Quantitative Liver Volumetric Parameters on Computed Tomography May Be Used for Identifying Severe Esophageal Varices and the Risk of First Variceal Hemorrhage

Abstract

Background: To assess whether the quantitative parameters of liver lobe volume (LLV) based on computed tomography (CT) can identify severity of esophageal varices (EV) and the risk of first variceal hemorrhage (FVH) in patients with liver cirrhosis. Methods: A total of 217 endoscopically confirmed EV patients were enrolled in this study and were divided into a non-conspicuous EV group (mild-to-moderate EV, n=83) and a conspicuous EV group (severe EV, n=134), a FVH group(n=17) and a non-FVH group (n=27), patients’ clinical finding were recorded. The left, right, caudate lobe volume and the corresponding functional volume (LV, RV, CV, LFV, RFV, CFV), total liver volume and the functional volume (TV, TFV) were measured respectively, and the ratio of CV/TV, CFV/TFV were calculated. Univariate and multivariate logistic analysis were used to determine the independent factors and the receiver operating characteristic(ROC) curves were performed to evaluate the diagnostic performance. Results: CV, CFV, CV/TV and CFV/TFV were significantly different in the conspicuous EV study and the FVH study (p <0.05). Multivariate analysis indicated that CV/TV and ascites were independent predictive factors for severe EV. A nomogram combing CV/TV and presence of ascites revealed a satisfactory diagnostic performance for severe EV(area under the curve (AUC)=0.853, 95%CI 0.797, 0.905). Furthermore, CV/TV and the presence of red color sign (RC) were found to be independent predictive factors for the risk of FVH, CV/TV showed a superior discriminative performance (AUC=0.851,95%CI 0.714-0.987) when compared with RC sign under endoscopy (AUC=0.779, 95%CI 0.649-0.91). Conclusions: Quantitative parameters of LLV have great potential be used as an alternative to identify EV severity and the risk of FVH. Funding Information: Not applicable. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: This study had approval from the Institutional Review Board of West China Hospital, and informed consent requirement was waved.