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Research purposes. Understanding of the lateral branch circulation of patients with portal hypertension doors on the 64-slice spiral CT imaging findings; evaluation of 64-slice spiral CT in cirrhosis and esophageal varices value. Materials and methods The study subjects underwent 64-slice spiral CT examination 100 cases, 50 cases of liver cirrhosis and portal hypertension, 50 cases of the same period in patients with liver disease. Cirrhosis patients 36 males, 14 females; non-cirrhotic patients were 34 males and 16 females. Above cirrhosis and portal hypertension in patients 20 routine gastroscopy. Instruments and medicines Lightspeed64 layer spiral CT (GE Company) configuration AW4.3 workstation. Microcomputer automatic high-pressure syringe, binoculars automatic injection pump (Medrad company). The non-ionic iodinated contrast agent iopromide 300mgI/ml. Electronic gastroscope (GIF-XQ240). 3. Inspection methods patients fasting over 6h 30 min before the inspection service clean water 800 ml, then serving about 500 ml of water before the test. Scan using thickness 5mm, layer spacing 5mm enhanced using the thickness of 0.625mm layer from 0.625mm pitch 0.175, rotation one week 0.35s, the tube ball voltage 120kV, current 240mA, matrix 512 × 512. Arterial phase delay time determined Bolus-tracking technology to set the trigger point threshold of 150 Hu/6s; portal venous phase scans in the 20s to start after the end of the arterial phase scan, scan delay time average of 45 s. The total amount of contrast agent 70 ml-90 ml injection rate 3.5ml / s; scan range from the tracheal bifurcation down to the level of the iliac wing length about 50CM. During the scan, require the patient to a state of calm, hold your breath, in order to avoid causing the scan level beating and artifacts due to respiratory motion. The raw data is then transmitted to the workstation for image post-processing. Graphic reconstruction method of image processing and data collection, including: 1, multiplanar reconstruction (multiplanar reformation, MPR); 2, maximum intensity projection (maximum intensity projection. MIP); volume rendering (volume rendering, VR) technology. Image analysis and data collection: three sets of images were evaluated by two Department of Radiology, MD (Associate Professor). Evaluation include the beginning and ending of the main portal vein branch vessels, out of shape, path; the esophageal varices morphology, degree of risk of bleeding; portal vein, splenic vein, left gastric vein diameter. Two diagnostic disagreement, reached the same conclusion through joint discussions. The gastroscope results were evaluated by the two gastroscopy Division, MD (Associate Professor), the evaluation include the morphology, the degree of risk of bleeding of esophageal varices. Statistical analysis using SPSS13.00 statistical software for statistical analysis to the data, to determine cirrhosis and portal hypertension when the portal vein, splenic vein and the left gastric vein diameter and t test; gastroscopy with 64-slice spiral CT angiography of both consistency between kappa values, K ≧ 0.75 for consistency excellent, the conventional view that K gt; 0.4 for consistency with statistical significance. 1 1.1 50 patients with cirrhosis of the imaging results when the varicose veins of the esophagus wall and blood for anterior branch dominant type (21/22), paraesophageal varices blood supply for the posterior branch of the advantages of type (18 / 20). The esophageal wall varicose veins and varicose veins coexist around its blood supply is balanced (8/8). Gastric varices: GEV1, GV and more for the left gastric vein blood supply (25/27); GEV2 type and the IGV-type, GV mainly by the stomach / after - short intravenous or separate blood supply (23/23). 1.2 15 cases of spleen / stomach - renal shunt splenic vein and its branches in the portal vein system, gastric vein, gastric vein by the left subphrenic vein to the left renal vein. 12 patients with portal vein system paraumbilical vein and umbilical venous network between anastomosis caused periumbilical varices, the formation of sea snake head levy. One cases of superior mesenteric vein distal branches by around the rectum, the upper end of the venous plexus draining into the systemic venous system, the formation of the rectal venous plexus varicose. 2. 2.1 cirrhosis the group portal vein diameter of statistically significant results for the 14.10-17.55mm, an average of 16.05mm, non-cirrhosis group diameter of 10.13 to 12.30mm average 11.21mm P lt; 0.001, t test between differences statistically significant. Cirrhosis group splenic vein diameter of 10.64 ~ 14.73mm, average 12.27mm; non-cirrhotic group transverse diameter from 4.74 to 9.68mm, an average of 7.22mm. t-test between P lt; 0.001, the difference was statistically significant. Cirrhosis group left gastric vein diameter of 5.14-8.46mm, an average of 6.34mm; non-cirrhosis group diameter of 1.00 ~ 4.75mm, an average of 2.79mm. t-test between P lt; 0.001, the difference was statistically significant. 2.2 the gastroscopy judgment for variceal bleeding in low-risk cases, CT 7 cases; the gastroscopy judgment for 12 cases of high risk of variceal bleeding, CT 13 cases. kappa = 0.89, consistency, and no significant difference. Slice spiral CT portal venography in conclusion 1,64 cirrhosis and portal hypertension door lateral branch circulation, clear images, clear anatomical relationship, varicose veins and its relationship with the surrounding structures from different angles, conducive to observation varicose vein the whole picture, on the site of the collateral circulation, shape, scope, extent and path to make the evaluation. 2,64 slice spiral CT portography and gastroscopy cirrhosis and portal hypertension, esophageal varices bleeding risk evaluation has a high degree of consistency, so the former can be used as a clinical routine examination of methods and means of follow-up effects were observed.
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