Willmann J K, Weishaupt D, Böhm T, Pfammatter T, Seifert B, Marincek B, Bauerfeind P
Institute of Diagnostic Radiology, University Hospital Zurich, Switzerland.
Gut. 2003 Jun;52(6):886-92. doi: 10.1136/gut.52.6.886.
The diagnosis of submucosal fundal varices is challenging. Currently, endoscopy and endoscopic ultrasound (EUS) are considered most useful for this purpose. The aim of this study was to evaluate if multi-detector row CT (MDCT) angiography contributes to the diagnosis of submucosal fundal varices.
Twenty two patients with endoscopically suspected fundal varices were prospectively included in the study. All patients underwent EUS and MDCT angiography. Levels of agreement between EUS and MDCT angiography for the detection of submucosal and perigastric fundal varices were evaluated by three blinded independent readers. In addition, variceal size and location, as well as afferent and efferent vessels of the submucosal varices, were determined.
Good or excellent image quality of MDCT angiography was obtained in 21/22 patients (95%). Based on EUS, submucosal varices were detected in 16 of 22 patients (73%) and perigastric varices in 22/22 patients (100%). Using MDCT angiography, the presence of submucosal varices was confirmed in all of these 16 patients by all three readers. Perigastric varices were also confirmed in all 22 patients by all three readers. In addition, all three readers noted the presence of a submucosal varix in an additional patient which was not detected on initial EUS. MDCT angiography showed an excellent interobserver reliability with regard to variceal diameter (kappa=0.90) and variceal location (kappa=0.94). Based on MDCT angiography, afferent and efferent vessels of submucosal varices included the left gastric vein in 11 (65%), the posterior/short gastric veins in 15 (88%), gastrorenal shunts in 10 (59%), the left inferior phrenic vein in six (35%), and the left pericardiophrenic vein in six (35%) of 17 patients.
MDCT angiography is equivalent to EUS in terms of detection and characterisation of fundal varices, in particular with regard to the distinction between submucosal and perigastric fundal varices.
胃底黏膜下静脉曲张的诊断具有挑战性。目前，内镜检查和内镜超声（EUS）被认为对此最为有用。本研究的目的是评估多排螺旋CT（MDCT）血管造影对胃底黏膜下静脉曲张诊断的贡献。
前瞻性纳入22例经内镜怀疑有胃底静脉曲张的患者。所有患者均接受了EUS和MDCT血管造影。由三位独立的盲法阅片者评估EUS和MDCT血管造影在检测胃底黏膜下和胃周静脉曲张方面的一致性水平。此外，还确定了静脉曲张的大小和位置，以及黏膜下静脉曲张的输入和输出血管。
22例患者中有21例（95%）获得了质量良好或优秀的MDCT血管造影图像。基于EUS，22例患者中有16例（73%）检测到黏膜下静脉曲张，22例患者中有22例（100%）检测到胃周静脉曲张。使用MDCT血管造影，所有三位阅片者均在这16例患者中证实了黏膜下静脉曲张的存在。所有三位阅片者也在所有22例患者中证实了胃周静脉曲张的存在。此外，所有三位阅片者均指出，在另外一名患者中存在黏膜下静脉曲张，而最初的EUS未检测到。MDCT血管造影在静脉曲张直径（kappa=0.90）和静脉曲张位置（kappa=0.94）方面显示出极好的观察者间可靠性。基于MDCT血管造影，17例患者中黏膜下静脉曲张的输入和输出血管包括胃左静脉11例（65%）、胃后/短静脉15例（88%）、胃肾分流10例（59%）、左膈下静脉6例（35%）和左心包膈静脉6例（35%）。
MDCT血管造影在胃底静脉曲张的检测和特征描述方面与EUS相当，特别是在区分胃底黏膜下和胃周静脉曲张方面。
