CT-maximum intensity projection is a clinically useful modality for the detection of gastric varices

AIM： To evaluate the efficacy of CT-maximum intensity projection （CT-MIP） in the detection of gastric varices and their infiowing and outflowing vessels in patients with gastric varices scheduled to undergo balloonoccluded retrograde transvenous obliteration （B-RTO）. METHODS： Sixteen patients with endoscopically confirmed gastric varices were included in this study. All patients were evaluated with CT-MIP using threedimensional reconstructions, before and after B-RTO. RESULTS： CT-MIP clearly depicted gastric varices in 16 patients （100%）, the left gastric vein in 6 （32.5%）, the posterior gastric vein in 12 （75.0%）, the short gastric veins in 13 （81.3%）, gastrorenal shunts in 16 （100%）, the hemiazygos vein （HAZV） in 4 （25.0%）, the pericardiophrenic vein （PCPV） in 9 （56.3%）, and the left inferior phrenic vein in 9 patients （56.3%）. Although flow direction itself cannot be determined from CT-MIP, this modality provided clear images of the inflowing and the outflowing vessels. Moreover, in one patient, short gastric veins were not seen on conventional angiographic portography images of the spleen, but were clearly revealed on CT-MIP. CONCLUSION： We suggest that CT-MIP should be considered as a routine method for detecting and diagnosing collateral veins in patients with gastric varices scheduled for B-RTO. Furthermore, CT-MIP is more useful than endoscopy in verifying the early therapeutic effects of B-RTO.

Angiotensin-Ⅱ administration is useful for the detection of liver metastasis from pancreatic cancer during pharmacoangiographic computed tomography

AIM: To improve the preoperative diagnosis of liver metastasis from pancreatic cancer, we estimated computed tomography during arterial angiography (CTA) with/without administration of angiotensin-Ⅱ (AT-Ⅱ). METHODS: Thirty-fi ve patients with pancreatic cancer were examined in this study. After conventional CTA was performed, pharmacoangiographic CTA was performed with a 1-3 microgram/5 mL solution of angiotensin Ⅱ injected through a catheter into the celiac artery during spiral computed tomography. We prospectively analyzed the relative region of interest (ROI) ratio of tumor to liver with/without AT-Ⅱ. RESULTS: In all patients, the relative ratio of each computed tomography (CT) number in the ROI was larger at pharmacoangiographic CT than at conventional angiographic CT. Administration of angiotensin-Ⅱ enhanced the metastatic liver tumor as compared with normal tissue. Intratumoral blood flow increased in all patients with malignant tumors due to the pressure effect of AT-Ⅱ. Furthermore, the metastatic lesions in the liver of three patients were represented by only pharmacoangiographic CT, not by conventional CT and conventional CT angiography. In even peripheral and central areas of metastatic liver tumor, the lesions were enhanced after administration of AT-Ⅱ. CONCLUSION: These results support that high detection rate of liver metastasis revealed by pharmacoangiographic CT suggests the improvement of diagnosis on preoperative staging. Moreover, chemotherapy under AT-Ⅱ induced hypertension may have a better effect on the treatment of metastatic liver tumors.