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Can the Computed Tomographic Aspect of Porto-Systemic Circulation in Cirrhotic Patients Be Associated with the Presence of Variceal Hemorrhage?

1
Department of Medical Imaging, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
2
Department of Radiology, Regional Institute of Gastroenterology and Hepatology “Prof. Dr Octavian Fodor”, 400158 Cluj-Napoca, Romania
3
Department of Radiology, Emergency Clinical County Hospital Cluj-Napoca, 400006 Cluj-Napoca, Romania
4
Department of Radiology, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540139 Târgu Mureș, Romania
5
Department of Gastroenterology and Digestive Endoscopy, Medical Center of Gastroenterology, Hepatology and Digestive Endoscopy, 400132 Cluj-Napoca, Romania
6
Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
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Department of Gastroenterology and Hepatology, Regional Institute of Gastroenterology and Hepatology “Prof. Dr Octavian Fodor”, 400158 Cluj-Napoca, Romania
8
Department of Gastroenterology and Hepatology, “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca, 400012 Cluj-Napoca, Romania
*
Author to whom correspondence should be addressed.
Medicina 2020, 56(6), 301; https://doi.org/10.3390/medicina56060301
Received: 6 May 2020 / Revised: 7 June 2020 / Accepted: 16 June 2020 / Published: 19 June 2020
(This article belongs to the Section Hepatology)
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. View Full-Text
Keywords: cirrhosis; portal hypertension; variceal hemorrhage; CT scan; porto-systemic circulation; oesophageal varices; left gastric vein cirrhosis; portal hypertension; variceal hemorrhage; CT scan; porto-systemic circulation; oesophageal varices; left gastric vein
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Caraiani, C.; Petresc, B.; Pop, A.; Rotaru, M.; Ciobanu, L.; Ștefănescu, H. Can the Computed Tomographic Aspect of Porto-Systemic Circulation in Cirrhotic Patients Be Associated with the Presence of Variceal Hemorrhage? Medicina 2020, 56, 301.

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