Clinical Study Of Of The Collateral Circulation In Hepatic Cirrhosis With Portal Hypertension In 64-slice Spiral CT

ObjectiveTo study the imaging of the collateral circulation in hepatic cirrhosis with portal hypertension in 64-slice spiral CT.To evaluate the value of 64-slice spiral CT in esophageal and gastric varices in 1 hepatic cirrhosis.Materials and MethodsSubjects:50 patients with hepatic cirrhosis with portal hypertension and 50 patients without hepatic diseases underwent 64-slice spiral CT. There were 36 male and 14 female in the patients with hepatic cirrhosis,and there were 34 male and 16 female in the patients without hepatic diseases.Twenty patients with hepatic cirrhosis underwent endoscope.Instruments and contrast agent:Light speed 64-slice spiral CT (GEUSA) with AW 4.3 workstation. Automatic CT injeetor with microcomputer and automatic injection pump(Medrad, USA).Non-ionic iodine contrast mediurn--Ultravist Solution (3oomgI/ml). electronic gastroscope(GIF-XQ240).Methods:The patients fasted for more than 6h,drinked water 800 ml in 30 min before the examination and 500 ml before the examination. Scan used thickness of 5 mm and spacing of 5 mm. Enhancement used thickness 0.625mm, layer distance 0.625 mm, pitch 0.175,rotating 1 week with 0.33s, pipe ball voltage 120kV, current 240mA and matrix 512×512.The delay time of arterial phase made Bolus-tracking technology and set the trigger point of threshold of 150 Hu/6s. The scans of portal venous phase began 20 s after the arterial phase and the average delay time was 45 s. The volume of contrast media was 70 ml～90 ml and injection rate was 3.5ml/s. The range was from the trachea down to the iliac wing level and the length was about 50CM.. During the scanning patients were required with a calm state of breath-hold, in order to avoid artifacts. The raw data were transmitted to the workstation for image post-processing.Graphic reconstruction methods included MPR and MIP and VR.Image analysis and data collection were completed by the two associate professors of the Radiology Department. Evaluation included start-stop and shape and the path of all major branches of portal vein. They measured diameters of the portal vein and splenic vein and left gastric vein.The two associate professor of gastroscopy evaluated gastroscopic results and the evaluation will include the form and degree and risk of esophageal and gastric varices.Statistical analysisStatistical analysis uses statistical software SPSS13.00 to compute the diameters of portal vein and splenic vein in liver cirrhosis portal hypertension and undertaked t test. The consistency between gastroscopy and 64-slice spiral CT angiography using kappa values.Result1 imaging result1.1 In the 50 patients with esophageal varices, When esophageal varices are mainly located in the wall of the esophagus, they are primarily supplied by the anterior branch-dominant type of left gastric vein(21/22).Paraesophageal varices are primarily supplied by the posterior branch-dominant type of left gastric vein(18/20).When esophagus varices in the wall of the esophagus are as severe as paraesophageal varices, esophagus varices are primarily supplied by the bilateral type of left gastric vein(8/8). In GEV1,GV are primarily supplied by the left gastric vein (25/27). In GEV2 and IGV, GV are primarily supplied by the posterior gastric vein (PGV) and/or the short gastric vein (SGV) (23/23).1.2 Gastrorenal or splenorenal shunts in 15 patients presented communication in the splenic vein Paragastric vein, Paragastric vein and the left renal vein through the left inferior phrenic vein. The inosculans between the paraumbilical vein and venous network in 12 patients resulting in varicose veins around the umbilicus and formed Medusa's head. The superior and inferior mesenteric vein in 1 patient inflowde into general circulation through the upper rectum vein formed rectal venous plexus varices.2 statistics result2.1 In the hepatic cirrhosis group,the diameters of portal vein and splenic vein and left gastric vein were 14.10～17.55 mm and 10.64～14.73 mm and 5.14～8.46 mm.The average were 16.05mm and 12.27mm and 6.34mm.In the non-cirrhosis group, the diameters of portal vein and splenic vein and left gastric vein were 10.13～12.30 mm and 4.74～9.68 mm and 1.00～4.75 mm.The average were 11.21 mm and 7.22 mm and 2.79 mm. In the t test, the differences were statistically significant(P<0.001, P<0.001, P<0.001).2.2 8 patients were determined to be in a low-risk group and 12 in a high-risk group for variceal bleeding at endoscopy.7 patients were determined to be in a low-risk group and 13 in a high-risk group for variceal bleeding at CT. There was substantial agreement between endoscopic and CT grades(kappa value=0.89).Conclusion64-slice spiral CT can clearly show the shape and course and varicose degree of lateral branch circulation of portal hypertension.64-slice spiral CT can be more accurately predict the risk of gastroesophageal varices of the hepatic cirrhosis and can be used as routine examination and one of the means of follow-up observation of clinical efficacy.