CT esophagography: Non invasive screening and grading of esophageal varices in cirrhosis

Abstract

PurposeTo evaluate the role of CT esophagography in the detection of esophageal varices (OV) and the differentiation of the varices at low risk and those at high risk of bleeding as compared to upper endoscopy. Patients and methodsThis study included 54 consecutive patients with liver cirrhosis. Patients with active or previous variceal bleeding, or with history of previous variceal ligation or injection were excluded. OV were best visualized on axial multidetector-CT (MD-CT) images in the post-contrast portal venous (PV) phase. No oral contrast media or air insufflation was used for esophageal lumen delineation. Four-point confidence scale (scores 1–4) was used to determine the grading of OV by CT scan: A diameter threshold of ⩾2mm was used for discrimination between high-risk (score 3 or 4) and low-risk varices (score 2). Score 1 indicated no varices. Upper endoscopy was the reference standard. ResultsThe patients with cirrhosis were 40 males (74%) and 14 females (26%). Their mean age was 56.84±7.52years. They were classified according to the CT findings into group I: 6 patients with no esophageal varices (11.1%), group II: 32 patients with low risk varices (59.3%), and group III: 16 patients with high risk varices (29.6%). The overall CT sensitivity for detection of OV was 96%, specificity 100%, positive predictive value 100% and negative predictive value 66.67%. The CT sensitivity for the high risk OV cases (100%) was higher than that for those with low risk OV (94.12%). There was no significant statistical difference in the distribution of age, sex and extra-esophageal CT findings between the low and high risk OV cases (P-value >0.05). ConclusionMD-CT esophagography is a good alternative non invasive diagnostic tool to conventional upper GI endoscopy for screening (high sensitivity) and grading of esophageal varices in cirrhosis. The diagnosis of other portal hypertension stigmata does not help in discrimination between the low risk and high risk varices. The use of abdominal triphasic CT scan as an initial full imaging method of cirrhosis is of higher cost-benefit than that of upper endoscopy for screening of esophageal varices.