基于二氧化碳的门静脉造影术：一种替代使用碘化造影剂进行传统成像的方法。

Carbon dioxide-based portography: an alternative to conventional imaging with the use of iodinated contrast medium.

作者信息

Maruyama Hitoshi, Okugawa Hidehiro, Ishibashi Hiroyuki, Takahashi Masanori, Kobayashi Satoshi, Yoshizumi Hiroaki, Yokosuka Osamu

机构信息

Department of Medicine and Clinical Oncology, Chiba University Graduate School of Medicine, Chiba, Japan.

出版信息

J Gastroenterol Hepatol. 2010 Jun;25(6):1111-6. doi: 10.1111/j.1440-1746.2010.06248.x.

DOI:10.1111/j.1440-1746.2010.06248.x

PMID:20594227

Abstract

BACKGROUND AND AIM

To clarify the efficacy of carbon dioxide (CO(2)) as a contrast material to evaluate portal vein images by percutaneous transhepatic portography (PTP).

METHODS

Twenty patients (38-76 years; male 13, female 7) with chronic liver diseases were the subjects of this prospective study. Portal venous opacification by PTP was compared between CO(2)-based images and iodinated contrast medium (ICM)-based images by two independent reviewers, according to the three-grade scoring; 0 for none, 1 for weak and 2 for sufficient.

RESULTS

Total scores of extrahepatic portal veins (137 for CO(2), 93 for ICM), collateral vessels (64 for CO(2), 60 for ICM) and intrahepatic portal veins (69 for CO(2), 76 for ICM) were not statistically significant between CO(2)-based and ICM-based images (P = 0.0623). Sufficient opacification of superior mesenteric vein was more frequent on CO(2)-based images (none 0, weak 4, sufficient 16) than ICM-based images (none 19, weak 0, sufficient 1; P < 0.0001). The score was not statistically significant between CO(2)-based and ICM-based images in portal trunk, splenic vein, inferior mesenteric vein and other collateral vessels. Although opacification grade in the intrahepatic left portal vein was not statistically significant between CO(2)-based and ICM-based images (P = 0.1515), weak opacification was significantly frequent on CO(2)-based images (weak 10, sufficient 10) compared to ICM-based images (weak 0, sufficient 20; P = 0.0003) in the intrahepatic right portal vein. Inter-reviewer agreement was excellent between the two reviewers for CO(2)-based images (kappa = 0.913) and ICM-based images (kappa = 0.924).

CONCLUSIONS

Carbon dioxide may be a first-line contrast material for evaluating portal vein images by PTP.

摘要

背景与目的

阐明二氧化碳（CO₂）作为对比剂通过经皮肝穿刺门静脉造影（PTP）评估门静脉图像的有效性。

方法

本前瞻性研究以20例慢性肝病患者（年龄38 - 76岁；男性13例，女性7例）为研究对象。由两名独立的评估者根据三级评分标准比较基于CO₂的图像和基于碘化造影剂（ICM）的图像经PTP后的门静脉显影情况；无显影为0分，显影弱为1分，显影充分为2分。

结果

基于CO₂的图像和基于ICM的图像在肝外门静脉（CO₂组137分，ICM组93分）、侧支血管（CO₂组64分，ICM组60分）和肝内门静脉（CO₂组69分，ICM组76分）的总分上无统计学差异（P = 0.0623）。基于CO₂的图像上肠系膜上静脉显影充分的情况（无显影0例，显影弱4例，显影充分16例）比基于ICM的图像更常见（无显影19例，显影弱0例，显影充分1例；P < 0.0001）。门静脉主干、脾静脉、肠系膜下静脉和其他侧支血管基于CO₂的图像和基于ICM的图像之间评分无统计学差异。虽然肝内左门静脉的显影等级在基于CO₂的图像和基于ICM的图像之间无统计学差异（P = 0.1515），但在肝内右门静脉中，基于CO₂的图像上显影弱的情况（显影弱10例，显影充分10例）比基于ICM的图像更显著常见（显影弱0例，显影充分20例；P = 0.0003）。两位评估者之间基于CO₂的图像（kappa = 0.913）和基于ICM的图像（kappa = 0.924）的评估者间一致性良好。