Correlation of Portal and Splenic Vein Diameter with Presence and Size of Esophageal and Gastric Varices in Liver Cirrhosis Patients on MDCT

Akhilesh Kumar Kasyap,Anamika Jha,Ghanshyam Gurung,Ranjit Kumar Chaudhary,Yusra Ali

doi:10.3126/njr.v10i2.35969

Abstract

Introduction: Variceal formation depends upon the pattern of dilatation of the portal and various splanchnic veins in patients with cirrhotic liver and portal hypertension. Multidetector Computed Tomography (MDCT) may be helpful in the evaluation of such gastroesophageal varices and predicting their risk of haemorrhage.Methods: After obtaining ethical clearance and consent, 50 patients meeting the inclusion criteria were included and MDCT obtained. The diameters of the portal vein (PV), splenic vein (SV) and left gastric vein (LGV) were measured and originating vein of LGV determined. Pattern, location and diameter of varix was evaluated. Association between the diameters of the originating vein and the grade and pattern of the esophagael and gastric fundic varices was determined.Results: Of the 50 patients, 41 had gastroesophageal (GE) varices equal to or larger than 1mm with 34% having high-risk varices. The SV was predominantly the originating vein of the LGV. Cutoff SV diameter of 7.75mm and LGV diameter of 5.75mm had a sensitivity of 77.8% with a specificity of 73.2% and 75.6% respectively for the presence of varices.Conclusions: In our study, EV and GEV was more common and mostly supplied by LGV while isolated gastric fundic varices were supplied by non LGV veins only. The diameters of SV and LGV were associated with the presence and grade of esophageal and gastric fundic varices. MDCT is an important non-invasive modality in patients with portal hypertension and should be used for diagnosis, risk stratification and monitoring of varices.

Highlights

Variceal formation depends upon the pattern of dilatation of the portal and various splanchnic veins in patients with cirrhotic liver and portal hypertension
We evaluated the utility of Multidetector Computed Tomography (MDCT) imaging for the evaluation of esophageal and gastric fundic varices in patients with liver cirrhosis to detect, correlate the size of originating vein to the pattern of the varices and categorize according to the classification on CT scan
left gastric vein (LGV) was detected as the main inflowing vein in 63.41% of the cases with varices

Summary

Introduction

Variceal formation depends upon the pattern of dilatation of the portal and various splanchnic veins in patients with cirrhotic liver and portal hypertension. One-third of those affected suffer at least one episode of haemorrhage with substantial morbidity and mortality.[1] Esophageal varices (EV) are more common but have a better prognosis while gastric varices (GV) account for 10- 30% of all variceal haemorrhage, are larger and more severe with higher mortality.[2] These hepatofugal varices result due to an elevated portal venous pressure secondary to morphological changes of chronic liver disease and enable portosystemic venous drainage.[3] Endoscopy being diagnostic and therapeutic is widely accepted and primarily used to detect, grade and follow up varices with prophylactic screening recommended for large varices.[4] it is an invasive technique with serious complications like perforation This has prompted noninvasive evaluation techniques for varices that are more suitable for screening, treatment monitoring, and follow-up.[5,6] Multidetector computerized tomography (MDCT) is one such noninvasive and adequately available technique that is recommended in chronic liver disease patients to rule out hepatocellular carcinoma.[7,8,9] Doppler ultrasound, which can image larger veins like portal vein (PV) or splenic vein (SV) and measure parameters like diameter, flow direction and flow velocity, is limited by evaluation of collaterals and other smaller or deeper veins. We evaluated the utility of MDCT imaging for the evaluation of esophageal and gastric fundic varices in patients with liver cirrhosis to detect, correlate the size of originating vein to the pattern of the varices and categorize according to the classification on CT scan

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Conclusion