| AIMS: In recent years,CT portal venography(CTPV)is widely used in the evaluation of portal hypertension and collateral circulation.CTPV is a noninvasive technology which can clearly show theroute and morphology of portal vein and collateral vessels.And CTPV can determine the presence of esophageal varices and splenorenal shunt.CTPV has important significance in the diagnosis of esophagogastric varices and the prevention and treatment of complications.This research aims to evaluate the diagnostic value of CTPVfor esophagogastricvarices in hepatic cirrhotic patients,and to discuss the clinical value of CTPV in predicting esophagogastric variceal bleeding(EVB).Methods: A retrospective cohort study was performed in 143 hepatic cirrhotic patients collected from Jan.2013 to Sep.2016 in the gastroenterology department of hospital of Qingdao University.All patients had underwent CTPV and endoscopy respectively.Esophagogastric varices were graded and typed.The consistency of CTPV and endoscopy in observation of esophagogastric varices was analyzed by Kappa test.All patients were divided into bleeding group and no-bleeding group.The diameters of the main portal vein(MPV)?splenic vein(SPV)?left gastric vein(LGV)were measured in two groups.The ability of these indexes in predicting EVB were evaluated by the area under the receiver operating characteristic(ROC)curves.Results: Among 143 patients with liver cirrhosis in CTPV examination,there were 24 caseswithout gastroesophageal varices and 119 caseswas positive,whichincluding 23 cases of esophageal varices(EV),44 cases of type GOV1,48 cases of type GOV2,4 cases of type IGV1,and no type IGV2 patients.And there were 37 cases of grade I,35 cases of grade II and 43 cases of grade III in CTPV grading.In the same time,gastroscopy showed that 28 cases were without gastroesophageal varicesand 115 cases were positive,including 28 cases of EV,38 cases of type GOV1,47 cases of type GOV2,2 cases of type IGV1,and no type IGV2 patients.And there were 30 cases withoutgastroesophageal varices,37 casesmild,37 casesmoderate and 39 casessevere in endoscopic grading.In addition,CTPV showed 5 cases of gastric renal shunt and 3 cases of spleen kidney shunt.CTPV clearly showed the esophagogastric varices in hepatic cirrhotic patients.CTPV and endoscopy had a good consistency in the typing and grading of esophagogastric varices,with the Kappa value of 0.793 and 0.775.The diameters of MPV?SPV and LGV were(17.9 ± 2.6)mm?(13.4 ± 2.2)mm?(6.7 ± 1.2)mm,respectively in the bleeding group,significantly higher than those in the no-bleeding group [(15.7 ± 2.2)mm?(12.3 ± 2.1)mm?(5.3 ± 0.9)mm,P<0.05].The areas under the receiver operating characteristic curve of MPV?SPV?LGV in predicting EBV were 0.741(95%CI: 0.660-0.823)?0.627(95%CI: 0.537-0.718)?0.816(95%CI: 0.747-0.885),respectively.And the cutoff points of MPV?SPV?LGV were 16.3mm?12.7mm?6.1mm,respectively.The accuracy of LGV was the highest in predicting bleeding,and the sensitivity and specificity were 65.71% and 84.93% when the cutoff points was 6.1mm.The sensitivity was higher when the cutoff points of MPV was 16.3 mm.Conclusions: CTPV can clearly show the portal vein and its collateral vessels,and CTPV has good consistency with endoscopy in observation of esophagogastric varices.LGV and MPV have certain accuracy of predicting EVB in hepatic cirrhotic patients.Therefore,CTPV can be used for diagnosis of portal hypertension with gastroesophageal varices and evaluation of the bleeding risk,and guideing endoscopic treatment. |
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