Cinical Value Of CT Portal Venograpy In The Diagnosis Of Liver Cirrhosis With Portal Hypertension

Objective: To judge the degree of portal hypertension in liver cirrhosis and the collateral circulation by means of CT portal venograpy(CTPV) , and to evalu- ate the relationship with clinic diagnosis and prognosis.Methods:20 patients with liver cirrhosis and 20 healthy individuals as control underwent CT liver three-phase contrast-enhanced scan. Maximum intensity projection(MIP),volume rendering(VR) and multi-planner refor- mation(MPR) were used as three-dimensional models to obtain the images of portal system and collateral circulation, the branches of the intrahepatic portal veins, distribution and extent of the collateral circulation, and the diameter of the main portal vein and branch were recorded. The date was analysted by statistical software of SPSS. Patients with liver cirrhosis were examed by gastroscopy as a routin, to compare the characteristic and in the accuracy of diagnosis of esophageal-gastric varices with CTPV.Results:1.The grade of branches of the intrahepatic portal veins of liver cirr- hosis group were displayed less than normal group(P<0.01). The portal sys- tem diameter of liver cirrhosis was larger than normal group significantly (main portal vein , splenic vein , superior mesenteric vein ; P<0.01). The portal system diameter of different groups according to hepatic function showed no significant deviation (P>0.05). The portal system diameter of the cases with esophageal hemorrhage was larger than non-esophageal hemorrh- age(P<0.01).2. CTPV simultaneously depicted the whole portal veins system and provided images of entire portosystemic collaterals. On patients with liver cirrhosis the images showed that left gastric varices in 12 patient(s60%), es- ophageal and gastric fundic varicosis in 13 cases(65%), paraesophageal varices in 3 cases(15%), short gatric veins or posterior gastric veins in 4 cases(20%), splenorenal shunts or gastrorenal shunts (GRS) in 6 cases(30%),retroperitoneal shunts in 1 case(s5%), arterioportal shunt in 2 cases(10%).In addition ,CTPV depicted cavernous transformation of the portal vein in 1 cases(5%), thrombogenesis of MPV and SMV in 1 cases(5%).3.The diagnosis of esophageal varices between CTPV and the gastroscope were showed no significant deviation (P>0.05) . The diagnosis of gastric varices CTPV were superior to gastroscopy (P<0.05).Conclusions:CTPV can institutionally demonstrate portal vein and its major tributaries, and show the courser and the distribution of the branches, and can constructe the stereo-spatial relationship, precisely measure the diamet- er of the blood vessel. It is useful for entirely analysis and evaluate the condition of the liver and the portal vein. It offers more evidence for dia- gonsis and treatment ,which is well clinical value to evaluate the assessment of patients, individual treatment and determine prognosis.