Yu S C H, Cho K J
Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
Acta Radiol. 2009 Apr;50(3):265-9. doi: 10.1080/02841850802712676.
Patients with splenic vein occlusion may present a diagnostic problem when the location, morphology, and cause of the obstructive lesion and the associated collateral veins cannot be clearly defined by standard diagnostic imaging modalities such as computed tomography, magnetic resonance venography, or indirect splenoportography (arterial portography).
To evaluate the safety and effectiveness of carbon dioxide (CO(2)) wedged arterial splenoportography for definitive investigation of splenic vein occlusion.
Following unsuccessful diagnosis with computed tomography and standard contrast arterial portography in a patient with recurrent gastric variceal bleeding, CO(2) was injected into a wedged splenic arterial catheter and successfully outlined splenic vein occlusion and gastric varices. Our experience with this patient prompted us to perform an experimental study in swine to evaluate the safety and effectiveness of CO(2) wedged arterial splenoportography for visualization of the splenic and portal veins. A microcatheter was advanced coaxially and wedged into the splenic arteries of three pigs. After checking the wedged positioning with contrast medium injection, CO(2) was injected manually and the splenic region imaged. The spleens were then removed for gross and microscopic examinations.
In the patient, CO(2) wedged arterial splenoportography demonstrated gastric varices associated with splenic vein occlusion. In all animals, CO(2) wedged arterial splenoportography visualized the splenic and portal veins. No CO(2) extravasations occurred in the spleen. Gross and microscopic examinations revealed no evidence of splenic rupture or intrasplenic hematoma.
CO(2) wedged arterial splenoportography may be a useful method for visualizing gastric varices associated with splenic vein occlusion. This new technique has the potential to replace the standard splenic arterial portography for visualization of splenic and portal veins, thus eliminating the need for injection of a large volume of iodinated contrast material. Further clinical studies are justified to evaluate this technique.
当脾静脉闭塞患者阻塞性病变的位置、形态、病因以及相关的侧支静脉无法通过计算机断层扫描、磁共振静脉造影或间接脾门静脉造影（动脉门静脉造影）等标准诊断成像方式清晰界定时，可能会出现诊断难题。
评估二氧化碳（CO₂）楔入式动脉脾门静脉造影对脾静脉闭塞进行明确检查的安全性和有效性。
在一名复发性胃静脉曲张出血患者经计算机断层扫描和标准对比动脉门静脉造影诊断失败后，将CO₂注入楔入式脾动脉导管，成功勾勒出脾静脉闭塞和胃静脉曲张情况。我们对该患者的经验促使我们在猪身上进行一项实验研究，以评估CO₂楔入式动脉脾门静脉造影用于脾静脉和门静脉显影的安全性和有效性。将一根微导管同轴推进并楔入三头猪的脾动脉。在注入造影剂检查楔入位置后，手动注入CO₂并对脾区进行成像。然后取出脾脏进行大体和显微镜检查。
在该患者中，CO₂楔入式动脉脾门静脉造影显示了与脾静脉闭塞相关的胃静脉曲张。在所有动物中，CO₂楔入式动脉脾门静脉造影均使脾静脉和门静脉显影。脾脏未发生CO₂外渗。大体和显微镜检查未发现脾破裂或脾内血肿的证据。
CO₂楔入式动脉脾门静脉造影可能是一种用于显示与脾静脉闭塞相关的胃静脉曲张的有用方法。这项新技术有可能取代标准的脾动脉门静脉造影用于脾静脉和门静脉显影，从而无需注入大量碘化造影剂。有必要进行进一步的临床研究来评估该技术。
