Gastric Varices in Patients With Portal Hypertension Evaluation With Multidetector Row CT
Gastric Varices in Patients With Portal Hypertension Evaluation With Multidetector Row CT
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DOI：
10.1097/mcg.0b013e3181c115c6
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发表时间：
2010-05-01
影响因子：
2.9
通讯作者：
Shan, Hong
中科院分区：
文献类型：
--
作者：
Zhu, Kangshun;Meng, Xiaochun;Shan, Hong
背景：胃静脉曲张（GV）是门脉高压患者消化道出血的主要原因。很少有研究利用多排计算机断层扫描 (MDCT) 评估 GV。目标：评估 MDCT 在检测 GV 和揭示肝硬化患者静脉曲张血流动力学变化方面的诊断性能。研究：对 127 例连续接受肝脏 MDCT 和食管胃十二指肠镜检查 (EGD) 的肝硬化患者进行回顾性分析。两名独立放射科医生审查了 MDCT 图像以检测 GV。 2位放射科医生在MDCT门静脉造影上一致评估静脉曲张血流动力学变化。结果：在EGD的基础上，127例患者中，36例出现GV（28.4%），其中小GV 15例，大GV（≥5mm）21例。在 GV 检测和分级方面，MDCT 和 EGD 之间存在中等一致性（kappa 值：0.514 至 0.563），但在区分需要预防性治疗的大静脉曲张方面，发现了显着的一致性（kappa 值：放射科医生 1 为 0.804，放射科医生 2 为 0.796）。对于放射科医生 1，MDCT 识别大 GV 的敏感性、特异性、准确性以及阳性和阴性预测值分别为 85.7%、96.2%、94.5%、81.8% 和 97.1%；而放射科医生 2 的比例分别为 81.0%、97.2%、94.5%、85.0% 和 96.3%。在评估静脉曲张的传入和传出静脉时，MDCT门静脉造影的敏感性、特异性、准确性和阳性预测值均大于80.0%。结论：MDCT是区分大GV和揭示肝硬化患者静脉曲张传入和传出静脉的有效筛查工具。
Background: Gastric varices (GVs) are a major cause of gastrointestinal bleeding in patients with portal hypertension. Few studies have evaluated GVs with multidetector row computed tomography (MDCT).Goals: To assess the diagnostic performance of MDCT in detecting GVs and revealing variceal hemodynamic changes in patients with cirrhosis.Study: A total of 127 consecutive cirrhotic patients who underwent both liver MDCT and esophagogastroduodenoscopy (EGD) were analyzed retrospectively. Two independent radiologists reviewed MDCT images for the detection of GVs. The variceal hemodynamic changes were assessed by the 2 radiologists in consensus on MDCT portography.Results: On the basis of EGD, of the 127 patients, 36 had GVs (28.4%), including small GVs in 15 patients and large GVs (>= 5mm) in 21 patients. In detecting and grading GVs, there were moderate agreements (kappa value: 0.514 to 0.563) between MDCT and EGD, but in differentiating large varices requiring prophylactic therapy, a substantial agreement (kappa value: 0.804 for radiologist 1 and 0.796 for radiologist 2) was found. For radiologist 1, the sensitivity, specificity, accuracy, and positive and negative predictive values of MDCT for the identification of large GVs were 85.7%, 96.2%, 94.5%, 81.8%, and 97.1%, respectively; whereas for radiologist 2, they were 81.0%, 97.2%, 94.5%, 85.0%, and 96.3%, respectively. In evaluating the afferent and efferent veins of varices, the sensitivity, specificity, accuracy, and positive predictive value of MDCT portography were more than 80.0%.Conclusions: MDCT is an effective screening tool for differentiating large GVs and revealing the afferent and efferent veins of varices in patients with cirrhosis.