| ObjectiveTo apply technique of three-dimensional reconstruction with multi-slice spiral CTportography (MSCTP), to observe the opening situation of collateral circulation of portalvenous system by measuring diameters of main, branches and major tributaries of portalvein, and the ability with B ultrasonography to judge the hemodynamics changes ofportal vein, to study for predictive value of esophageal variceal bleeding (EVB) withMSCTP and B ultrasonography, comparisons of the accuracy of the two methods forpredicting EVB, looking for an effective method to predict the incidence of EVB.MethodsCollected116cases diagnosed patients with liver cirrhosis from May2012toOctober2013at the department of Gastroenterology in the Affiliated Hospital of Yan’anUniversity.(1)64cases in patients with liver cirrhosis were examined with MSCTP, andmeasuring the diameters of main portal vein (MPV), left branch of portal vein (LPV),right branch of portal vein (RPV), splenic vein (SPV) and left gastric vein (LGV);Patients with liver cirrhosis were divided into bleeding group and non-bleeding groupaccording to signs and symptoms, clinical manifestations, laboratory examination and theperformance of gastroscope. Compared bleeding group with non-bleeding group, thediameters of MPV, LPV, RPV, SPV and LGV whether there were statistic significance ornot. The sensitivity and specificity of above indexes in predicting EVB was evaluated bythe area under the receiver operating characteristic curves (AUC). (2)112cases in patients with liver cirrhosis were examined with B ultrasonography,and recording platelet count (PC), measuring splenic length (SL), splenic thickness (ST),pulsatility index of splenic artery (PI), the diameter of portal vein (DPV) and mean bloodflow velocity of portal vein (PBVmean) with B ultrasonography, and calculating PC/DPV,PC/SL, PC/ST, PC/splenic index (SI), portal blood flow (PBF) and pressure of portalvein (PPV); Compared bleeding group with non-bleeding group, the PC/DPV, PC/SL,PC/ST, PC/SI, PBF and PPV whether there were statistic significance or not. The valueof above indexes in predicting EVB was evaluated by the AUC.(3)60patients with cirrhosis were simultaneously examined by the two methods,and recording the actual cases of bleeding patients, applying the results obtained by thetwo methods, recording the cases of predict bleeding by the two methods, through thecases of predicting bleeding/the cases of actual bleeding, calculating respectively the rateof detection of the two methods, comparisons of the two methods for the rate of detectionof EVB whether had statistic significance or not.Results(1) Data analysis of patients with MSCTP found that:1The average age was (57.07±12.07) y in bleeding group, it was (56.88±12.22) yin non-bleeding group. The distribution of age between two groups had no statisticalsignificance (t=0.061, P=0.952). There were22cases of males and8cases of females inbleeding group, there were20cases of males and14cases of females in non-bleedinggroup. The distribution of gender between two groups showed no statistic significance(X2=1.487, P=0.223). The distribution of causes of liver cirrhosis between two groups,there was not statistically significant (X2=1.489, P=0.914).2The diameters of MPV, SPV, LGV and LPV in bleeding group (1.78±0.16) cm,(1.28±0.15) cm,(1.54±0.20) cm and (0.62±0.10) cm, respectively, were much higherthan those in patients with non-bleeding group (1.60±0.21) cm,(1.15±0.13) cm,(1.36±0.13) cm and (0.45±0.06) cm, respectively, there were statistic significance(t=3.843, P=0.000; t=3.859, P=0.000; t=4.316, P=0.000; t=7.884, P=0.000). But the diameter of RPV had no statistic significance (t=0.700, P=0.487) between patients withbleeding group (1.29±0.21) cm and non-bleeding group (1.25±0.23) cm.3AUC of LGV was highest, it was0.906, its predictive ability was the best, whenLGV＞0.61cm, the sensitivity and specificity of predicting the incidence of EVB were93.3%and58.8%respectively.