Evaluation of gastric fundic and oesophageal varices by 64-row multidetector computed tomography before and after transjugular intrahepatic portosystemic shunt with concurrent left gastric vein embolization

Abstract

To determine the utility of 64-row multidetector computed tomography (MDCT) in assessing the changes of gastric fundic and oesophageal varices before and after transjugular intrahepatic portosystemic shunt (TIPS) with concurrent left gastric vein embolization. Twenty-eight consecutive patients with gastric fundic and oesophageal varices resulted from posthepatitic cirrhosis, clinically confirmed with endoscopy, were enrolled into our study. All the patients underwent thoracicoabdominal triphasic enhancement scans with 64-row MDCT 2 weeks before TIPS along with embolizing left gastric vein, and 6 months after the therapy. Before and after the therapy, the varices shown on multiplanar reconstruction (MPR) were compared by Fisher's exact test to evaluate the changes. Gastric fundic and oesophageal varices were shown in 26 patients (92.9%) and 25 (89.3%) on MPR before the therapy, respectively. After the therapy, these varices diminished markedly, and were illustrated in six (21.4%) and 10 patients (35.7%), respectively (all P<0.05). As for the main inflowing vessel of the varices (left gastric vein), it was illustrated in 28 patients (100.0%) on preoperative CT-MPR. After the embolization, the left gastric vein had been completely occluded on postoperative CT-MPR. Significant eradication of gastric fundic and oesophageal varices on follow-up CT-MPR portography can be considered to assess the changes of gastric fundic and oesophageal varices before and after TIPS with concurrent left gastric vein embolization, and 64-row MDCT can be an effective modality to evaluate the changes.