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目的通过与胃镜及直接门静脉造影(DSA)对比,评价多层 CT(MDCT)在门静脉高压症胃静脉曲张(GV)诊断及血流动力学研究中的价值。方法经胃镜确诊为 GV 的36例门静脉高压症患者,在内镜检查后2周内,均进行了上腹部 MDCT 动态增强扫描及 DSA 造影检查,CT 扫描后,均进行了 CT 门静脉成像(CTP)。由3名有经验的影像科医师,独立 CT 阅片,应用 Kappa(k)检验比较3位观察者诊断黏膜下 GV和胃周 GV 的一致性。3名医师共同评价 GV 的大小、部位及 GV 的供血静脉和引流静脉,并与胃镜和 DSA 结果比较。依据 GV 的分类,比较不同类型 GV 的血供及引流路径差异。结果3位观察者诊断黏膜下 GV 的病例数均达到了34例(94.4%),所有36例患者3位观察者均诊断胃周 GV(100%),诊断黏膜下 GV(k=0.85)和胃周 GV(k=1.0)的一致性均较好。MDCT 与胃镜诊断 GV 大小和部位的符合率分别达到86.1%和88.9%。CTP 显示 GV 供血血管和引流路径的敏感度、特异度、准确度、阳性预测值均达到80%以上。胃后静脉、胃短静脉参与胃底静脉曲张(胃食管静脉曲张2型和孤立型胃底静脉曲张)供血的发生率分别达到94.1%和70.6%,明显高于胃食管静脉曲张1型(GEVI,分别为52.6%和31.6%,P<0.05)。经奇静脉系统引流到上腔静脉是 GEV1的主要引流路径(100%),经胃肾分流引流到下腔静脉是胃底静脉曲张的主要引流路径(82.4%)。结论多层 CT 可作为诊断黏膜下 GV 和胃周 GV 的重要手段,可清楚地显示曲张静脉的大小、部位及血流动力学。
Objective To evaluate the value of multi-slice computed tomography (MDCT) in the diagnosis and hemodynamics of gastric varices (GV) in patients with portal hypertension by comparing with gastroscopy and direct portal venous angiography (DSA). Methods Thirty-six patients with portal hypertension diagnosed as GV by gastroscope underwent dynamic contrast-enhanced enhanced radiography (MDCT) and DSA imaging of the upper abdomen within 2 weeks after endoscopy. CT portography (CTP) . Three experienced imaging physicians, independent CT scan, Kappa (k) test was used to compare three observers to diagnose the consistency between submucosal GV and gastric GV. Three physicians evaluated the size, location, and venous and venous drafts of GV in comparison with endoscopy and DSA results. According to GV classification, different types of GV blood supply and drainage path differences. Results All three observers had 34 cases (94.4%) diagnosed submucosal GV. All three observers in 36 cases diagnosed GV (100%), submucosal GV (k = 0.85) and Gastric week GV (k = 1.0) consistency are better. The coincidence rates of MDCT and gastroscopy in the diagnosis of GV were 86.1% and 88.9%, respectively. CTP showed that the sensitivity, specificity, accuracy and positive predictive value of GV blood supply and drainage pathways reached more than 80%. Gastric varices and gastric short veins were associated with a 94.1% and 70.6% incidence of gastric varices (type 2 gastroesophageal varices and solitary type fundal varices), significantly higher than those with type 1 gastroesophageal varices (GEVI , Respectively, 52.6% and 31.6%, P <0.05). Drainage to the superior vena cava through the azygos vein is the main drainage path (100%) of GEV1. The diverticulum diverted to the inferior vena cava is the main drainage path of gastric varices (82.4%). Conclusion Multi-slice CT can be used as an important method to diagnose GV in submucosal and GV in the stomach. It can clearly show the size, location and hemodynamics of varicose veins.