The Potential of Transabdominal 3D Color Doppler Ultrasonography for Diagnosis of Gastric Varices

Abstract

To examine the potential of transabdominal 3-dimensional (3D) color Doppler ultrasonography (3D-US) as a noninvasive tool to characterize gastric varices. This was a prospective study in which endoscopy was performed on 107 patients with chronic liver disease. Among these patients, 70 (42 males, 28 females) had gastric varices (46 fundal varices, 24 cardia varices; 30 small, 28 medium, and 12 large), and the 37 patients (25 males, 12 females) without gastric varices served as controls. The 3D-US data and endoscopic findings were compared with respect to grade, location, and similarity of varices. The sensitivity and specificity of the 3D-US technique to detect gastric varices were 88.6% (62/70) and 100% (37/37), respectively. Although all fundal varices appeared adjacent to the posterior gastric wall, cardia varices were detected separately from the wall with a mean distance of 21.2 mm. The vascular volumes (mL) were 0.84±0.71 in small varices, 5.52±3.81 in medium varices, and 10.9±6.3 in large varices, with significant differences between different grades. The best cutoff value to detect medium-grade/large-grade gastric varices was 2.0 mL, with 83.3% sensitivity and 95.8% specificity. Seventy-nine percent (55/70) of patients showed partial resemblance or better between the 3D images and the endoscopic findings with good interreviewer agreement. 3D-US can quantitatively characterize gastric varices noninvasively in terms of grade, location, and appearance. This approach has the potential to improve objectivity and reduce invasiveness in the management of gastric varices.