Abstract
Background and objectives: Variceal bleeding is a serious complication caused by portal hypertension, frequently encountered among cirrhotic patients. The purpose of this study was to determine whether the aspect of the collateral, porto-systemic circulation, as detected by CT are associated with the presence variceal hemorrhage (VH). Materials and Methods: 81 cirrhotic patients who underwent a contrast-enhanced CT examination were retrospectively included in the study. Patients were divided into two groups: Cirrhotic patients with variceal hemorrhage during the hospital admission concomitant, with the CT examination (n = 33) and group 2-cirrhotic patients, without any variceal hemorrhage in their medical history (n = 48). The diameter of the left gastric vein, the presence or absence and dimensions of oesophageal and gastric varices, paraumbilical veins and splenorenal shunts were the indicators assessed on CT. Results: The univariate analysis showed a significant association between the presence of upper GI bleeding and the diameters of paraoesophageal veins, paragastric veins and left gastric vein respectively, all of these CT parameters being higher in patients with variceal bleeding. In the multivariate logistic regression analysis, only the diameter of the left gastric vein was independently associated with the presence of variceal hemorrhage (OR = 1.6 (95% CI: 1.17–2.19), p = 0.003). We found an optimal cut-off value of 3 mm for the diameter of the left gastric vein useful to discriminate among patients with variceal hemorrhage from the ones without it, with a good diagnostic performance (AUC = 0.78, Se = 97%, Sp = 45.8%, PPV = 55.2%, NPV = 95.7%). Conclusions: Our observations point out that an objective CT quantification of porto-systemic circulation can be correlated with the presence of variceal hemorrhage and the diameter of the left gastric vein can be a reliable parameter associated with this condition.
Highlights
Portal hypertension develops when there is increased resistance to the portal blood flow [1].The imaging hallmark of portal hypertension involves the development of portocaval collateral circulation, mainly of gastric and oesophageal varices
Mortality during the first episode of variceal bleeding is as high as 20–30% and it increases in patients with Child-Pugh C liver cirrhosis [4]
The aim of our study was to determine if the aspect of the collateral, porto-systemic circulation, as detected by Computed tomography (CT) can be associated with the presence of variceal hemorrhage (VH)
Summary
Portal hypertension develops when there is increased resistance to the portal blood flow [1].The imaging hallmark of portal hypertension involves the development of portocaval collateral circulation, mainly of gastric and oesophageal varices. Mortality during the first episode of variceal bleeding is as high as 20–30% and it increases in patients with Child-Pugh C liver cirrhosis [4]. Patients with oesophageal or gastric varices develop hemorrhage at a rate of 10–30% per year [5]. Most patients with liver cirrhosis will undergo endoscopic screening for the presence of oesophageal varices [7]. In the multivariate logistic regression analysis, only the diameter of the left gastric vein was independently associated with the presence of variceal hemorrhage (OR = 1.6 (95% CI: 1.17–2.19), p = 0.003). Conclusions: Our observations point out that an objective CT quantification of porto-systemic circulation can be correlated with the presence of variceal hemorrhage and the diameter of the left gastric vein can be a reliable parameter associated with this condition
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