Diagnostic Accuracy of Multidetector Computed Tomography in Detection of Esophageal Varices

Hassan, Maria; Husen, Yousuf; Abbasi, Summar-Un-Nisa; Hussain, Zainab

doi:10.7759/cureus.3933

Cited by 8 publications

(9 citation statements)

References 18 publications

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“…Salahshour et al [26] reported 63.49% sensitivity, 81.97% specificity, and 72.58% accuracy. Hassan et al [27] reported 98% sensitivity and 100% specificity. Deng et al [28] reported 95% sensitivity and 71% specificity.…”

Section: Discussionmentioning

confidence: 98%

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Assessment of variceal bleeding in cirrhotic patients: accuracy of multi-detector computed tomography

Samy

Gamal

Othman

et al. 2022

Egypt J Radiol Nucl Med

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Background Esophageal variceal hemorrhage (EVH) has been shown to be a leading cause of mortality in patients with portal hypertension. Our purpose was to assess the utility of multi-detector computed tomography (MDCT) features in the assessment of esophageal varices (EVs) and esophageal variceal hemorrhage (EVH). This prospective study included 85 cirrhotic patients who underwent MDCT and Upper Gastrointestinal Tract (UGIT) endoscopy within 2 weeks. Four radiologists evaluated the presence of EVs and the presence and size of different collaterals. Multivariable logistic regression analysis was calculated to investigate the significant predictors influencing EV and EVH. Results Findings of EV with MDCT were the best predictor of EV or EVH. The presence (and/or size) of following collaterals had significant association with both EV and EVH: paraesophageal (p < 0.001, < 0.001), short gastric (p = 0.024, 0.010), gastric varicosities (p < 0.001, < 0.001), coronary (p < 0.001, < 0.001), and main coronary vein (MCV) (p < 0.001, = 0.011). We proposed an imaging-based model (presence of coronary collaterals, main coronary vein size > 3.5 mm, presence of short gastric collaterals, presence of gastric varicosities, size > 1.5 mm) with 97% sensitivity, 91% specificity, and 94% accuracy to predict EVs. We suggested another model (presence of paraesophageal collaterals, presence of short gastric vein (SGC), SGC size > 2.5 mm, main coronary vein size > 3.5 mm, gastric varicosities size > 1.5 mm, size of EVs > 4 mm, and Child C score) to predict EVH with 98% sensitivity, 81% specificity, and 89.5% accuracy. Inter-observer agreement was high in the detection of EVs (W. Kappa = 0.71–0.88). Conclusion MDCT is an effective modality in the diagnosis of EVs. At MDCT, the presence and/or size of various collaterals including para-esophageal, short gastric, coronary collaterals, and gastric varicosities are accurate predictors for either EVs existence or EVH. We suggested two computed tomography imaging-based models with high reproducibility and acceptable accuracy for the prediction of EV and EVH. With cirrhotic patients, we recommend that radiologists report collaterals in their daily practice.

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Section: Discussionmentioning

confidence: 98%

“…Several studies [26][27][28] assessed the accuracy of MDCT in the prediction of EVs with variable results. Salahshour et al [26] reported 63.49% sensitivity, 81.97% specificity, and 72.58% accuracy.…”

Section: Discussionmentioning

confidence: 99%

Assessment of variceal bleeding in cirrhotic patients: accuracy of multi-detector computed tomography

Samy

Gamal

Othman

et al. 2022

Egypt J Radiol Nucl Med

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“…In a prospective study, CT was found to have approximately 90% sensitivity and 50% specificity in detecting esophageal varices [14]. A recent retrospective study reported a CT sensitivity of 98.96%, specificity of 100%, and diagnostic accuracy of 98.97% for EV in patients with chronic liver disease [35]. Therefore, CT can be considered as a potential noninvasive, less expensive and more compliant EV detection method compared to the invasive endoscopic screening modality.…”

Section: Discussionmentioning

confidence: 99%

Predicting the risk of early bleeding following endoscopic variceal ligation in cirrhotic patients with computed tomography

Ryu,

Kim,

Yoon

et al. 2023

BMC Gastroenterol

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Background Life-threatening bleeding following endoscopic variceal ligation (EVL) in patients with cirrhosis rarely can occur. The present study aimed to evaluate the performance of computed tomography (CT) in predicting the risk of early bleeding following EVL in cirrhotic patients. Methods We retrospectively investigated 285 cirrhotic patients who had undergone EVL. EVL was performed for prophylaxis or acute variceal bleeding. The patients were classified into 2 groups: early bleeding (< 14 days after EVL) and non-early bleeding. We compared baseline characteristics including CT findings between the patient groups. Results Among the 285 patients who underwent EVL treatment, 19 patients (6.7%) experienced early bleeding. On average, these bleeding occurred 9.3 ± 3.5 days after the EVL, with a range of 3 to 13 days. Patients who experience early bleeding had a higher six-week bleeding-related mortality rate compared to those in the non-early bleeding group (31.6% vs. 10.2%; p = 0.014). There was a correlation between the grade of esophageal varix observed during endoscopy and the diameter of esophageal varix observed on CT (p < 0.001). The diameter of esophageal varix on CT was identified as the only significant predictive factor for early bleeding (p = 0.005). Conclusion A larger esophageal varix diameter observed on CT is associated with an increased risk of early bleeding after EVL treatment. Early identification of this high-risk group can provide a change of treatment strategies to improve patient outcomes.

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“…Multidetector CT (MDCT) has a predictive value of GEVs [76]. Hassan M et al showed MDCT displayed a diagnostic accuracy of 98.97% for EVs [77]. Contrast- enhanced CT scans displayed an AUROC of 0.835 for EV detection [78].…”

Section: The Diagnosis Of Small Varicesmentioning

confidence: 99%

Small varices in chronic liver diseases

Zhu

Cheng

Chen

et al. 2022

Current Opinion in Gastroenterology

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Purpose of reviewGastroesophageal varices are common complications of chronic liver diseases (CLDs) and portal hypertension. Small varices have the risk of progressing to larger varices, causing bleeding or even death. Thus, early detection and appropriate management of small varices are necessary. The purpose of this review is to summarize the advance in the recent 5years about diagnosing and managing the small varices in CLDs. Recent findingsThe diagnosing methods of small varices in recent studies include improved endoscopic examinations, such as capsule endoscopy, and many noninvasive methods, including blood tests, ultrasound, computed tomography and magnetic resonance. For the management of small varices, though it is controversial, prevention using nonselective beta-blockers is still an essential part.

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Diagnostic Accuracy of Multidetector Computed Tomography in Detection of Esophageal Varices

Cited by 8 publications

References 18 publications

Assessment of variceal bleeding in cirrhotic patients: accuracy of multi-detector computed tomography

Assessment of variceal bleeding in cirrhotic patients: accuracy of multi-detector computed tomography

Predicting the risk of early bleeding following endoscopic variceal ligation in cirrhotic patients with computed tomography

Small varices in chronic liver diseases

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