Abdominal Imaging

, Volume 39, Issue 2, pp 251–256

Esophageal varices on computed tomography and subsequent variceal hemorrhage

Authors

    • Division of Gastroenterology, Department of MedicineUniversity of California, San Francisco
  • Katherine To’o
    • Department of Radiology and Biomedical ImagingUniversity of California, San Francisco
  • Mujtaba Ali
    • Department of RadiologyUniversity of Colorado Hospital
  • Eric Vittinghoff
    • Department of Epidemiology and BiostatisticsUniversity of California, San Francisco
  • Benjamin M. Yeh
    • Department of Radiology and Biomedical ImagingUniversity of California, San Francisco
  • Judy Yee
    • Department of Radiology and Biomedical ImagingUniversity of California, San Francisco
  • Alex Monto
    • Division of Gastroenterology and Hepatology, Department of MedicineSan Francisco Veterans Affairs Medical Center
  • John M. Inadomi
    • Division of Gastroenterology and Hepatology, Department of MedicineUniversity of Washington
  • Rizwan Aslam
    • Department of Radiology and Biomedical ImagingUniversity of California, San Francisco
Article

DOI: 10.1007/s00261-013-0057-x

Cite this article as:
Somsouk, M., To’o, K., Ali, M. et al. Abdom Imaging (2014) 39: 251. doi:10.1007/s00261-013-0057-x

Abstract

Purpose

Endoscopy is recommended to screen for esophageal varices in patients with cirrhosis. The objective of this study was to identify features on abdominal CT imaging associated variceal hemorrhage (VH).

Methods

A case–control study was performed among patients with cirrhosis who had a CT scan. Consecutive patients who experienced VH were included as cases, and patients without VH served as controls. Two radiologists recorded the maximal esophageal varix diameter in addition to other measures of portal hypertension at CT.

Results

The most powerful CT parameter associated with VH was the esophageal varix diameter (5.8 vs. 2.7 mm, p < 0.001; adjusted OR 1.84 per mm, p = 0.009). 63% of individuals with VH had a maximal varix diameter ≥5 mm compared to 7.5% of cirrhotic patients without VH (p < 0.001). In contrast, the proportion of individuals whose largest varix was <3 mm was 7.4% among VH cases compared to 54.7% among controls (p = 0.001). The varix diameter powerfully discriminated those with and without VH (C-statistic 0.84).

Conclusions

A large esophageal varix diameter is strongly associated with subsequent VH. A threshold of <3 and ≥5 mm appears to identify patients with cirrhosis at low and high risk for hemorrhage.

Key words:

Portal hypertensionVariceal hemorrhageCTCirrhosis

Supplementary material

261_2013_57_MOESM1_ESM.doc (72 kb)
Supplementary material 1 (DOC 72 kb)

Copyright information

© Springer Science+Business Media New York 2013