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Gastric varices in patients with portal hypertension: evaluation with multidetector row CT
Kangshun Zhu1, Xiaochun Meng, Pengfei Pang
1Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, Guangdong Province, China.
Insights
Multidetector row computed tomography (MDCT) effectively detects gastric varices (GVs) in cirrhosis patients. This imaging tool aids in differentiating large GVs and understanding variceal hemodynamics for better patient management.
Area of Science:
- Radiology
- Gastroenterology
- Medical Imaging
Background:
- Gastric varices (GVs) are a significant cause of gastrointestinal bleeding in patients with portal hypertension.
- Few studies have utilized multidetector row computed tomography (MDCT) for evaluating GVs.
Purpose of the Study:
- To evaluate the diagnostic performance of MDCT in identifying GVs.
- To assess MDCT's ability to reveal hemodynamic changes in varices among cirrhotic patients.
Main Methods:
- Retrospective analysis of 127 cirrhotic patients who underwent both liver MDCT and esophagogastroduodenoscopy (EGD).
- Two radiologists independently reviewed MDCT images for GV detection and assessed hemodynamic changes via MDCT portography.
Main Results:
- MDCT showed moderate agreement with EGD for GV detection and grading (kappa: 0.514–0.563).
- Substantial agreement was found for differentiating large GVs requiring therapy (kappa: 0.796–0.804).
- MDCT demonstrated high sensitivity and specificity for identifying large GVs and evaluating afferent/efferent veins (>80%).
Conclusions:
- MDCT serves as an effective screening tool for differentiating large gastric varices in cirrhotic patients.
- MDCT accurately visualizes the afferent and efferent veins of varices, aiding in treatment decisions.
Background:
Gastric varices (GVs) are a major cause of gastrointestinal bleeding in patients with portal hypertension. Few studies have evaluated GVs with multidetector row computed tomography (MDCT).
Goals:
To assess the diagnostic performance of MDCT in detecting GVs and revealing variceal hemodynamic changes in patients with cirrhosis.
Study:
A total of 127 consecutive cirrhotic patients who underwent both liver MDCT and esophagogastroduodenoscopy (EGD) were analyzed retrospectively. Two independent radiologists reviewed MDCT images for the detection of GVs. The variceal hemodynamic changes were assessed by the 2 radiologists in consensus on MDCT portography.
Results:
On the basis of EGD, of the 127 patients, 36 had GVs (28.4%), including small GVs in 15 patients and large GVs (>or=5 mm) in 21 patients. In detecting and grading GVs, there were moderate agreements (kappa value: 0.514 to 0.563) between MDCT and EGD, but in differentiating large varices requiring prophylactic therapy, a substantial agreement (kappa value: 0.804 for radiologist 1 and 0.796 for radiologist 2) was found. For radiologist 1, the sensitivity, specificity, accuracy, and positive and negative predictive values of MDCT for the identification of large GVs were 85.7%, 96.2%, 94.5%, 81.8%, and 97.1%, respectively; whereas for radiologist 2, they were 81.0%, 97.2%, 94.5%, 85.0%, and 96.3%, respectively. In evaluating the afferent and efferent veins of varices, the sensitivity, specificity, accuracy, and positive predictive value of MDCT portography were more than 80.0%.
Conclusions:
MDCT is an effective screening tool for differentiating large GVs and revealing the afferent and efferent veins of varices in patients with cirrhosis.
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