الفهرس 
List of contentsOnly 14 pages are availabe for public view
 |  | from | 103 |  |  |
| | | from | 103 | | |
Abstract
Multi slice CT is a very important method for the detection of collateral sites, draining routes, grading, and also the presence of portal vein thrombosis which is important in the prediction of cirrhosis complication. For this purpose, 85 patients diagnosed to have portal hypertension and suffering from liver cirrhosis were evaluated in our study by MSCT Portography. It was noticed that; age, sex and a etiology of liver cirrhosis had no effect on bleeding esophageal varices or occurrence of hepatic encephalopathy. This was consistent with Dai et al (2017) but patients with bleeding varices had insignificant older ages (Dai G, Wang H, et al 2017). Many studies in literature have identified impairment in liver morphology with disease progression, although hemodynamic changes secondary to a decline in liver function as well as to portal hypertension have not been extensively studied by using imaging methods. There have been only a few studies emphasizing that an increase in splenic artery diameter can lead to the development of splenic artery aneurysm and an increase in portal vein diameter (Liu W, Wang J,et al ,2019) One of the most widely accepted classifications for degree of disease severity in patients with liver cirrhosis is Child-Pugh classification. Variceal bleeding, hepatic encephalopathy and different complications of liver cirrhosis are obviously related to this classification. (Krige J, Spence RT,et al 2020) In the current study we revealed that mean diameter of LGV, IHRPV, IHLPV, MPV and SPV were significantly higher among patients with Child C class in comparison to those with Child A class. In line with the current study, a previous study found that diameters of portal vein system vessels in Child-Pugh grade C group are larger than those in grade A. These findings suggest that portal vein blood flow and resistance are increased when cirrhosis is aggravated, and expand blood vessels in portal vein system (Dai G, Wang H,et al 2017) The current study found that mean diameters of LGV, IHRPV, IHLPV, MPV and SPV were significantly higher among patients bleeding in comparison to those without bleeding. Although result of Dai et al (2017) was consistent with the current study, but there reported that diameter of IHRPV wasn’t different between both groups. It was reported that there was a significant correlation between the PV diameter and the number of collaterals. The increase in collateral number is associated with the decrease in PV diameter. There is a high significant correlation between the PV diameter and splenic vein diameter. The increase in PV diameter is associated with an increase in splenic vein diameter.(El-Assaly H, Metwally LIA,et al 2020) Similarly, Perri et al reported another advantage of CT is that demonstrated high sensitivity for assessment of high-risk gastric varices and in addition detected gastric varices in many patients in whom gastric varices not reported in endoscope (Perri et al,2008). Also, we found that mean diameters of these vessels were significantly higher among patients with hepatic encephalopathy in comparison to those without encephalopathy. This could be attributed to establishment of dilated portal vein and its tributaries, portal hypertension, and portal collateral circulation causes a large amount of portal venous blood to bypass the liver and flow into systemic circulation with subsequent encephalopathy (Chu Q, Li Z, et al 2004). It was previously reported that formation rate of hepatic artery-portal vein fistula is significantly different among cirrhosis patients with different HE grades, suggesting that hepatic arterioportal vein fistula may increase the risks for HE. This may be due to the reason that hepatic artery-portal vein fistula increases portal venous pressure, promotes the establishment of collateral circulation, and reduces the return of normal portal venous blood into the liver (Häussinger D et al 2013). By using ROC, cut off points of diameters of these vessels were determined for prediction of variceal bleeding in patients with liver cirrhosis. Although these vessels had great role in such issue, but LGV was the best one where it has 88.9% sensitivity and 89.3%speicifity with area under curve was 0.88 at cut of point > 0.60 cm. In agreement with the current study, it was reported that LGV has the highest sensitivity and specificity in the prediction of the occurrence of EVB when LGV diameter is greater than 0.61 cm (Dai G, et al 2017) In accordance with the current study, it was reported that measuring diameters of LGV by MSCT could be used to evaluate liver function and the degree of portal hypertension in cirrhosis patients and to predict the risk of upper gastrointestinal hemorrhage. The dilated degree of LGV and PV is positively correlated with the advancing in the stages of liver cirrhosis (HU Q,et al 2009) Out of the enrolled patients in the currents; 11(12.9%) patients had portal vein thrombosis (PVT). There was statistically significant association between hepatic encephalopathy and PVT (p value = 0.028). The present study was consistent with Dai et al (2017) that revealed patients with HE have significantly higher frequency of PVT in comparison to those without HE, suggesting that formation of portal vein embolus increases the risk for HE. PVT is a common finding in cirrhotic patients, with a 5‐year prevalence of roughly 10%. The development of PVT in cirrhotics is typically associated with portal hypertension and resultant low‐flow state through the portal circulation. In addition, rebalanced hemostasis in cirrhotic patients frequently leads to hypercoagulability, primarily as a result of decreased circulating levels of the anticoagulant factors antithrombin III and proteins C and S (Cool J, et al 2019).Generally, prevalence of PVT among patients with liver cirrhosis wasn’t well studied. Its incidence in previous study ranged between 5 and 175 of cases with liver cirrhosis (Agrawal S, et al 2013). Also, Dai et al (2017) reported that single esophageal and gastric varices, and paraesophageal varices are not correlated with HE, but the combination of hepatic artery-portal vein fistula or portal vein embolus suggests the occurrence or aggravation of HE. This results were consistent that of Che et al (2004). It was reported that simple esophageal varices, gastric varices and Para esophageal varices would not induce severe encephalopathy. However, the portal vein emboli, or hepatic artery-portal vein fistula, or wide portal vein-vena cava shunt, particularly the dilated left renal vein and Para gallbladder varices, which may hint encephalopathy, would occur or deteriorate (Chu Q, Li Z, et al 2004). In conclusion, MSCT clearly displays vessels with collateral circulation induced by portal hypertension in cirrhosis. The diameters of main portal vein and its branches are of predictive value for EVB, and LGV is a sensitive indicator for predicting EVB. MSCTP can be used to evaluate the risks for EVB and improves preventive effect. In addition, MSCT shows the severity of hepatic cirrhosis and predicts the risks for hepatic encephalopathy. *Limitation of the study: The main limitation of our study was the small size of the study sample. This study evaluated CT correlation only to child Pugh scoring system, which need a reference standard as biopsy. Although correlation with clinical outcomes (e.g., prediction of variceal bleeding) based on CT grading would have been useful, this was not possible because patients were appropriately treated based on concurrent endoscopic findings. CT portography has no significant guiding value in the occurrence risk of HE. CT portography has no significant guiding value in the occurrence risk of HE.
• Severity of liver cirrhosis is clinically determined using the Child-Pugh classification. Radiologic evaluation is an important part of clinical follow-up in patients with chronic liver disease and its complications.
• Esophageal variceal bleeding (EVB) and hepatic encephalopathy (HE) are serious complications of hepatic cirrhosis, and they may lead to high mortality rate and severely threaten life quality of the patients.
• MSCTP grading has consistent grading of cirrhosis severity with child Pugh grading.
• The diameters of main portal vein and its branches are of predictive value for EVB, and LGV is a sensitive indicator for predicting EVB.
• MSCTP can be used to evaluate the risks for EVB and improves preventive effect.
• simple esophageal varices, gastric varices and Para esophageal varices would not induce severe encephalopathy
• PVT is a common finding in cirrhotic patients, with a 5‐year prevalence of roughly 10%
• Formation of portal vein embolus increases the risk for HE.
MSCT shows the severity of hepatic cirrhosis and predicts the risks for hepatic encephalopathy