Computed Tomographic Portography with Esophageal Variceal Measurements in the Evaluation of Esophageal Variceal Severity and Assessment of Esophageal Variceal Volume Efficacy

Shang Wan; Yi Wei; Haopeng Yu; Yawen Li; Shan Yao; Bin Song

doi:10.1016/j.acra.2019.05.015

Computed Tomographic Portography with Esophageal Variceal Measurements in the Evaluation of Esophageal Variceal Severity and Assessment of Esophageal Variceal Volume Efficacy

Acad Radiol. 2020 Apr;27(4):528-535. doi: 10.1016/j.acra.2019.05.015. Epub 2019 Jul 11.

Authors

Shang Wan¹, Yi Wei¹, Haopeng Yu¹, Yawen Li², Shan Yao¹, Bin Song³

Affiliations

¹ Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province 610000, China.
² West China School of Public Health, West China Forth Hospital, Sichuan University, Chengdu, Sichuan Province, China.
³ Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province 610000, China. Electronic address: songlab_radiology@163.com.

PMID: 31303576
DOI: 10.1016/j.acra.2019.05.015

Abstract

Rationale and objectives: The aim of our study is to evaluate the severity of esophageal varices (EV), based on the computed tomographic portography (CTP) measurement of EV in the distal esophagus and to assess the prediction value of EV volume.

Patients and methods: A total of 53 EV patients examined by CTP within 4 weeks of upper endoscopy were evaluated, the patients were divided into a nonconspicuous EV group (mild-to-moderate EV, n = 28) and a conspicuous EV group (severe EV, n = 25) according to endoscopy results. The diameter, cross-sectional surface area (CSA), and volume of EV were measured independently using 3D-slicer (Boston) by two experienced abdominal radiologists blinded to endoscopy findings. The averaged values measured by the two observers were used in the final dataset, these indicators' predictive performances were studied by using receiver operating characteristic curve analysis, and the area under the curve (A_z) and the cutoff values were calculated to distinguish mild-to-moderate from severe EV.

Results: The A_z values of volume, diameter and CSA in differentiating severe EV were 0.817, 0.794, and 0.784 for observer-1, corresponding values for observer-2 were 0.796, 0.774, and 0.707, there was almost perfect interobserver agreement for all measurements. All indices were larger in the conspicuous group than the nonconspicuous group in both observers (p ≤ 0.01). In the final dataset, application of a 654.0-mm³-volume criterion yielded sensitivity, specificity of 96%, 50%, application of a 5.2-mm-diameter criterion yielded sensitivity, specificity of 80%, 75%, and application of a 68.6-mm²-CSA criterion yielded sensitivity, specificity of 52%, 93%.

Conclusion: The volume of EV could be used as a new effective indictor for evaluating EV, and use of volume, diameter, and CSA of EV based on CTP allows discrimination between mild-to-moderate and severe EV in cirrhotic patients.

Keywords: Esophageal varices; computed tomographic portography; endoscopy; receiver operating characteristic curve (ROC) analysis; volume.

MeSH terms

Cross-Sectional Studies
Esophageal and Gastric Varices* / diagnostic imaging
Humans
Liver Cirrhosis / complications
Liver Cirrhosis / diagnostic imaging
Portography*
Predictive Value of Tests
ROC Curve