Evaluation of portosystemic collaterals by MDCT-MPR imaging for management of hemorrhagic esophageal varices.
OBJECTIVE
To study the correlation between changes in portosystemic collaterals, evaluated by multidetector-row computed tomography imaging using multiplanar reconstruction (MDCT-MPR), and prognosis in patients with hemorrhagic esophageal varices (EV) after endoscopic treatment.


METHODS
Forty-nine patients with primary hemostasis for variceal bleeding received radical endoscopic treatment: endoscopic injection sclerotherapy (EIS) or endoscopic variceal ligation (EVL). Patients were classified according to the rate of reduction in feeding vessel diameter on MDCT-MPR images, into the narrowing (n=24) and no-change (n=25) groups. We evaluated changes in portosystemic collaterals by MDCT-MPR before and after treatment, and determined rebleeding and survival rates.


RESULTS
The left gastric and paraesophageal (PEV) veins were recognized as portosystemic collaterals in 100 and 80%, respectively, of patients with EV on MDCT-MPR images. The rebleeding rates at 1, 2, 3, and 5 years after endoscopic treatment were 10, 15, 23, and 23%, respectively, for the narrowing group, and 17, 24, 35, and 67%, respectively, for the no-change group (P=0.068). Among no-change group, the rebleeding rate in patients with large PEV was significantly lower than that with small PEV (P=0.027). The rebleeding rate in patients with small PEV of the no-change group was significantly higher than that in the narrowing group (P=0.018). There was no significant difference in rebleeding rates between the no-change group with a large PEV and narrowing group (P=0.435).


CONCLUSIONS
Changes in portosystemic collaterals evaluated by MDCT-MPR imaging correlate with rebleeding rate. Evaluation of portosystemic collaterals in this manner would provide useful information for the management of hemorrhagic EV.
Kodama
Hideaki
H
Department of Medicine and Molecular Science, Division of Frontier Medical Science, Graduate School of Biomedical Science, Hiroshima University, Minami-ku, Hiroshima, Japan.
Aikata
Hiroshi
H
Takaki
Shintaro
S
Azakami
Takahiro
T
Katamura
Yoshio
Y
Kawaoka
Tomokazu
T
Hiramatsu
Akira
A
Waki
Koji
K
Imamura
Michio
M
Kawakami
Yoshiiku
Y
Takahashi
Shoichi
S
Toyota
Naoyuki
N
Ito
Katsuhide
K
Chayama
Kazuaki
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003097:Collateral Circulation; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery*; D004947:Esophagus / Q000098:blood supply* / Q000000981:diagnostic imaging*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome