Comparative analysis of computed tomography techniques in assessing the topographic and anatomical condition of the gastric veins

Introduction. Computed tomography is the most common diagnostic method for pathological changes in the abdominal organs in institutions providing routine and emergency medical care. Computed tomography is increasingly becoming a method for assessing the condition of blood vessels, including in patients with portal hypertension, which requires assessment of the condition of the veins of the esophagus and stomach.

The purpose of the study. Determination of the optimal technique for performing computed tomography to study the gastric veins.

Materials and methods. The results of studies of 1562 patients who underwent various computed tomography techniques in medical institutions in Moscow from December 2020 to December 2023 were retrospectively assessed. The research results are archived in the unified radiological information system (RIS) in Moscow.

Results. 1051 patients were examined using the standard multiphase computed tomography technique. The topographic and anatomical characteristics of the gastric veins were determined just in 50.01% of cases due to the collapsed state of the stomach. 78 studies were carried out after taking oral contrast agents, veins were identified in 37.44% of cases. The difficulty of imaging is determined by the presence of hyperdense contrast agent in the gastric lumen. After gastric inflation with air, the results of a study of 52 patients were assessed. Positive visualization of gastric veins was obtained in 45% of patients. 381 patients underwent computed tomography with the stomach filled with water (hydro-CT). Normal veins measuring 1 or more millimeters in diameter were visualized and localized in 60.6–72.5% of patients, which is significantly better compared to the standard research method (p < 0.001).

Conclusion. Assessment of the condition of the gastric veins should be carried out using the hydro-CT technique, which significantly improves the assessment of the topographic and anatomical features of the vessels compared to the standard CT technique.

1. Klyaritskaya I.L., Moshko Y.A., Volkov A.V. et al. Modern methods of diagnosis and treatment of esophageal and gastric varices. Crimean Therapeutic Journal. 2020; 1: 5–17. (In Russian)

2. Laghi A. MDCT Protocols Whole Body and Emergencies. Springer, 2012. 253 p. eBook ISBN 978-88-470-2403-8. https://doi.org/10.1007/978-88-470-2403-8

3. Gombolevsky V.A., Kharlamov K.A., Pyatnitsky I.A. et al. Methodological recommendations No. 23. Templates for protocol descriptions of studies in the specialty “Radiology”. CT scan. M.: Moscow Department of Health, 2016. 40 p. https://thanatoradiology.ru/wp-content/uploads/2022/03/shablony_protokolov_opisaniy_issledovaniy_mrt_2016.pdf (In Russian)

4. Kitaev V.M., Kitaev S.V. Computed tomography in gastroenterology: A guide for doctors. M.: MEDpress-inform, 2019. 200 p. (In Russian)

5. Park H.S., Lee J.M., Kim S.H. et al. Three-Dimensional MDCT for Preoperative Local Staging of Gastric Cancer Using Gas and Water Distention Methods: A Retrospective Cohort Study. Am. J. Roentgenol. 2010; 195 (6): 1316–1323. https://doi.org/10.2214/AJR.10.4320

6. Amelina I.D., Shevkunov L.N., Karachun A.M. et al. Visualization of gastric cancer: computed tomographic pneumogastrography. Journal of Radiology and Nuclear Medicine. 2021; 102 (3): 155–165. https://doi.org/10.20862/0042-4676-2021-102-3-155-165 (In Russian)

7. Horton K.M., Fishman E.K. Helical CT of the stomach: evaluation with water as an oral contrast agent. Am. J. Roentgenol. 1998; 171 (5): 1373–1376. https://doi.org/10.2214/ajr.171.5.9798881

8. Wani Z.A., Bhat R.A., Bhadoria A.S. et al. Gastric varices: Classification, endoscopic and ultrasonographic management. J. Res. Med. Sci. 2015; 20 (12): 1200–1207. https://doi.org/10.4103/1735-1995.172990

9. Ivashkin V.T., Maevskaya M.V., Zharkova M.S. et al. Clinical Recommendations of the Russian Scientific Liver Society and Russian Gastroenterological Association on Diagnosis and Treatment of Liver Fibrosis, Cirrhosis and Their Complications. Russian Journal of Gastroenterology, Hepatology, Coloproctology 2021; 31 (6): 56–102. https://doi.org/10.22416/1382-4376-2021-31-6-56-102 (In Russian)

10. Willmann J.K., Weishaupt D., Böhm T. et al. Detection of submucosal gastric fundal varices with multi-detector row CT angiography. Gut. 2003; 52 (6): 886–892. https://doi.org/10.1136/gut.52.6.886

11. Svintsitskaja N.L., Sherstjuk O.A., Dejnega T.F. et al. Classical and up-to-date conceptions on bloods supply of intact human stomach. Actual problems of modern medicine: Bulletin of the Ukrainian Medical Stomatological Academy. 2009; 9 (4): 256–261. (In Russian)

12. Makovleva O.A. Macromicroscopic anatomy of the vascular bed of the walls of the stomach. Young Scientist. 2015; 11(91): 83–86. (In Russian)

13. Manukyan G.V., Shertsinger A.G., Zhigalova S.V. et al. Primary prevention of bleeding from esophageal and gastric varices in patients with portal hypertension. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2016; 21 (2): 93–104. https://doi.org/10.16931/1995-5464.2016293-104 (In Russian)

14. Khoronko Yu.V., Dmitriev A.V., Shitikov I.V. et al. Modern possibilities of endoscopic diagnosis and treatment of varicose esophageal-gastric bleeding in portal hypertension. Modern problems of science and education. 2016; 6. URL: https://science-education.ru/ru/article/view?id=25736 (date of access: 04/09/2024) (In Russian)