螺旋CT门静脉造影对门脉高压侧支循环的研究

Evaluation of portacaval collateral vessels with multi-slice spiral CT portal venography

目的探讨多排螺旋CT门静脉造影(CT portal venography,CTPV)显示肝硬化门脉高压侧支循环血管的临床应用价值。方法对92例肝硬化门脉高压的患者分别进行CT门脉造影,获得门脉侧支循环血管的清晰图像,测量门静脉主干和胃左静脉直径,将胃镜与CT门静脉造影两种技术进行比较。结果应用CT门静脉造影能清晰显示和测量门脉侧支循环的血管。CT门静脉造影与胃镜两种方法对食管和胃底曲张静脉的显示能力具有一致性,Kappa值分别为0.502和0.478。结论应用多排螺旋CT门静脉造影能很好显示和测量门体间侧支循环血管。联合应用多排螺旋CT门静脉造影与胃镜两种方法,对于肝硬化门静脉高压患者的诊断、病情判断和估计预后有帮助。

Objective To detect the clinical applicative value of multi-slice spiral CT portal venography in displaying portacaval collateral vessels in patients of liver cirrhosis with portal hypertension. Methods 92 patients of liver cirrhosis with portal hypertension underwent endoscopy and 8-detector row CT portal venography which need image post-processing techniques to show the portacaval collateral vessels. It was evaluated that the degree of concordance between endoscopy and 8-detector row CT portal venography. Results Excellent image quality of portacaval collateral vessels with CTPV was obtained in all patients. The diameter of portal vein and left gastric vein was also obtained in this study. There was a good degree of concordance between CTPV and endoscopy in revealing esophageal varices （ Kappa = 0. 502） and gastric fundic varices （ Kappa = 0. 478）. Conclusion CTPV is very effective and valuable for providing important and accurate information of the collateral circulation in cirrhotic patients with portal hypertension. There is a good degree of concordance between CTPV and endoscopy in revealing esophageal varices and gastric fundic varices. It is helpful to diagnose and make prognosis by CTPV and endoscopy simultaneously in cirrhotic patients with portal hypertension.