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Noninvasive evaluation of esophageal varices in cirrhotic patients based on spleen hemodynamics: a dual-energy CT study

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate noninvasively the severity of esophageal varices (EV) in cirrhotic patients using splenic hemodynamics obtained with dual-energy CT.

Methods

We retrospectively analyzed 72 cirrhotic patients with EV between December 2018 and June 2019. Patients were divided into three groups: mild (EV1), medium (EV2), or severe (EV3) EV groups based on severity of EV assessed by endoscopy. An additional control group included 20 patients with normal liver CT. All patients underwent contrast-enhanced dual-energy CT. The iodine weight in spleen (IW-S) was calculated as IW-S = IC-S (iodine concentration in spleen) × V-S (spleen volume). Differences between EV and control groups were analyzed using one-way analysis of variance with Welch’s correction. Games-Howell test made further pairwise comparison. The diagnostic value of IW-S on high-risk EV (EV2, EV3, or EV1 with red color sign) was evaluated using the ROC curve. p < 0.05 indicated statistical significance.

Results

The overall difference of IW-S between the control and EV groups was statistically significant (p < 0.001). Patients with more severe EV had higher IW-S values. Pairwise comparisons showed that except for control vs. EV1 groups, the IW-S between any other two groups was significantly different (p < 0.05). With a cutoff value at 1087 mg, the AUC for using IW-S for the detection of high-risk EV was 0.87 (95% CI 0.77~0.94). Sensitivity and specificity were 84.9% and 84.2%, respectively.

Conclusion

IW-S obtained with dual-energy CT can noninvasively predict EV severity.

Key Points

• A higher iodine weight in spleen (IW-S) was observed in case of severe esophageal varices.

• Cirrhotic patients have significantly higher IW-S than normal-liver patients.

• IW-S in dual-energy CT maybe used to evaluate the severity of EV.

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Abbreviations

EV:

Esophageal varices

EVB:

Esophageal varices bleeding

IC-S:

Iodine concentration in spleen

IW-S:

Iodine weight in spleen

V-S:

Volume of spleen

References

  1. Kovalak M, Lake J, Mattek N, Eisen G, Lieberman D, Zaman A (2007) Endoscopic screening for varices in cirrhotic patients: data from a national endoscopic data-base. Gastrointest Endosc 65:82–88

    Article  Google Scholar 

  2. Reverter E, Tandon P, Augustin S et al (2014) A MELD-based model to determine risk of mortality among patients with acute variceal bleeding. Gastroenterology 146:412–419.e3

    Article  Google Scholar 

  3. Fortune BE, Garcia-Tsao G, Ciarleglio M et al (2017) Child-Turcotte-Pugh class is best at stratifying risk in variceal hemorrhage: analysis of a US multicenter prospective study. J Clin Gastroenterol 51:446–453

    Article  Google Scholar 

  4. D’Amico G (2004) Esophageal varices: from appearance to rupture; natural history and prognostic indicators. In: Groszmann RJ, Bosch J (eds) Portal hypertension in the 21st century. Springer, Dordrecht

    Google Scholar 

  5. García-Pagán JC, Gracia-Sancho J, Bosch J (2012) Functional aspects on the pathophysiology of portal hypertension in cirrhosis. J Hepatol 57:458–461

    Article  Google Scholar 

  6. Kayacetin E, Efe D, Doğan C (2004) Portal and splenic hemodynamics in cirrhotic patients: relationship between esophageal variceal bleeding and the severity of hepatic failure. J Gastroenterol 39:661–667

    Article  Google Scholar 

  7. de Franchis R, Baveno VI Faculty (2015) Expanding consensus in portal hypertension: report of the Baveno VI Consensus Workshop: stratifying risk and individualizing care for portal hypertension. J Hepatol 63:743–752

    Article  Google Scholar 

  8. Stankovic Z, Csatari Z, Deibert P et al (2012) Normal and altered three-dimensional portal venous hemodynamics in patients with liver cirrhosis. Radiology 262:862–873

    Article  Google Scholar 

  9. Abe H, Midorikawa Y, Matsumoto N et al (2019) Prediction of esophageal varices by liver and spleen MR elastography. Eur Radiol 29:6611

    Article  Google Scholar 

  10. Bannas P, Roldán-Alzate A, Johnson KM et al (2016) Longitudinal monitoring of hepatic blood flow before and after TIPS by using 4D-flow MR imaging. Radiology 281:574–582

    Article  Google Scholar 

  11. Stankovic Z (2016) Four-dimensional flow magnetic resonance imaging in cirrhosis. World J Gastroenterol 22:89–102

    Article  CAS  Google Scholar 

  12. Hassan M, Husen Y, Abbasi SU, Hussain Z (2019) Diagnostic accuracy of multidetector computed tomography in detection of esophageal varices. Cureus 11:e3933

    PubMed  PubMed Central  Google Scholar 

  13. Feng LM, Lei SJ, Zeng X et al (2017) The evaluation of non-invasive multi-slice spiral computed tomography-based indices for the diagnosis and prognosis prediction of liver cirrhosis. J Dig Dis 18:472–479

