摘要
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-detector row CT （MDCT） in the diagnosis and hemodynamic studies of gastric varices （GV） in portal hypertension by comparison with endoscopy and DSA direct portography. Methods Thirty-six consecutive cirrhotic patients with GV confirmed by endoscopy underwent tri-phase contrast-enhanced CT scans and CT portography （CTP） within 2 weeks after endoscopy examination. Three independent experienced radiologists, who were blinded to the patients＇ clinical data, analyzed the CT images, including the size and location of GV as well as afferent and efferent veins of GV, separately. Interobserver agreement among the 3 radiologists with regard to the diagnosis of submucosal and perigastric GV was determined by Kappa （k） values. The findings of endoscopy were used as standards. Results Sub mucosal GV was diagnosed in 34 of the 36 patients （94.4%） and perigastric GV in all 36 patients （100%） by the observation of the 3 radiologists. MDCT showed an excellent interobserver reliability with regard to the diagnosis of submucosal GV （ k = 0.85 ） and perigastric GV （ k = 1.0）. Agreement between MDCT and endoscopy with regard to the opacification of variceal size and location were 86.1% and 88.9% respectively. The sensitivity, specificity, accuracy, and positive predictive value of CTP in the opacification of afferent and efferent veins of GV were all more than 80%. The frequencies of participation of posterior gastric vein and short gastric vein in blood supply to gastric fundal varices in the isolated gastric varices and gastroesophageal varices type 2 （GEV2） were 94.1% and 70.6% respectively,both significantly higher than those in the gastroesophageal varices type 1 （ GEV1, 52.6% and 31.6%, respectively, both P 〈 0.05）. The main blood drainage route of GEV1 was via azygous system into the super vena cava （100%）, whereas in the gastric fundal varices the main blood drainage route was via the gastrorenal shunts into the inferior vena cava （82.4%）. Conclusion MDCT can be used as an important tool for detecting submucosal and perigastric GV, and can clearly reveal the size, location, and hemodynamics of GV.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2007年第46期3251-3255,共5页
National Medical Journal of China
基金
广东省自然科学基金研究团队资助项目(05200177)
