Abstract
The assessment of hemodynamism is important for determining the best strategy for treatment of esophageal varices. We have been using invasive angiography for this purpose. We, however, recently introduce less invasive methods including endoscopic ultrasonography (EUS), magnetic resonance angiography (MRA), and multidetector-row CT (MD-CT). While three-dimensional CT (3D-CT) has been shown to be useful in the assessment of portal hemodynamics, particularly of gastric varices, hemodynamics of esophageal varices cannot be clearly imaged by this method because of potential overlapping of lung and heart images. We describe herein the improved construction of 3D-CT images of esophageal varices in 2 cases by volume rendering (VR) after analyzing detailed hemodynamics using MD-CT with the maximum intensity projection (MIP). We first highlight images of esophageal varices, then accentuate those of extraesophago-gastric collateral veins, and lastly superimpose these images on VR images. These procedures clearly visualize both esophageal varices feeding veins and perforating veins. Thus, innovated 3D-CT of esophageal varices is useful for evaluating portal hemodynamics.
