CT-maximum intensity projection is a clinically useful modality for the detection of gastric varices.
OBJECTIVE
To evaluate the efficacy of CT-maximum intensity projection (CT-MIP) in the detection of gastric varices and their inflowing and outflowing vessels in patients with gastric varices scheduled to undergo balloon-occluded retrograde transvenous obliteration (B-RTO).


METHODS
Sixteen patients with endoscopically confirmed gastric varices were included in this study. All patients were evaluated with CT-MIP using three-dimensional reconstructions, before and after B-RTO.


RESULTS
CT-MIP clearly depicted gastric varices in 16 patients (100%), the left gastric vein in 6 (32.5%), the posterior gastric vein in 12 (75.0%), the short gastric veins in 13 (81.3%), gastrorenal shunts in 16 (100%), the hemiazygos vein (HAZV) in 4 (25.0%), the pericardiophrenic vein (PCPV) in 9 (56.3%), and the left inferior phrenic vein in 9 patients (56.3%). Although flow direction itself cannot be determined from CT-MIP, this modality provided clear images of the inflowing and the outflowing vessels. Moreover, in one patient, short gastric veins were not seen on conventional angiographic portography images of the spleen, but were clearly revealed on CT-MIP.


CONCLUSIONS
We suggest that CT-MIP should be considered as a routine method for detecting and diagnosing collateral veins in patients with gastric varices scheduled for B-RTO. Furthermore, CT-MIP is more useful than endoscopy in verifying the early therapeutic effects of B-RTO.
Ishikawa
Toru
T
Department of Gastroenterology, Saiseikai Niigata Second Hospital, Teraji 280-7, Niigata 950-1104, Japan. toruishi@ngt.saiseikai.or.jp
Ushiki
Takashi
T
Mizuno
Ken-ichi
K
Togashi
Tadayuki
T
Watanabe
Kouji
K
Seki
Kei-ichi
K
Ohta
Hironobu
H
Yoshida
Toshiaki
T
Takeda
Keiko
K
Kamimura
Tomoteru
T
D000368:Aged; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards