Primary Study In Predicting Risk Of The Esophageal Variceal Bleeding Of Portal Hypertension Caused By Hepatic Cirrhosis With The Spectral CT Imaging

Objective To evaluate the hemodynamic changes of liver artery, splenic artery, portalvein and splenic vein in portal hypertension caused by hepatic cirrhosis with applicationspectral CT imaging, and explore the value of hemodynamic changes of portal vein andsplenic vein in predicting portal hypertension caused by hepatic cirrhosis complicatedwith EVB.Materials and methods The spectral CT imaging datas of60patients with hepaticcirrhosis and portal hypertension (30patients complicated with EVB and30patientswithout it) and30cases of control patients were retrospectively analyzed. Spectralscanning mode: the tube voltage with instant switching between140KVp and80KVp in0.5ms, the tube current of550mA,0.8s circle, pitch of1.375, detector width with0.625mm×64. In the iodine-water material decomposition images of the arterial andportal venous phase, three ROIs (50±2) mm2without any vessels involved and overlapwere respectively put on left, right and caudate lobe of liver parenchyma and splenicparenchyma in hilar lever, and the iodine concentrations in three ROIs were averaged torepresent each position. The diameters of GCV were measured in the MIP image of70KeV portal vein. The general information, and mean iodine concentrations of the left,right, caudate lobe of liver parenchyma and splenic parenchyma, and the diameter ofGCV in the three groups were respectively compared with Chi-square test and one-wayANOVA analysis, the comparison of two groups were compared with LSD or TamhaneT2. According to the sensitivity and specificity of diagnosis test methods, the ROC were drew to evaluate the diagnosis performance that use iodine concentrations of left, right,caudate lobe of liver parenchyma and splenic parenchyma in portal venous phase, andthe diameter of GCV to predict the EVB. The all parameters were selected to evaluatethe value of joint diagnosis by discriminant analysis.Results The general information among bleeding group, non-bleeding group, andcontrol group were not statistically significant(P＜0.05）. The mean iodineconcentrations of left, right, caudate lobe of liver parenchyma and splenic parenchymain arterial phase were statistically significant(P＜0.05）. The mean iodine concentrationsof left, right, caudate lobe of liver parenchyma in bleeding group, non-bleeding grouprespectively comparison with control group were statistically significant (P＜0.05）,However, it were not statistically significant that between bleeding group andnon-bleeding group (P＜0.05）. The mean iodine concentrations of splenic parenchymain arterial phase were all statistically significant comparison between group (P＜0.05）.The mean iodine concentrations of left, right, caudate lobe of liver parenchyma andsplenic parenchyma in portal venous phase in three group were statisticallysignificant(P＜0.05）, the comparison of two groups were all statistically significant (P＜0.05）. The diameter of GCV were statistically significant (P＜0.05）, the comparisonof two groups were all statistically significant as well(P＜0.05）. The results of ROCdemonstrated that the cut-off values of iodine concentrations in left, right and caudatelobe of liver and splenic parenchyma, and the diameter of GCV were respectively17.56mg∕ml,18.29mg∕ml,23.01mg∕ml,36.02mg∕ml,5.8mm, the AUG were0.833,0.874,0.701,0.946,0.726respectively, the sensitivity and specificity of predicting EVBwere80.0%,86.7%,70.0%,92.3%,73.3%and66.7%,76.7%,60.0%,84.6%,63.3%respectively, the PPV and NPV were76.9%,85.2%,62.1%,88.9%,66.7%and70.6%,78.8%,63.6%,81.8%,69.2%respectively. The discriminant analysis showed that thediagnostic accuracy of multi-parameter was95.6%. Conclusions The portal vein perfusion of intrahepatic is obviously reduced while theblood flow of splenic vein is increased significantly in hepatic cirrhosis and portalhypertension, especially in the EVB patients. Meanwhile, it also lead to the blood flowof hepatic artery increased, that is HABR, However, the compensatory ability of HABRis certainly limited. It is the highest sensitivity and specificity in all indicators thatdegree of blood flow increases in splenic vein to predict the risk of occurrence the EVB.It is the highest sensitivity and specificity in the liver parenchyma that the extent ofblood flow reduction of the right lobe. The expansion of GCV diameter can be as anindicator to predict the risk of occurrence EVB, but the specificity is not high. It hashigher valve that the joint application of multi-parameter.