Moubarak Elie, Bouvier Antoine, Boursier Jérôme, Lebigot Jérôme, Ridereau-Zins Catherine, Thouveny Francine, Willoteaux Serge, Aubé Christophe
Department of Radiology, Angers University Hospital, Angers, France.
Abdom Imaging. 2012 Oct;37(5):746-66. doi: 10.1007/s00261-011-9811-0.
Portosystemic collateral vessels (PSCV) are a consequence of the portal hypertension that occurs in chronic liver diseases. Their prognosis is strongly marked by the risk of digestive hemorrhage and hepatic encephalopathy.
CT was performed with a 16-MDCT scanner. Maximum intensity projection and volume rendering were systematically performed on a workstation to analyze PSCV.
We describe the PSCV according to their drainage into either the superior or the inferior vena cava. In the superior vena cave group, we found gastric veins, gastric varices, esophageal, and para-esophageal varices. In the inferior vena cava group, the possible PSCV are numerous, with different sub groups: gastro and spleno renal shunts, paraumbilical and abdominal wall veins, retroperitoneal shunts, mesenteric varices, gallbladder varices, and omental collateral vessels. Regarding clinical consequences esophageal and gastric varices are most frequently involved in digestive bleeding; splenorenal shunts often lead to hepatic encephalopathy; the paraumbilical vein is an acceptable derivation pathway for natural decompression of the portal system.
Knowledge of precise cartography of PSCV is essential to therapeutic decisions. MDCT is the best way to understand and describe the different types of PSCV.
门体侧支循环血管（PSCV）是慢性肝病中门静脉高压的结果。其预后受消化性出血和肝性脑病风险的显著影响。
使用16层螺旋CT扫描仪进行CT检查。在工作站上系统地进行最大密度投影和容积再现，以分析PSCV。
我们根据PSCV向上腔静脉或下腔静脉的引流情况对其进行描述。在上腔静脉组中，我们发现了胃静脉、胃静脉曲张、食管及食管旁静脉曲张。在下腔静脉组中，可能的PSCV众多，有不同的亚组：胃脾分流、脾肾分流、脐旁及腹壁静脉、腹膜后分流、肠系膜静脉曲张、胆囊静脉曲张和网膜侧支血管。关于临床后果，食管和胃静脉曲张最常导致消化性出血；脾肾分流常导致肝性脑病；脐旁静脉是门静脉系统自然减压的可接受的分流途径。
了解PSCV的精确分布图对于治疗决策至关重要。多层螺旋CT是了解和描述不同类型PSCV的最佳方法。
