Computed tomographic portal venography in patients with portal hypertension

Objective To study the use of computed tomographic portal venography (CTPV) in patients with portal hypertension.Methods We selected 40 patients with portal hypertension who presented with upper gastrointestinal hemorrhage as the study group and 20 normal people as the control group.The CTPV images of the individuals were studied.The diameters of the main portal vein and its branches were measured and the patterns of drainage of the left gastric vein were studied.The data were handled using a linear fitting way.Results All 60 patients underwent CTPV successfully.In the study group,the diameter of the main portal vein was (16.62±4.80) mm,the superior mesenteric vein (12.36±2.67) mm,and the splenic vein (14.29±4.24) mm.In the control group,the diameter of the main portal vein was (10.84 ± 2.14)mm,the superior mesenteric vein (8.79 ±1.44) mm,and the splenic vein (8.32±1.78) mm.In most cases,the left gastric vein drained into the splenic-portal vein and the splenic vein.The diameter of the portal vein X was 18.33 mm under the mathematical axiom 11/18=X/30.The visualization ratio of the esophageal branch of the left gastric vein was 52.38％,the gastric branch 66.67％ and these two branches were displayed at the same time in 23.81％.There was non visualization of the left gastric vein in a significant proportion of patients.The visualization ratio of the retroperitoneal vein was 25％.Conclusions CTPV has great values in the clinical application in the pre-operative assessment of patients with esophageal and gastric varices.It gives information on the morphology and function of the portal system which can guide devascularization procedure.In patients who present with bleeding varices,there is a higher chance that the left gastric vein drains into the splenic-portal vein and splenic vein.The diameter of the main portal vein X ≥18 mm can be used as a threshold value pressure on CTPV imaging.The esophageal/gastric branches of the left gastric vein may not be displayed in some patients.Improvements need to be made to better visualization the retroperitoneal vein. Key words: Portal hypertension;  Portal venography;  Computed tomography;  Regional devascularization