Department of Radiology, Section of Interventional Radiology, Loma Linda School of Medicine, 11234 Anderson St, Ste MC-2605E, Loma Linda, CA 92354.
Department of Surgery, Division of Vascular Surgery, Loma Linda University School of Medicine, Loma Linda, CA.
AJR Am J Roentgenol. 2020 Nov;215(5):1247-1251. doi: 10.2214/AJR.19.22460. Epub 2020 Sep 9.
The purpose of this study was to quantify abdominal CT predictors of endoscopically refractory, uncontrolled variceal hemorrhage requiring portal venous intervention. From 2009 to 2018, 64 patients with endoscopically refractory variceal hemorrhage requiring portal venous intervention (variceal hemorrhage group) and 67 patients without hemorrhage but with symptomatic, pressure gradient-proven portal hypertension (control group) underwent CT. CT scans were retrospectively reviewed for the following: varix size, variceal intraluminal protrusion, liver and spleen volumes, and portal vein diameter. Gastric variceal protrusion was found to be a strong CT parameter associated with refractory hemorrhage (mean depth, 0.75 mm in variceal hemorrhage group vs -2.91 mm in control group; = 0.001). Gastric varix size was also associated with variceal hemorrhage (mean diameter, 8.03 vs 6.51 mm; = 0.001). However, this trend was not observed in the sizes of the esophageal varices (mean diameter, 6.28 vs 6.43 mm; = 0.370). Larger spleen volume (mean, 1312 vs 1152 cm; = 0.029) and liver volume (mean, 1514 vs 1143 cm; = 0.004) were also found to be predictors of variceal hemorrhage. Significant CT threshold findings included gastric variceal protrusion depth more than 0 mm (odds ratio [OR], 6.44), gastric varix size more than 6 mm (OR, 3.89), spleen volume more than 1000 cm (OR, 2.63), and liver volume more than 1000 cm (OR, 2.82). Quantitative imaging parameters on abdominal CT, such as intraluminal protrusion of gastric varices, gastric varix size, and larger spleen and liver volumes, were predictive of portal venous intervention, whereas esophageal varix size was not.
本研究旨在量化腹部 CT 预测内镜难治性、无法控制的静脉曲张出血需要门静脉干预的指标。2009 年至 2018 年，64 例内镜难治性静脉曲张出血需要门静脉干预的患者（静脉曲张出血组）和 67 例无出血但有症状、压力梯度证实的门静脉高压患者（对照组）接受了 CT 检查。对以下方面进行了 CT 扫描回顾性分析：静脉曲张大小、静脉曲张腔内突起、肝脾体积和门静脉直径。胃静脉曲张突起被发现是与难治性出血密切相关的 CT 参数（平均深度，静脉曲张出血组为 0.75mm，对照组为-2.91mm； = 0.001）。胃静脉曲张大小也与静脉曲张出血相关（平均直径，8.03mm 与 6.51mm； = 0.001）。然而，食管静脉曲张的大小没有观察到这种趋势（平均直径，6.28mm 与 6.43mm； = 0.370）。较大的脾脏体积（平均，1312cm 与 1152cm； = 0.029）和肝脏体积（平均，1514cm 与 1143cm； = 0.004）也被发现是静脉曲张出血的预测指标。显著的 CT 阈值发现包括胃静脉曲张突起深度大于 0mm（比值比 [OR]，6.44）、胃静脉曲张大小大于 6mm（OR，3.89）、脾脏体积大于 1000cm（OR，2.63）和肝脏体积大于 1000cm（OR，2.82）。腹部 CT 的定量成像参数，如胃静脉曲张腔内突起、胃静脉曲张大小以及较大的脾脏和肝脏体积，可预测门静脉干预，而食管静脉曲张大小则不能。
