Abstract
ObjectiveTo determine the diagnostic accuracy of multidetector computed tomography (MDCT) in the detection of esophageal varices by taking endoscopy as the reference standard.Materials and methodsThis was a cross-sectional prospective study conducted at the Department of Radiology, Aga Khan University Hospital, (AKUH) Karachi, for the duration of 12 months from August 1, 2014 to July 31, 2015. One hundred ninety-six patients with a suspicion of chronic liver disease/cirrhosis undergoing 64 slice MDCT were enrolled in our study and underwent computed tomography (CT) scanning in the Department of Radiology at AKUH. Biphasic CT was performed with images obtained during the hepatic arterial phase (30-second delay) and the portal venous phase (65-second delay) after the intravenous (IV) injection of 120 mL of nonionic contrast material at a rate of 3.5 mL/s. The presence of esophageal varices was evaluated on MDCT with endoscopy as gold standard. The sensitivity, specificity, negative predictive value and positive predictive value, and accuracy of MDCT were assessed against the gold standard.ResultsOur results yielded an MDCT sensitivity of 98.96%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 66.67%, and diagnostic accuracy of 98.97% for esophageal varices in chronic liver disease (CLD) patients.ConclusionThe rate of detection of esophageal varices in patients with chronic liver disease on MDCT in our country is comparable to the international data and we advocate that MDCT should be used as a screening tool in patients with chronic liver disease to exclude esophageal varices.
Highlights
Chronic liver disease and cirrhosis is a worldwide disease accountable for significant morbidity and mortality [1]
One hundred ninety-six patients with a suspicion of chronic liver disease/cirrhosis undergoing 64 slice multidetector computed tomography (MDCT) were enrolled in our study and underwent computed tomography (CT) scanning in the Department of Radiology at AKUH
Our results yielded an MDCT sensitivity of 98.96%, specificity of 100%, positive predictive value (PPV) of 100%, negative predictive value (NPV) of 66.67%, and diagnostic accuracy of 98.97% for esophageal varices in chronic liver disease (CLD) patients
Summary
Chronic liver disease and cirrhosis is a worldwide disease accountable for significant morbidity and mortality [1]. In Pakistan, its incidence is on the rise mostly due to chronic hepatitis B and C infections, the prevalence of which is reported to be up to 4.3% and 4.7%, respectively [2,3,4] During their entire lifetime, at least 50% of cirrhotic patients develop esophageal varices [5]. Lifethreatening upper gastrointestinal (UGI) bleeding due to the esophageal varices and as a complication of portal hypertension develops in about 30%–40% of cirrhotic patients. These patients have a 10%–30% risk of variceal haemorrhage per year leading to increased morbidity and mortality with a mortality rate of 20%– 35% at their first bleeding episode [6,7]. Prophylactic endoscopic and medical interventions are offered to these patients so that the associated morbidity and mortality can be reduced [7]
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