| Part 1: the application of multi-slice spiral CT angiography for study ofvascular anatomy related to intrahepatic portosystemic shunt(TIPS)Objective To study vascular anatomy related to transjugular intrahepatic portosystemic shunt(TIPS) using MSCT angiography and image processing technology.Materials and Methods Between June,2014 and December 2015, patients to take abdominal CT scans were divided into normal group and cirrhosis group. After processing raw image and performing three-dimensional reconstruction images,branch type of extraand intra-hepatic portal vein and hepatic vein was shown, angle between hepatic vein and inferior vena cava, and angle between hepatic veins, contact of portal vein and hepatic parenchyma, diameter and angle of extra-hepatic portal vein, etc.were measured. And also, the volume of the liver and its lobes were analyzed.Results In this study, 64 cases of normal group and cirrhosis group were divided into 43 cases of hepatic vein type I(67.1%,43/64); 21 of type II(32.9%, 21/64); type III, none was not found. In cirrhosis group, the angle of right hepatic vein, left hepatic vein and inferior vena cava were significantly increased, and the angle between middle hepatic vein and left hepatic vein was also significantly increased(P<0.05). According to the classification of hepatic new segmentation, normal group were able to show that the right hepatic vein for each branch of the right anterior ventral branches, right anterior dorsal branch and posterior branch. For portal vein of liver, cirrhosis portal vein trunk length, portal vein diameter, the left branch of the portal vein diameter increased comparing with normal group increased(P < 0.05). The contact of the left branch of the portal vein and hepatic tissue was close compared with normal group. Total volume of cirrhotic liver decreased, the volume of left liver increased(P <0.05).Conclusion MSCT angiography can accurately provide the the vascular anatomy of jugular intrahepatic portal systemic shunt(TIPS); liver new partition based on portal vein and MSCT vascular reconstruction research, more in line with the applied anatomy of the liver; In cirrhosis, right wall and rear wall of on the right portal wall and rear wall, left wall and the sagittal part wall are close which turn to be in puncture point.Part 2: Multislice Spiral CT angiography Aseessing intrahepaticportosystemic shunt through left portal veinObjective: Using MSCT image postprocessing technique to simulate and compare intrahepatic shunts of TIPS in order to select the best one.Materials and Methods: From June 2014 to December 2015, patients with abdominal MSCT scans were divided into normal group(n=27) and cirrhosis group(n=37). Through VR, MIP and MPR image processing technology, different shunts were simulated and compared: angle between hepatic vein and shunt(∠BAC), the distance of shunt(AB), angle between shunt and portal vein(∠ABD).Results: A total of 12 different shunts were compared: from the right and middle hepatic vein(1cm or 2cm from the opening points), the right, left and crotch portal vein. Among them, as for the shunt from hepatic vein and left branch of portal vein, in comparison of hepatic vein 1cm and 2cm from opening points, angles between hepatic vein and shunt were greater and angles between portal vein and shunt were small; in comparison of middle and right hepatic vein, the angles of the hepatic vein end angle and portal vein end are greater; the distance of shunts were similar. In comparison of cirrhosis group and normal group, as for the left portal vein shunt, the hepatic vein end angle and portal vein end angle in cirrhosis group were greater than the normal group, and distance of shunts were shorter.Conclusion:(1) MSCT angiography and image processing technology was able to accurately assess the intrahepatic shunts of TIPS.(2) The shunts through left branch of portal vein had a moderate distance, a proper angles of hepatic vein end and the portal vein end, and is an ideal intraheaptic shunt. Part 3: A primary clinical analysis of intrahepatic portosystemic shunt(TIPS) through left portal veinObjective: To review transjugular intrahepatic portal systemic shunt(TIPS) through the left portal vein, and to analyze the clinical efficacy and complications, and evaluate the shunts with MSCT.Materials and Methods: From June 2014 to December 2015, TIPS through left portal vein in the treatment of GI bleeding due to esophageal and gastric fundus varices rupture were analyzed. Five days failure, 6 week mortality, mortality, rebleeding, hepatic encephalopathy,etc. were evaluated. Stent dysfunction(stenosis or occlusion) were also evaluated with CT.Results: A total of 28 cases were successful performed with TIPS procedures and 36 stents were implanted(32 covered, 4 bare metal stents).No serious complications such as bleeding, pericardial sac etc. were found. After the operation, the bleeding was controlled effectively, and 5-day failure rate was 0, and 6-week mortality rate was 7.1%(2/28). During follow-up of(246.8 + 140.1) days, 1 patients died(408 days after the operation), and the cumulative mortality was 10.7%. The rate of rebleeding was 7.7%(2/26). The incidence of refractory hepatic encephalopathy was 11.5%(3/26). CT follow-up confirmed that the shunt obstruction or restenosis rate was 11.5%(3/26).Conclusions: TIPS through left portal vein was performed safely and successfully using comprehensive puncture techniques; TIPS through left portal vein was found a trend of reduction in hepatic encephalopathy and no increase of recurrence of bleeding, which need to be confirmed by further studies. MSCT angiography and image processing technology in postoperative follow-up of TIPS,especially in the assessment of stent shunt dysfunction, was safe and reliable. |
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