of portal hypertension3 64 channel multidector row CT venography can predict initially the genesis of massive hemorrhage of upper gastrointestinal tract and hepatic encephalopathy.PART 2 COMPARISON BETWEEN 64 CHANNEL MULTIDECTOR ROW CT VENOGRAPHY AND GASTROSCOPE IN THE DIAGNOSIS OF GASTRIC VARICESObjective: To observe the morphous, degree, features about blood supply and shunt status in different types of gastric varices, compare with those by gastroscope, and discuss the value of CT portal venography in the diagnose of gastric varices.Materials and methods: 35 cases with 64 channel multidector row CT venography verified by gastroscope in our hospital were selected. 64 channel multidector row CT scanner(GE, Lightspeed VCT) was employed, scan range was from 1 cm above diaphragm to the superior border of iliac ala. Plain scanning was first carried out, following with enhancement scanning of three phrases and postprocessing with the reconstruction techniques of volume rendering(VR), maximum intensity projection(MIP), multi-planar reconstruction(MPR), in order to display the morphous and degree of varicose veins of gastric fundus, supporting vessels and splenic/gastric-renal vein shunt.Results: CT portal venography detected 35 cases of gastric varices, gastroscope detected 34 cases, with the coincidence of 97.1%. There was no significant difference in morphous between CT portal venography and gastroscope. Gastroesophagealvarices 1 was usually supported by the left gastric vein(17/19). Gastroesophagealvarices 2 was supported by the left gastric vein, posterior and short gastric veins(8/8). Isolated gastric varices was mainly upported by the posterior and short gastric veins. The incidence of splenic/gastric-renal vein shunt in Gastroesophagealvarices 1 was 15.8%, that in Gastroesophagealvarices 2 was 50%, that in isolated gastric varices was 62.5%.Conclusions: 64 channel multidector row CT venography can display noninvasively gastric varices, with high coincidence with gastroscope. Different types of gastric varices are of different blood supply with different shunt incidence, then of different treatment and therapeutic effect. So 64 channel multidector row CT venography is a valid method to display gastric varices. |
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