Hepatofugal flow on computed tomography of arterial portography: its correlation with esophageal varices bleeding.
OBJECTIVE
To study the portal flow patterns from CTAP (computed tomography of arterial portography), then to predict the existence of esophageal varices bleeding clinically.


METHODS
192 patients who underwent CTAP from superior mesenteric artery infusion were recruited in this study. The obtained images were classified according to our proposed criteria. Stage 0: hepatopetal flow, when all the contrast medium from the superior mesenteric vein entered the portal vein. Stage 1: when the contrast medium opacified the splenic vein or the other collateral vessels. Stage II: when the contrast medium opacified the paraesophageal vessels without entering the inner wall of the esophagus. Stage III: when the contrast medium opacified the collaterals up to the inner wall of the esophagus.


RESULTS
The incidence of bleeding esophageal varices was correlated to the different stages of collateral flows pattern obtained. The esophageal varices bleeding rates were 0/137, 1/16, 1/14, 16/25 for stage 0, I, II and III, respectively. The incidence of bleeding esophageal varices was significantly higher in stage III group than in the other groups (P < 0.001). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of stage III patients in regard to the occurrence of bleeding esophageal varices were estimated as 80.0%, 98.8%, 88.9%, 94.8%, and 94.3%, respectively.


CONCLUSIONS
Our results show that CTAP demonstrates the portal flow patterns and collateral veins clearly, which can serve as an excellent imaging modality to predict the risk of esophageal varices bleeding.
Tsai
H M
HM
Department of Radiology, National Cheng Kung University, College of Medicine, Tainan, Taiwan. sjfhmt@mail.ncku.edu.tw
Lin
X Z
XZ
Chang
Y C
YC
Lin
P W
PW
Hsieh
C C
CC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004932:Esophageal and Gastric Varices; D004947:Esophagus / Q000098:blood supply* / Q000000981:diagnostic imaging; D005260:Female; D006471:Gastrointestinal Hemorrhage; D006801:Humans; D008297:Male; D008875:Middle Aged; D011168:Portal System / Q000000981:diagnostic imaging; D011172:Portography; D011237:Predictive Value of Tests; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed