Esophageal varices in patients with cirrhosis: multidetector CT esophagography--comparison with endoscopy

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Kim, Se Hyung; Kim, Yoon Jun; Lee, Jeong Min; Choi, Kee Don; Chung, Young Jin; Han, Joon Koo; Lee, Jae Young; Lee, Min Woo; Han, Chang Jin; Choi, Joon Il; Shin, Kyung-Sook; Choi, Byung Ihn
Issue Date
Radiological Society of North America
Radiology 2007;242:759-768
AdultAgedEsophageal and Gastric Varices/*diagnosis/*etiologyEsophagoscopy/*methodsFemaleHumansLiver Cirrhosis/*complications/*diagnosisMaleMiddle AgedReproducibility of ResultsSensitivity and SpecificityTomography, X-Ray Computed/instrumentation/*methods
PURPOSE: To evaluate the use of multidetector computed tomographic (CT) esophagography to grade esophageal varices and differentiate between varices at low risk and those at high risk for bleeding, with endoscopy as the reference standard. MATERIALS AND METHODS: This study was approved by the institutional review board; all subjects gave informed consent. Ninety patients with cirrhosis (65 men, 25 women; mean age, 54.8 years; range, 21-77 years) were prospectively enrolled and underwent endoscopy and CT esophagography. Esophageal varices were graded independently at endoscopy by two endoscopists. CT esophagograms were interpreted retrospectively with a four-point scale by two radiologists blinded to other findings. Interobserver agreement between each radiologist and endoscopist was determined; endoscopic and CT esophagographic grades of esophageal varices were correlated. Radiologist performance for differentiation between low- and high-risk varices for bleeding on the basis of morphology at endoscopy was evaluated with receiver operating characteristic analysis. Patients were interviewed to determine acceptance at both examinations. RESULTS: Thirty-seven of 90 patients had grade 0, 23 had grade 1, 18 had grade 2, and 12 had grade 3 esophageal varices. Thus, 60 patients were determined to be in a low-risk group and 30 in a high-risk group for variceal bleeding at endoscopy. There was almost perfect agreement in grading esophageal varices between endoscopists. There was close correlation (P < .001) and substantial agreement between endoscopic and CT esophagographic grades. Radiologist performance for differentiating between low- and high-risk varices was 0.931-0.958 (area under receiver operating characteristic curve). Patient interview results revealed that CT esophagography had better acceptance than did endoscopy (P < .001). CONCLUSION: Use of CT esophagography allows grading of esophageal varices and differentiation between low- and high-risk varices and shows better patient acceptance than does endoscopy.
0033-8419 (Print)
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Radiation Applied Life Science (대학원 협동과정 방사선응용생명과학전공)Journal Papers (저널논문_방사선응용생명과학)
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