    Article  Google Scholar 

  14. Dong J, He F, Wang L et al (2018) Iodine density changes in hepatic and splenic parenchyma in liver cirrhosis with dual energy CT (DECT): a preliminary study. Acad Radiol 26:872–877

    Article  Google Scholar 

  15. Tajiri T, Yoshida H, Obara K et al (2010) General rules for recording endoscopic findings of esophagogastric varices (2nd edition). Dig Endosc 22:1–9

    Article  Google Scholar 

  16. Morishita N, Hiramatsu N, Oze T et al (2014) Liver stiffness measurement by acoustic radiation force impulse is useful in predicting the presence of esophageal varices or high-risk esophageal varices among patients with HCV-related cirrhosis. J Gastroenterol 49:1175–1182

    Article  Google Scholar 

  17. Gaduputi V, Patel H, Sakam S et al (2015) Value of portal venous system radiological indices in predicting esophageal varices. Clin Exp Gastroenterol 8:89–93

    Article  Google Scholar 

  18. Keller EJ, Kulik L, Stankovic Z et al (2017) JOURNAL CLUB: four-dimensional flow MRI-based splenic flow index for predicting cirrhosis-associated hypersplenism. AJR Am J Roentgenol 209:46–54

    Article  Google Scholar 

  19. Talakić E, Schaffellner S, Kniepeiss et al (2017) CT perfusion imaging of the liver and the spleen in patients with cirrhosis: is there a correlation between perfusion and portal venous hypertension? Eur Radiol 27:4173–4180

    Article  Google Scholar 

  20. Garcia-Tsao G, Groszmann RJ, Fisher RL, Conn HO, Atterbury CE, Glickman M (1985) Portal pressure, presence of gastroesophageal varices and variceal bleeding. Hepatology 5:419–424

    Article  CAS  Google Scholar 

  21. Mendonca PR, Lamb P, Sahani DV (2014) A flexible method for multi-material decomposition of dual-energy CT images. IEEE Trans Med Imaging 33:99–116

    Article  Google Scholar 

  22. Mulé S, Pigneur F, Quelever R et al (2018) Can dual-energy CT replace perfusion CT for the functional evaluation of advanced hepatocellular carcinoma? Eur Radiol 28:1977–1985

    Article  Google Scholar 

  23. Iwakiri Y (2014) Pathophysiology of portal hypertension. Clin Liver Dis 18:281–291

    Article  Google Scholar 

  24. Tsubaki T, Sato S, Fujikawa H et al (2007) Values of Doppler sonography predicts high risk variceal bleeding in patients with viral cirrhosis. Hepatogastroenterology 2007(54):96–99

    Google Scholar 

  25. Yin XY, Lu MD, Huang JF, Xie XY, Liang LJ (2001) Color Doppler velocity profile assessment of portal hemodynamics in cirrhotic patients with portal hypertension: correlation with esophageal variceal bleeding. J Clin Ultrasound 29:7–13

    Article  CAS  Google Scholar 

  26. Nelson RC, Sherbourne GM, Spencer HB, Chezmar JL (1993) Splenic venous flow exceeding portal venous flow at Doppler sonography: relationship to portosystemic varices. AJR Am J Roentgenol 161:563–567

    Article  CAS  Google Scholar 

  27. Karatzas A, Triantos C, Kalafateli M et al (2016) Multidetector computed tomography versus platelet/spleen diameter ratio as methods for the detection of gastroesophageal varices. Ann Gastroenterol 29:71–78

    PubMed  PubMed Central  Google Scholar 

  28. Mileto A, Barina A, Marin D et al (2016) Virtual monochromatic images from dual-energy multidetector CT: variance in CT numbers from the same lesion between single-source projection-based and dual-source image-based implementations. Radiology 279:269–277

    Article  Google Scholar 

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Acknowledgments

The authors wish to thank Dr. Jianying Li for his technical support.

Funding

This work was supported by a grant from the Beijing Natural Science Foundation (No. 7192042), in the collection and analysis of data.

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Author notes

  1. Xinjun Han and Weimin An contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China

    Xinjun Han, Qiuting Cao, Shufan Shang & Liqin Zhao

  2. Department of Radiology, The Fifth Medical Center of PLA General Hospital, Beijing, 100039, China

    Weimin An & Changchun Liu

  3. Department of Radiology, The Hospital of Shunyi District Beijing, Beijing, 101300, China

    Shufan Shang

Authors
  1. Xinjun Han
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  2. Weimin An
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  3. Qiuting Cao
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Corresponding author

Correspondence to Liqin Zhao.

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Guarantor

The scientific guarantor of this publication is Liqin Zhao.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required because written informed consent was obtained for undergoing the dual-energy CT examination, but the informed consent for the post-analysis was waived in this study due to its retrospective nature.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Han, X., An, W., Cao, Q. et al. Noninvasive evaluation of esophageal varices in cirrhotic patients based on spleen hemodynamics: a dual-energy CT study. Eur Radiol 30, 3210–3216 (2020). https://doi.org/10.1007/s00330-020-06680-5

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  • DOI: https://doi.org/10.1007/s00330-020-06680-5

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