Value of portal venous system radiological indices in predicting esophageal varices

Abstract

IntroductionPortal hypertension results from increased resistance to portal blood flow and has the potential complications of variceal bleeding and ascites. The splenoportal veins increase in caliber with worsening portal hypertension, and partially decompress by opening a shunt with systemic circulation, ie, a varix. In the event of portosystemic shunting, there is a differential decompression across the portal vein and splenic vein (portal vein > splenic vein), with a resultant decrease in the ratio of portal vein diameter to that of splenic vein. Portal vein to splenic vein diameter ratio and gradient could be valuable tools in predicting the presence of portosystemic shunting.MethodsWe retrospectively reviewed patients with cirrhosis who underwent esophagogastroduodenoscopy (EGD) for variceal screening and had a computerized tomogram (CT) of the abdomen within 6 months of the index endoscopic study, between January 2009 and December 2013. Patients on nonselective beta blockers, patients with presinusoidal portal hypertension (portal vein thrombosis or extrinsic compression), and patients who had undergone portosystemic shunting procedures (transjugular intrahepatic portosystemic shunt [TIPS]) or balloon-occluded retrograde transvenous obliteration (BRTO) were excluded from the study. Splenic and portal vein diameters were measured (in mm) just proximal and distal to the splenomesenteric venous confluence, respectively.ResultsA total of 164 patients were included in the study; of these, 60% (n=98) were male and 40% (n=66) were female. The mean age of the study population was 58.7 years. A total of 126 patients (77%) had varices, while 38 patients (33%) did not. The mean Model for End-Stage Liver Disease (MELD) score was 5.9 for those who had varices as compared with 7.03 for those who did not. The mean of ratios of portal vein to splenic vein diameters in patients with varices was 1.27 (±0.2), while it was 1.5 (±0.23) in those without varices. This difference was statistically significant (P<0.001). The mean of the gradients between the portal vein and splenic vein diameters was 2.7 (±2) mm for patients with varices as compared with 5 (±1.8) mm in those without varices. This difference was also statistically different (P<0.001). These correlations were statistically significant even after controlling for age, sex, and MELD. These radiological indices also had statistically significant correlations with the presence of gastric varices (P=0.018 for the ratio and P=0.01 for the gradient). A discriminant function analysis was performed that generated the equation: D = 2.68 (ratio of portal vein to splenic vein diameters) + 0.187 (gradient of portal vein to splenic vein diameters, in mm) − 4.152. This equation had a very high sensitivity, of 95%, but low specificity, of 26.3%, in predicting the presence of esophageal varices.ConclusionBoth venous diameter ratio (portal vein size/splenic vein size) and venous diameter gradient in mm (portal vein size – splenic vein size) calculated from CTs of the abdomen were good ...

Identification of two distinct hereditary hemorrhagic telangiectasia patient subsets with different hepatic perfusion properties by combination of contrast-enhanced ultrasound (CEUS) with perfusion imaging quantification

“…Portal hypertension is one of the most common complications of HHT. It is associated with higher portal vein diameter [27, 28] and lower portal vein velocity [29, 30] within the liver. As showed in Figs 1–3, in the estimated high-risk group 1 the intrahepatic portal vein diameter was significantly higher, while portal vein peak velocity was significantly lower than in group 2.…”

Association of Esophageal Varices with Portal Vein Diameter More Than 13 mm in Chronic Liver Disease Patients

“…The mortality rate becomes alarmingly high in this condition and around 20% of patients develop fetal complications. 15,16 This study only included patients with portal vein diameter more significant than 13cm. Our results revealed that patients with portal vein diameter above 13 mm had a high frquency of esophageal varices.…”

“…It also carries the risk of bleeding due to manipulation, as proved by a study in 2015. 15 Only 30-40% of patients with compensated cirrhosis were found to have gastro-oesophageal varices on screening endoscopy. 19 USG may therefore be a more cost-effective and non-invasive method to routinely screen patients at high risk for the presence of varices, to reduce the increasing burden and procedure costs of endoscopy units.…”

To determine the correlation between mean platelet count and frequency of grading of esophageal varices in patients of liver cirrhosis.

“…4,6,10 These alternate procedures include Doppler USG, CT, MRI and Angiography. 11 In addition to these Platelet count is also a noninvasive parameter with high accuracy for the prediction of esophageal varices as cirrhotic pts having esophageal varices usually have a platelet count of < 100,000/cmm. 3 As a matter of fact there is quite a low chance of esophageal varices in cirrhotics having high platelet count a fact which enables us to avoid costly methods of screening such pts for esophageal varices.…”

“…15 Various risk factors for variceal hemorrhage from esophageal varices include; size, presence of red sign, child classification, alcohol intake and local changes in distal esophagus such as GERD. 11 In view of the dreadful outcome of this life threatening disease, early detection and treatment even prophylactic, is vital in improving the outcome in these patients as this will lower down the upper Gl related mortality. 17,18 For this purpose alternative noninvasive methods instead of endoscopy are now being preferably used.…”