Clinically severe portal hypertension: role of multi-detector row CT features in diagnosis.

Abstract

BACKGROUND AND AIM: To explore the CT signs which permit estimation of clinically

severe portal hypertension (PH) [>/= 12 of hepatic vein pressure gradient

(HVPG)]. METHODS: One-hundred and seven consecutive patients who underwent HVPG

measurement in the PH group and 52 controls were included. The diameters of main

portal vein (oMPV), superior mesenteric vein (oSMV), splenic vein (oSV), and left

gastric vein, oMPV/oSV, oSMV/oSV, as well as estimated spleen volumes were

evaluated on the CT scan. The grade of varix and ascites were also evaluated

semi-quantitatively. We explored the statistically significant CT features

related to severe PH and performed a logistic regression analysis for an

estimation model for severe PH. RESULTS: oMPV/oSV and oSMV/oSV tended to

gradually increase as the PH became severer, and the difference between severe

and not severe groups was statistically significant (p = 0.015 and 0.038,

respectively). According to the regression analysis, oSMV/oSV and the grade of

esophageal varix and ascites were finally included as related variables for

predicting severe PH. The odds ratio (OR) of oSMV/oSV was 4.596, and large

esophageal varix (OR 4.135) and mild (OR 3.051) and large amount of ascites (OR

21.781) were statistically significantly related to severe PH. CONCLUSION:

Changing diameters of portal system, the grades of esophageal varices and ascites

on multi-detector row computed tomography might be indicative features for

clinically severe PH.