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Clinical Trial
. 2004 Jul 1;10(13):1939-42.
doi: 10.3748/wjg.v10.i13.1939.

Relationship between encephalopathy and portal vein-vena cava shunt: value of computed tomography during arterial portography

Qian Chu  1 , Zhen Li, Su-Ming Zhang, Dao-Yu Hu, Ming Xiao
Affiliations
Clinical Trial

Relationship between encephalopathy and portal vein-vena cava shunt: value of computed tomography during arterial portography

Qian Chu et al. World J Gastroenterol. .

Abstract

Aim: To assess the value of computed tomography during arterial portography (CTAP) in portal vein-vena cava shunt, and analysis of the episode risk in encephalopathy.

Methods: Twenty-nine patients with portal-systemic encephalopathy due to portal hypertension were classified by West Haven method into grade I(29 cases), grade II(16 cases), grade III(10 cases), grade IV( 4 cases). All the patients were scanned by spiral-CT. Plane scans, artery phase and portal vein phase enhancement scans were performed, and the source images were thinly reconstructed to 1.25 mm. We reconstructed the celiac trunk, portal vein, inferior vena cava and their branches and subjected them to three-dimensional vessel analysis by volume rendering (VR) technique and multiplanar volume reconstruction (MPVR) technique. The blood vessel reconstruction technique was used to evaluate the scope and extent of portal vein-vena cava shunt, portal vein emboli and the fistula of hepatic artery-portal vein. The relationship between the episode risk of portal-systemic encephalopathy and the scope and extent of portal vein-vena cava shunt, portal vein emboli and fistula of hepatic artery- portal vein was studied.

Results: The three-dimensional vessel reconstruction technique of spiral-CT could display celiac trunk, portal vein, inferior vena cava and their branches at any planes and angles and the scope and extent of portal vein-vena cava shunt, portal vein emboli and the fistula of hepatic artery- portal vein. In twenty-nine patients with portal-systemic encephalopathy, grade I accounted for 89.7% esophageal varices, 86.2% paragastric varices; grade II accounted for 68.75% cirsomphalos, 56.25% paraesophageal varices, 62.5% retroperitoneal varices and 81.25% dilated azygos vein; grade III accounted for 80% cirsomphalos, 60% paraesophageal varices, 70% retroperitoneal varices, 90% dilated azygos vein, and part of the patients in grades II and III had portal vein emboli and fistula of hepatic artery-portal vein; grade IV accounted for 75% dilated left renal vein, 50% paragallbladder varices, all the patients had fistula of hepatic artery- portal vein.

Conclusion: The three-dimensional vessel reconstruction technique of spiral-CT can clearly display celiac trunk, portal vein, inferior vena cava and their branches at any planes and angles and the scope and extent of portal vein-vena cava shunt. The technique is valuable for evaluating the episode risk in portal-systemic encephalopathy.

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Figures

Figure 1
Figure 1
Portal vein in artery phase and in portal vein phase. A: Portal vein in artery phase. VR technique could display artery-portal vein fistula clearly in artery phase, the portal vein was visualized early, even portal vein blood up the stream. The arrow points the fistula aperture between the right hepatic artery and right portal vein. B: Portal vein in portal vein phase. The portal vein was very slightly developed and portal vein-vena cava shunt emerged in the portal vein phase.
Figure 2
Figure 2
Enlarged portal vein and a non-flow region in the trunk (arrow).
Figure 3
Figure 3
Image of portal vein reconstructed by MPVR. We could see the emboli’s scopes and sizes at different planes (arrow).
Figure 4
Figure 4
Portal vein-vena cave shunt, portal vein emboli and fistula of hepatic artery-portal vein on MPVR images. A: Paraesophageal varices and dilated azygos vein on MPVR image (arrow). B: Paragastric varices on MPVR image (arrow).
See this image and copyright information in PMC

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