Computed tomography predictors of gastroesophageal varices in cirrhotic patients: the added value of portosystemic collaterals

Abstract

BackgroundDetection of ‘spontaneous’ portosystemic collateral veins (PSCV) serves as an important tool in diagnosing portal hypertension (PTHN) and predicting prognosis. Multidetector computed tomography (MDCT) imaging is noninvasive and allows accurate assessment of variceal site and size. So, this study was conducted to assess the role of MDCT in predicting, detecting and grading gastroesophageal varices in correlation with endoscopy in cirrhotic patients in relation to other portosystemic collaterals.MethodsAnalytical cross-sectional prospective study was conducted on 100 cirrhotic patients. All patients were subjected to history taking, upper gastrointestinal endoscopic assessment, and triphasic CT or contrast-enhanced CT assessment of abdomen and pelvis.ResultsPatients who had esophageal varices in MDCT show a statistically significant difference (p = 0.016) with its endoscopic grading. There was good agreement between endoscopy and MDCT in diagnosing grade of esophageal varices as k = 0.882. The presence of ascites, splenic size, and esophageal vein diameter serve as clinically significant predictors of esophageal varices. Splenic size showed a significant difference according to endoscopic grades of EV (esophageal varices) as p = 0.031 as patients with no varices had splenic size of (15.9 ± 1.4) cm, patients with grade I had a mean splenic size of (15.2 ± 8.7) cm, patients with grade II had mean splenic size of (16.9 ± 1.8) cm and patients with grade III had mean splenic size of (18 ± 4.2) cm, while other veins diameters showed increase with advanced grades of EV but with statistically insignificant differences as p > 0.05.ConclusionsMultidetector CT features of the presence of PSCVs, splenic size, and ascites are accurate predictors of PTHN in either EVs presence or absence. MDCT can be an excellent alternative for patients who are contraindicated for endoscopy. Moreover, it can be potential screening tool for early detection of esophageal varices in very early stage of chronic liver disease and in the early care of patient with varices. MDCT remains the most applicable noninvasive diagnostic tool for patients with portosystemic collaterals.