Correlation Between The MSCT Portal Venous Anatomy And The Different Clinical Features Of Portal Hypertension In Posthepatitic Cirrhosis

BackgroundPortal hypertension(PHT) is a clinical syndrome that refers to the portal vein pressure increased and broader collateral circulation caused by different causes of portal vein blood flow obstruction or abnormal blood flow increases. Different etiology cause different parts of the portal blood flow obstructed, accordingly, the portal hypertension can be divided into prehepatic, intrahepatic and posthepatic type. When portal hypertension, blood of portal system flow through portal vein anastomoses of the collateral vessels returned to the systemic circulation and form number of collateral pathway flow out of liver. Different causes of different feature of collateral circulation Opened in portal hypertension. Even if the same etiology, the feature of collateral circulation opened also differ. Is the feature of collateral circulation opened associated with anatomical variation of Portal vein or not? At home and abroad to researches in this area is rare at present. In recent years, Multi-slice spiral CT(MSCT) has been development rapidly and widespread use in clinical. The MSCT scan speed faster and faster,scanning with narrow alignment,spatial and temporal resolution improved significantly. And combination using a variety of image processing technology,by one-time scan it can display clear,comprehensive and three-dimensional anatomy of Portal-systemic and collateral circulation in PHT.As a non-invasive examination methods,imaging techniques of multi-slice spiral CT in portal vein system has been quite mature.This study by 64-detector row spiral CT Portal venography(MSCTPV)to classifying the anatomical variation of portal vein branch,and to explore the characteristics of collateral circulation and the relationship of anatomical variation of portal vein,as well as the diameters of main branch of portal vein,the number of collateral circulation opened relationships with clinical manifestations of liver cirrhosis.For provide evidence for the clinical to evaluate of liver function damaged and predict the clinical symptoms of portal hypertension appears. Objective:The research and application of multi-slice spiral CT portal venography technique to classifying the anatomical variation of portal vein branch, measure diameters of main branch of portal vein and observe the portal collateral vessels opened.To explore the anatomy of portal vein-type relationship with the formation of collateral circulation in posthepatitic cirrhosis.Study on the relationship between anatomical types of portal vein and Child-Pugh grading, ascites, hepatic encephalopathy and liver cirrhosis complications.Study on Child-Pugh grading, ascites, hepatic encephalopathy and liver cirrhosis complications and the diameters of main branch of portal vein and number of collateral vessels opened relationships.For provide evidence for the clinical to evaluate of liver function damaged and predict the clinical symptoms of portal hypertension appears. Materials and methodologies:Select hepatitis cirrhosis(n=95) cases examined the upper abdomen enhanced CT from May 2014 to October 2015 at the Peking University of Shenzhen Hospital.And 74 males,21 females.Age of 27-81,average 54.4 ± 12.2. 88 cases of hepatitis B and hepatitis C in 7 cases.All cases have the main branches of the portal vein system and collateral vessels of maximum intensity projection(MIP),multiple planar-reconstruction( MPR)and volume rendering(VR).Than measure diameters of main branch of portal vein and observe the collateral circulation opened in PHT.Diagnosis of liver cirrhosis based on clinical manifestations,imaging and laboratory comprehensive judgement.All cases with esophageal varicose veins without surgery or medication,and except for portal vein thrombus formation,portal vein cavernous transformation,huge hepatic space occupying lesion,liver surgery and other factors that affect the hemodynamic of portal vein.By Child-Pugh grading:A-34,B-4,C-17. According to the severity of ascites:non-ascites 54 cases,mild ascites 17 cases, moderate-severe ascites 24 cases. Classified portal vein branch anatomic variations, and use the type of the portal vein anatomic variations,clinical features of liver cirrhosis for statistical analysis. Results:1 According to the left gastric vein(LGV)drains into portal vein(PV), the splenic vein(SV), the confluence of the PV and SV three different ways,LGV variations are divided into three types.LGV drains into SV is the most common,a total of 40 cases,account for all types of 42.1%.LGV drains into PV of 35 cases,for 36.8%.LGV drains into the confluence of the PV and SV of 20 cases,for21.1%.According to the inferior mesenteric vein(IMV) drains into the SV, superior mesenteric vein(SMV) and the confluence of the SV and SMV three different ways,IMV variations are divided into three types.IMV drains into SV is the most common,a total of 43 cases,account for all types of 45.3%.IMV drains into SMV of 38 cases,for 40%.LGV drains into the confluence of the SV and SMV of 20 cases,for 21.1%.2 Comparison among the three types of LGV variations,the number of collateral vessels opened were no statistically significant(P> 0.05),the probability of main collateral vessels opened in PHT were no statistically significant(P> 0.05).Comparison among the three types of IMV variations,the number of collateral vessels opened were no statistically significant(P> 0.05),the probability of main collateral vessels opened in PHT were no statistically significant(P> 0.05).Comparison among the three groups of Child-Pugh A,B,C,the number of LGV variations or IMV variations in the three groups were no statistically significant(P>0.05).Comparison among the three groups of no ascites, mild, moderate- severe ascites,the number of LGV variations or IMV variations in the three groups were no statistically significant(P>0.05).3 Comparison among the three groups of Child-Pugh A,B,C,LGV diameter in the Child-Pugh A and B, A and C were significant differences between groups(P<0.05),the diameters of other main branches of portal vein system were no statistically significant(P>0.05).4 Comparison among the three groups of no ascites, mild, moderate-severe ascites,LGV diameter in the group of no ascites and moderate-severe ascites group were significant differences(P<0.05),the diameters of other main branches of portal vein system were no statistically significant(P>0.05).5 There are correlation between Child-Pugh classification, severity of ascites and collateral vessels opened(P<0.05). Conclusion:1 There are no correlation between the features of the collateral circulation opened in PHT and portal vein anatomic variations.2 There are no correlation between Child-Pugh grading, severity of ascites and portal vein anatomic variations.3 The diameters of the main portal vein, superior mesenteric vein, splenic vein and inferior mesenteric vein has no correlation with the severity of cirrhosis.4 The Left gastric vein diameter were significantly different in the different severity of cirrhosis,so the left gastric vein dilation may predict the liver parenchymal damage of cirrhosis to some extent.5 The number of collateral vessels opened positively related to the severity of liver cirrhosis,so the number of collateral vessels opened may predict the liver parenchymal damage of cirrhosis to some extent.