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Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 21, 2005; 11(47): 7515-7519
Published online Dec 21, 2005. doi: 10.3748/wjg.v11.i47.7515
CT-maximum intensity projection is a clinically useful modality for the detection of gastric varices
Toru Ishikawa, Takashi Ushiki, Ken-ichi Mizuno, Tadayuki Togashi, Kouji Watanabe, Kei-ichi Seki, Hironobu Ohta, Toshiaki Yoshida, Keiko Takeda, Tomoteru Kamimura
Toru Ishikawa, Takashi Ushiki, Ken-ichi Mizuno, Tadayuki Togashi, Kouji Watanabe, Kei-ichi Seki, Hironobu Ohta, Toshiaki Yoshida, Tomoteru Kamimura, Department of Gastroenterology, Saiseikai Niigata Second Hospital, Niigata, Japan
Keiko Takeda, Department of Radiology, Saiseikai Niigata Second Hospital, Niigata, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Toru Ishikawa, Department of Gastroenterology, Saiseikai Niigata Second Hospital, Teraji 280-7, Niigata 950-1104, Japan. toruishi@ngt.saiseikai.or.jp
Telephone: +81-25-233-6161 Fax: +81-25-233-8880
Received: March 8, 2005
Revised: July 23, 2005
Accepted: July 28, 2005
Published online: December 21, 2005
Abstract

AIM: To evaluate the efficacy of CT-maximum intensity projection (CT-MIP) in the detection of gastric varices and their inflowing and outflowing vessels in patients with gastric varices scheduled to undergo balloon-occluded retrograde transvenous obliteration (B-RTO).

METHODS: Sixteen patients with endoscopically confirmed gastric varices were included in this study. All patients were evaluated with CT-MIP using three-dimensional reconstructions, before and after B-RTO.

RESULTS: CT-MIP clearly depicted gastric varices in 16 patients (100%), the left gastric vein in 6 (32.5%), the posterior gastric vein in 12 (75.0%), the short gastric veins in 13 (81.3%), gastrorenal shunts in 16 (100%), the hemiazygos vein (HAZV) in 4 (25.0%), the pericardiophrenic vein (PCPV) in 9 (56.3%), and the left inferior phrenic vein in 9 patients (56.3%). Although flow direction itself cannot be determined from CT-MIP, this modality provided clear images of the inflowing and the outflowing vessels. Moreover, in one patient, short gastric veins were not seen on conventional angiographic portography images of the spleen, but were clearly revealed on CT-MIP.

CONCLUSION: We suggest that CT-MIP should be considered as a routine method for detecting and diagnosing collateral veins in patients with gastric varices scheduled for B-RTO. Furthermore, CT-MIP is more useful than endoscopy in verifying the early therapeutic effects of B-RTO.

Keywords: Gastric varices; CT-MIP; Portal hypertension