title: MDCT angiography to evaluate the therapeutic effect of PTVE for esophageal varices.
abstract: OBJECTIVE
  To evaluate the role of multi-detector row computed tomography (MDCT) angiography for assessing the therapeutic effects of percutaneous transhepatic variceal embolization (PTVE) for esophageal varices (EVs).
  
  
  METHODS
  The subjects of this prospective study were 156 patients who underwent PTVE with cyanoacrylate for EVs. Patients were divided into three groups according to the filling range of cyanoacrylate in EVs and their feeding vessels: (1) group A, complete obliteration, with at least 3 cm of the lower EVs and peri-/EVs, as well as the adventitial plexus of the gastric cardia and fundus filled with cyanoacrylate; (2) group B, partial obliteration of varices surrounding the gastric cardia and fundus, with their feeding vessels being obliterated with cyanoacrylate, but without reaching lower EVs; and (3) group C, trunk obliteration, with the main branch of the left gastric vein being filled with cyanoacrylate, but without reaching varices surrounding the gastric cardia or fundus. We performed chart reviews and a prospective follow-up using MDCT images, angiography, and gastrointestinal endoscopy.
  
  
  RESULTS
  The median follow-up period was 34 mo. The rate of eradication of varices for all patients was 56.4% (88/156) and the rate of relapse was 31.3% (41/131). The rates of variceal eradication at 1, 3, and 5 years after PTVE were 90.2%, 84.1% and 81.7%, respectively, for the complete group; 61.2%, 49% and 42.9%, respectively, for the partial group; with no varices disappearing in the trunk group. The relapse-free rates at 1, 3 and 5 years after PTVE were 91.5%, 86.6% and 81.7%, respectively, for the complete group; 71.1%, 55.6% and 51.1%, respectively, for the partial group; and all EVs recurred in the trunk group. Kaplan-Meier analysis showed P values of 0.000 and 0.000, and odds ratios of 3.824 and 3.603 for the rates of variceal eradication and relapse free rates, respectively. Cyanoacrylate in EVs disappeared with time, but those in the EVs and other feeding vessels remained permanently in the vessels without a decrease with time, which is important for the continued obliteration of the feeding vessels and prevention of EV relapse.
  
  
  CONCLUSIONS
  MDCT provides excellent visualization of cyanoacrylate obliteration in EV and their feeding veins after PTVE. It confirms that PTVE is effective for treating EVs.
authors.affiliation: Department of Gastroenterology, Provincial Hospital Affiliated with Shandong University, Jinan 250021, Shandong Province, China.
authors.forename: Aitao
authors.initials: A
authors.lastname: Sun
authors.forename: Yong-Jun
authors.initials: YJ
authors.lastname: Shi
authors.forename: Zhuo-Dong
authors.initials: ZD
authors.lastname: Xu
authors.forename: Xiang-Guo
authors.initials: XG
authors.lastname: Tian
authors.forename: Jin-Hua
authors.initials: JH
authors.lastname: Hu
authors.forename: Guang-Chuan
authors.initials: GC
authors.lastname: Wang
authors.forename: Chun-Qing
authors.initials: CQ
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D003487:Cyanoacrylates / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy; D006801:Humans; D007267:Injections; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003487:Cyanoacrylates
keywords: Cyanoacrylate; Esophageal varices; Multi-detector row computed tomography; Percutaneous transhepatic variceal embolization; Therapeutic effect
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