(2) Data analysis of patients with B ultrasonography found that:4The average age was (55.27±11.47) y in bleeding group, it was (58.59±12.83) yin non-bleeding group. The distribution of age between two groups showed no statisticsignificance (t=1.444, P=0.152). Males were all38cases, females were all18cases inbleeding group and non bleeding group. The distribution of gender between two groupshad no statistical significance (X2=0.000, P=1.000). The distribution of causes of livercirrhosis had not statistically significant between two groups (X2=6.335, P=0.610).5PBF and PPV in bleeding group (1161.58±136.05) ml/min and (26.76±3.41)mmHg, respectively, were higher than those in patients with non-bleeding group(945.38±192.73) ml/min and (21.15±4.38) mmHg, respectively, there were statisticsignificance (t=5.101, P=0.000; t=2.640, P=0.002). PC/DPV, PC/SL, PC/ST and PC/SIhad no statistic significance (t=2.107, P=0.170; t=2.318, P=0.078; t=0.956, P=0.064;t=1.931, P=0.051) between two groups.6AUC of PBF was0.763, which was better indicator to predict EVB. when PBF＞1098.36ml/min, the sensitivity and specificity of assessing the incidence of EVB were77.3%and63.1%respectively.(3) Data analysis of patients with MSCTP and B ultrasonography found that:7The average age was (57.71±12.24) y in bleeding group, it was (55.75±11.68) yin non-bleeding group. The distribution of age between two groups showed no statisticsignificance (t=0.633, P=0.529). There were21cases of males and7cases of females inbleeding group, there were19cases of males and13cases of females in non-bleedinggroup. The distribution of gender between two groups had no statistical significance(X2=1.641, P=0.200). The distribution of causes of liver cirrhosis between two groups, there was not statistically significant (X2=2.277, P=0.685).8There were28cases of actually bleeding within60cases in patients, accordingto LGV＞0.61cm,25cases were detected bleeding, the rate of detection was89.29%(25/28), according to PBF＞1098.36ml/min,17cases were detected bleeding, the rate ofdetection was60.71%(17/28). The rate of detection in two methods by MSCTP and Bultrasonography, there was statistic significance (X2=6.095, P=0.029), we can considerobjectively that rate of detection (89.29%) by MSCTP was higher than (60.71%) by Bultrasonography.928cases in patients with actual bleeding by gastroscope found that26cases inpatients had esophageal varices bleeding,2cases in patients had not esophageal varicesbleeding. Using the McNemar test revealed, the examination by MSCTP and gastroscopyfor predictive result of EVB, there was not statistical significance (P=1.000), usingKappa coefficient analysis showed the alignment of the two methods had statisticsignificance and higher (matching coefficient K=0.781，P=0.000).10The examination by B ultrasonography and gastroscopy for predictive resultof EVB, there was statistical significance (P=0.012), using Kappa coefficient analysisshowed the alignment of the two methods had no statistic significance (matchingcoefficient K=0.038，P=0.747).Conclusion1Esophageal variceal bleeding in cirrhotic patients with the distribution of age,gender and cause of liver cirrhosis had no significant relationship.2The examination by MSCTP found that the incidence of EVB and the diametersof MPV, LPV, SPV and LGV, there was a certain relationship, the wider the diameters ofabove indicators, the greater the likelihood of the incidence of EVB; While the diameterof RPV had no obvious relationship with the incidence of EVB.3The examination by B ultrasonography found that the incidence of EVB andPBF and PPV, there was a certain relationship, the more PBF and PPV, the greater thelikelihood of the incidence of EVB; While PC/DPV, PC/SL, PC/ST and PC/SI had no obvious relationship with the incidence of EVB. PBF＞1098.36ml/min can be usedobjectively as an effective non-invasive indicator for predicting EVB. But it would needto use a complicated formula to get the data, and the results of examination of Bultrasonography and gastroscopy had poor consistency.4Compared with B ultrasonography calculated PBF, the diameter of LGVexamined by MSCTP had better the rate of detection for the incidence of EVB, MSCTPcan not only clearly and multi-anglely show the vessels of collateral circulation of portalvenous system in liver cirrhosis, but also had very important value for predicting EVB,and when LGV＞0.61cm, was much more sensitive indicator for predicting EVB. SoMSCTP would be suitable for screening and follow-up for patients, and monitoringhigh-risk patients, which can be taken as one of the reference factors for predicting EVBin patients with liver cirrhosis in the clinical, and can reduce fear caused by gastroscopy.Due to the sample size of this study was relatively small, it would be necessary toincrease the sample size in order to further validation. |
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