| AIM: To evaluate the role of CT Angiography in the management of cirrhotic patients with portal hypertension and gastric fundal varices.METHODS: Forty cirrhotic patients in the first affiliated hospital of Anhui Medical University participated in this retrospective study from Jan 2011 to Jun 2014. All patients underwent CTA and endoscopy. Based on portal venous images, the type and the grade of gastric fundal varices, the corresponding collateral vessels were analyzed. The findings of CTA and performance of endoscope were compared.RESULTS: Of the forty patients who underwent CTA, gastric fundal varices in all patients had detected by multi-detector row CT portography screening. However, two patients did not detected gastric fundal varices by endoscopy。The location and morphology of the GV had the obvious corresponding relationship between Gastroscopy and portal CTA in the blood supply. Underwent endoscopy,there were 15 cases of GOV1, a large part of the GV’s configuration was tortuous shape, the blood supply underwent CTA was the left gastric vein(LGV) alone or as the main blood supply; Underwent endoscopy,there were 13 cases of GOV2, most of the GV’s configuration was nodiform, the blood supply underwent CTA was the left gastric vein(LGV), posterior gastric vein(PGV) and(or) short gastric vein(SGV) which involved in the the blood supply of GV, and the latter were seen more ofen; Isolated gastric varices(IGV) type was 10 cases, 4 cases was nodiform and 6 cases was tuberiform,the blood supply underwent CTA was the PGV and(or) SGV alone or as the main blood supply.The two checking methods for the test of consistency contast about the configuration of the varices in gastric fundus vein(Kappa = 0.870, P<0.01),The difference was statistically significant. In addition,analyse the results underwent CTA of the shunt, the type of GOV2 and IGV had more possibility withgastric and(or) splenorenal shunt, reach to 60.87%.In this group, the scope of the portal vein’s diameter was 0.72- 2.14 cm, with an avenrage of 1.46 cm±0.29 cm.17 cases had the presence of stomach / spleen- renal shunt, the portal vein diameter averaged 1.39 cm ± 0.25 cm; 21 cases had no stomach / spleen- renal shunt formation, the average of the portal vein diameter was 1.56 cm ± 0.31 cm. Because there were three cases which had been underwent splenectomy, splenic vein diameter could not be measured, including two cases of splenectomy had vice spleen formation, and therefore the final completion of the splenic vein to measure was 37 cases.The diameter of the splenic vein was 0.75-1.48 cm, with the average of 1.09 cm ± 0.23 cm. The diameter measurements of the superior mesenteric vein was 0.72-1.46 cm, the average was 1.09 cm ± 0.2 cm.Based on the above findings, the CTA examination found the shunt diameter of some FV larger than 5mm, five cases chose the merge TIPS shunt occlusion therapy.Symptoms were all under control.For the patient with non-shunt or the diameter in patients was small,we used the treatment of injection with gum tissue by endoscopy, no embolization was seen in these patients, the treatment was certified to be safe and effective.CONCLUSION: CTA can display the type and characteristics of gastric varices of collateral circulation, the triage status and prognosis value have great significant to choose adapt methods to the patients. |
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