Hammer Simone, Zeman Florian, Schlitt Hans Jürgen, Stroszczynski Christian, Greiner Barbara, Doppler Michael Christian, Uller Wibke
Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
Center for Clinical Trials, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
Sci Rep. 2022 Apr 21;12(1):6554. doi: 10.1038/s41598-022-10454-y.
In this study the diagnostic capability and additional value of sequential CT arterioportography-arteriosplenography (CT AP-AS) in comparison to standard cross-sectional imaging and upper gastrointestinal endoscopy (UGE) in pediatric portal hypertension (PH) was analyzed. Patients with clinical signs of PH who underwent CT AP-AS in combination with additional contrast-enhanced magnetic resonance imaging (CE-MR) and/or contrast-enhanced computed tomography (CE-CT) were included. Two radiologists reviewed independently imaging regarding the capability to prove patency of (1) extrahepatic and intrahepatic main stem portal vein (PV), (2) intrahepatic PV system and (3) splenomesenteric venous axis. Imaging was reviewed for detection of abdominal varices and results were compared to UGE. Main venous supply of varices (PV and/or splenic vein system) and splenorenal shunting were evaluated. 47 imaging studies (20 CT AP-AS, 16 CE-MR, 11 CE-CT) and 12 UGE records of 20 patients were analyzed. CT AP-AS detected significantly more splenorenal shunts (p = 0.008) and allowed more confident characterization of the extra-/intrahepatic PV-system and splenomesenteric veins in comparison to CE-MR (p < 0.001). Extra- and intrahepatic PV-system were significantly more confidently assessed in CT AP-AS than in CE-CT (p = 0.008 and < 0.001 respectively). CT AP-AS was the only modality that detected supply of varices and additional gastric/duodenal varices. In this retrospective study CT AP-AS was superior to standard cross-sectional imaging concerning confident assessment of the venous portosplenomesenteric axis in pediatric patients. CT AP-AS detected additional varices, splenorenal shunting and supply of varices.
本研究分析了序贯CT动脉门静脉造影-动脉脾门静脉造影（CT AP-AS）相较于标准横断面成像和上消化道内镜检查（UGE）在儿童门静脉高压（PH）中的诊断能力及附加价值。纳入有PH临床体征且接受了CT AP-AS联合额外的对比增强磁共振成像（CE-MR）和/或对比增强计算机断层扫描（CE-CT）的患者。两名放射科医生独立审查影像，以评估其证明以下结构通畅的能力：（1）肝外和肝内门静脉主干（PV）、（2）肝内PV系统以及（3）脾肠系膜静脉轴。审查影像以检测腹部静脉曲张，并将结果与UGE进行比较。评估静脉曲张的主要静脉供血（PV和/或脾静脉系统）以及脾肾分流情况。分析了20例患者的47项影像研究（20例CT AP-AS、16例CE-MR、11例CE-CT）和12份UGE记录。与CE-MR相比，CT AP-AS检测到的脾肾分流显著更多（p = 0.008），并且对肝外/肝内PV系统和脾肠系膜静脉的特征描述更具把握（p < 0.001）。与CE-CT相比，CT AP-AS对肝外和肝内PV系统的评估更具把握（分别为p = 0.008和< 0.001）。CT AP-AS是唯一能检测到静脉曲张供血及额外胃/十二指肠静脉曲张的检查方式。在这项回顾性研究中，就对儿童患者门静脉脾肠系膜轴的可靠评估而言，CT AP-AS优于标准横断面成像。CT AP-AS检测到了额外的静脉曲张、脾肾分流以及静脉曲张供血。
