Dynamic CT of portal hypertensive gastropathy: significance of transient gastric perfusion defect sign

Kim, T.U.; Kim, S.; Woo, S.K.; Lee, J.W.; Lee, T.H.; Jeong, Y.J.; Heo, J.

doi:10.1016/j.crad.2008.02.003

« Previous Next »Clinical Radiology
Volume 63, Issue 7 , Pages 783-790, July 2008

Dynamic CT of portal hypertensive gastropathy: significance of transient gastric perfusion defect sign

T.U. Kim
- Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, Busan 602-739, Republic of Korea
S. Kim
- Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, Busan 602-739, Republic of Korea
- Guarantor and correspondent: S. Kim, Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine, #1-10, Ami-Dong, Seo-gu, Busan 602-739, Republic of Korea. Tel.: +82 51 240 7354; fax: +82 51 240 7534.
S.K. Woo
- Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, Busan 602-739, Republic of Korea
J.W. Lee
- Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, Busan 602-739, Republic of Korea
T.H. Lee
- Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, Busan 602-739, Republic of Korea
Y.J. Jeong
- Department of Diagnostic Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, Busan 602-739, Republic of Korea
J. Heo
- Department of Gastrointestinal Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, Busan 602-739, Republic of Korea

Received 19 November 2007; received in revised form 30 January 2008; accepted 11 February 2008.

Aim

To evaluate the “transient gastric perfusion defect” sign as a way of diagnosing portal hypertensive gastropathy (PHG) on multidetector computed tomography (CT).

Materials and methods

Ninety-two consecutive patients with cirrhosis underwent three-phase CT and endoscopy. Endoscopy was performed within 3 days of the CT examination. As controls, 92 patients without clinical evidence of chronic liver diseases who underwent CT and endoscopy were enrolled; the findings at endoscopy were used as a reference standard for patients with PHG. Two radiologists who were unaware of the results of the endoscopy retrospectively interpreted the CT images. PHG was diagnosed on dynamic CT if the transient gastric perfusion defect sign was present. The transient gastric perfusion defect was defined as the presence of transient, segmental or subsegmental hypo-attenuating mucosa in the fundus or body of the stomach on hepatic arterial imaging that returned to normal attenuation on portal venous or equilibrium-phase imaging. The frequency of the transient gastric perfusion defect sign was compared between these two groups using Fisher's exact test. The frequency, sensitivity, specificity, positive predictive values, and negative predictive values of the transient gastric perfusion defect sign were also compared between patients with PHG and without PHG in the cirrhosis group.

Results

Nine patients of 92 patients with cirrhosis were excluded because of previous procedure or motion artifact; the remaining 83 patients with cirrhosis were evaluated. In the cirrhosis group, 40 (48.1%) of 83 patients showed the transient gastric perfusion defect sign. In the control group, none of the 92 patients showed the transient gastric perfusion defect sign. In the cirrhotic group, the frequency of the transient gastric perfusion defect sign was significantly higher in the patients with PHG (75%, 36/48) than in patients without PHG (11.4%, 4/35). The sensitivity, specificity, positive predictive values, and negative predictive values of the sign for CT diagnosis of PHG in the cirrhosis group were 75, 88.6, 90, and 72.1% respectively.