Standardization of MIP Technique in Three-dimensional CT Portography: Usefulness in Evaluation of Portosystemic Collaterals in Cirrhotic Patients.
10.3348/jkrs.2003.49.2.99
- Author:
Jong Gi KIM
1
;
Yong KIM
;
Chang Won KIM
;
Jun Woo LEE
;
Suk Hong LEE
Author Information
1. Department of Diagnostic Radiology, College of Medicine, Pusan National University. jwlee@pusan.ac.kr
- Publication Type:Original Article
- Keywords:
Portography;
Liver, cirrhosis;
Computed tomography (CT), maximum intensity projection;
Shunts, portosystemic
- MeSH:
Axis, Cervical Vertebra;
Bias (Epidemiology);
Consensus;
Dilatation;
Esophageal and Gastric Varices;
Esophagus;
Gastric Fundus;
Humans;
Liver;
Liver Diseases;
Portasystemic Shunt, Surgical;
Portography*;
Renal Veins;
Tomography, Spiral Computed;
Varicose Veins;
Veins
- From:Journal of the Korean Radiological Society
2003;49(2):99-105
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: To assess the usefulness of three-dimensional CT portography using a standardized maximum intensity projection (MIP) technique for the evaluation of portosystemic collaterals in cirrhotic patients. MATERIALS AND METHODS: In 25 cirrhotic patients with portosystemic collaterals, three-phase CT using a multidetector-row helical CT scanner was performed to evaluate liver disease. Late arterial-phase images were transferred to an Advantage Windows 3.1 workstation (Gener Electric). Axial images were reconstructed by means of three-dimensional CT portography, using both a standardized and a non-standardized MIP technique, and the respective reconstruction times were determined. Three-dimensional CT portography with the standardized technique involved eight planes, namely the spleno-portal confluence axis (coronal, lordotic coronal, lordotic coronal RAO 30 degree, and lordotic coronal LAO 30 degree), the left renal vein axis (lordotic coronal), and axial MIP images (lower esophagus level, gastric fundus level and splenic hilum). The eight MIP images obtained in each case were interpreted by two radiologists, who reached a consensus in their evaluation. The portosystemic collaterals evaluated were as follows: left gastric vein dilatation; esophageal, paraesophageal, gastric, and splenic varix; paraumbilical vein dilatation; gastro-renal, spleno-renal, and gastrospleno-renal shunt; mesenteric, retroperitoneal, and omental collaterals. RESULTS: The average reconstruction time using the non-standardized MIP technique was 11 minutes 23 seconds, and with the standardized technique, the time was 6 minutes 5 seconds. Three-dimensional CT portography with the standardized technique demonstrated left gastric vein dilatation (n=25), esophageal varix (n=18), paraesophageal varix (n=13), gastric varix (n=4), splenic varix (n=4), paraumbilical vein dilatation (n=4), gastro-renal shunt (n=3), spleno-renal shunt (n=3), and gastro-spleno-renal shunt (n=1). Using three-dimensional CT portography and the non-standardized MIP technique, the portosystemic collaterals demonstrated were similar to those demonstrated using the standardized technique. Additionally, howerer, the former revealed features not revealed by the latter, namely splenic varix (n=1), mesenteric collaterals (n=4), retroperitoneal collaterals (n=3), and omental collaterals (n=2). CONCLUSION: In patients with liver desease, three-dimensional CT portography using a standardized of MIP technique helps evaluate portosystemic collaterals, reduces interobserver bias, and saves reconstruction time.
