Evaluation of Collateral Circulation in Cirrhosis by Computed Tomography Portal Venography

Abstract

Objective: Cirrhotic portal hypertension can lead to extensive collateral circulation in the portal vein system, and the esophagogastric variceal bleeding (EVB) can easily lead to death. Computed tomography portal venography (CTPV) can display the composition of portal vein noninvasively. The purpose of this study was to investigate the diagnostic value of CTPV in collateral circulation of cirrhosis and to predict the risk of EVB. Methods: A total of 37 patients with cirrhosis in our hospital were analyzed retrospectively. All patients underwent CTPV and gastroscope to observe and classify varicose veins. The consistency of the two methods was analyzed. The diameters of patients with major tributaries of portal vein were compared between the hemorrhagic and non-hemorrhagic patients. The receiver operation characteristic (ROC) curves were used to evaluate the predictive value for EBV. Patients with varicose veins underwent endoscopic esophagogastric variceal ligation. Results: The tributaries of portal vein and the collateral circulation was showed clearly in CTPV. The esophagogastric varices was found in 30 patients, and the Kim grades I, II and III were 8, 10 and 12 respectively. The varicose was found in 28 patients under gastroscope. The CTPV and endoscopy were highly consistent in grading of esophagogastric varices (kappa 0.674). Compared with the non-hemorrhagic patients, the diameter of SMV, LGV and SV in hemorrhagic patients increased significantly. The ROC curves of predicted EBU by these diameters were 0.64, 0.76, and 0.83, respectively. There was no statistical difference between the diameter of portal vein and its tributaries before and after endoscopic variceal ligation. Conclusion: The CTPV can show the collateral vessels of portal vein in patients with cirrhosis, evaluate the degree of varicosity, and determine the risk of varicose rupture.