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Three-dimensional portography using multislice helical CT is clinically useful for management of gastric fundic
A Matsumoto1, M Kitamoto, M Imamura
1First Department of Internal Medicine, Hiroshima University School of Medicine, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
Insights
Three-dimensional helical CT portography effectively visualizes gastric fundic varices and portosystemic collaterals. This less invasive imaging technique aids in patient selection and therapeutic outcome evaluation for retrograde transvenous obliteration.
Area of Science:
- Radiology
- Medical Imaging
- Gastroenterology
Background:
- Gastric fundic varices are a significant cause of upper gastrointestinal bleeding.
- Accurate assessment of portosystemic collaterals is crucial for treatment planning.
Purpose of the Study:
- To evaluate the utility of three-dimensional (3D) helical CT portography in patients with gastric fundic varices.
- To compare 3D helical CT portography with conventional angiographic portography.
Main Methods:
- 30 consecutive patients with gastric fundic varices underwent both 3D helical CT portography and conventional angiographic portography.
- Assessment focused on visualization of varices, feeding veins, and shunts, and evaluation of treatment selection and results.
Main Results:
- 3D helical CT portography visualized gastric fundic varices in 100% of patients and depicted portosystemic collaterals effectively.
- It offered superior visualization of posterior and short gastric veins compared to conventional angiography in some cases.
- Therapeutic success was achieved in 29 out of 30 patients, with 3D helical CT portography facilitating outcome assessment.
Conclusions:
- 3D helical CT portography is a highly effective and less invasive alternative to conventional angiography for assessing portosystemic collaterals.
- It is valuable for selecting patients with gastric fundic varices for retrograde transvenous obliteration and for monitoring treatment efficacy.
Objective:
This study seeks to evaluate three-dimensional (3D) helical CT portography as a tool for examining patients with gastric fundic varices.
Subjects And Methods:
We compared 3D helical CT portography and conventional angiographic portography in 30 consecutive patients with gastric fundic varices. We assessed whether 3D helical CT portography is useful in selecting patients and in evaluating the results of balloon-occluded retrograde transvenous obliteration.
Results:
Three-dimensional helical CT portography simultaneously depicted second or third branches of the intrahepatic portal vein and provided images of entire portosystemic collaterals. On 3D helical CT portography, gastric fundic varices were seen in 30 patients (100%), left gastric veins in 19 (63%), posterior gastric veins or short gastric veins in 28 (93%), gastrorenal shunts in 27 (90%), paraumbilical veins in three (10%), and inferior phrenic veins in two patients (7%). Findings of 3D helical CT portography and conventional angiographic portography were in close agreement. However, in four patients, posterior gastric veins or short gastric veins were not seen on conventional angiographic portography images of the spleen, but they were clearly revealed on 3D helical CT portography. Treatment was successful in all patients except one. Three-dimensional helical CT portography could easily evaluate therapeutic results.
Conclusion:
Three-dimensional helical CT portography proved so effective that it can be considered a less invasive alternative than conventional angiographic portography in assessing portosystemic collaterals. CT portography is useful in selecting candidates from patients with gastric fundic varices for retrograde transvenous obliteration and also in evaluating therapeutic results.