CT门静脉成像对门静脉高压致上消化道出血的临床预测研究

Multi-detector helical CT portography presage of Portal Hypertension and Upper Gastrointestinal Hemorrhage

目的通过多排螺旋CT门静脉成像技术（multi—detector helical portography，MDCTP），探讨门静脉及其各属支管径与食管胃底静脉曲张出血 （esophageal varices bleeding，EVB）的关系及MDCTP预测食管胃底静脉曲张出血的应用价值。方法回顾性收集2015年9月-2017年6月在武警总医院均行胃镜检查和MDCTP肝硬化门脉高压患者47例，对MDCTP与胃镜对食管胃底静脉曲张结果行一致性检验；应用最大密度投影（maximal intensity projection，MIP）等方法测量47例患者的门静脉主干（main portal vein，MPV）、肝内门静脉左支（intrahepatic left portal vein，IHLPV）、肝内门静脉右支（intrahepatic right portal vein，IHRPV）、脾静脉（plenic vein，SPV）、胃左静脉（left gastric vein，LGV）、肠系膜上静脉（superior mesenterie vein，SMV）；应用ROC曲线评价门静脉及其属支对食管胃底静脉曲张破裂出血的预测价值。结果MDCTP与胃镜对食管胃静脉曲张的诊断一致性较好（κ=0．790）。MPV近端径及远端径、IHLPV、SPV、LGV直径在出血组及未出血组组间的差异有统计学意义，其在预测食管胃静脉曲张破裂出血的ROC曲线下面积分别为0．668、0．690、0．737、0．626、0．846，LGV直径的准确性最高。结论多排螺旋CT门静脉成像可用于肝硬化食管胃底静脉曲张的临床诊断，其中胃左静脉直径最有助于食管胃底静脉曲张破裂出血的预测。

Objective To evaluate the abiIity of multi-detector helical CT portography（MDCTP） to predict a risk of upper gastrointestinal hemorrhage in patients with liver cirrhosis and portal hypertension. Methods 47 cases with liver cirrhosis and portal hypertension were collected in this study. All patients were examined by endoscopy and MDCTP. The results of MDCTP were compared with endoscopy by Kappa consistency test. The diameters of the main portal vein（MPV）, intrahepatic left portal vein（IHLPV）, intrahepatic right portal vein（IHRPV）, plenic vein（SPV）, left gastric vein （LGV）, and Superior mesenteric vein（SMV） were measured; The ability of these indexes in prediction of EVB were evaluated by the area under the receiver operating characteristic（ROC） curves（AUC）. Results MDCTP was highly consistent with gastroscopy for evaluating esophageal varication（κ=0.790）, There was statistically significant difference in MPV, IHLPV, SPV, LGV diameter in the bleeding group and not bleeding group. The area under the ROC curve（AUC）, of prediction of EVB were 0.668, 0.690, 0.737, 0.626, 0.846, LGV diameter of the highest accuracy. Conclusion Multi-detector helical CT portography （MDCTP） can be used for the clinical diagnosis of EV, LGV is most helpful for the prediction of EVB.