European Radiology

, Volume 29, Issue 12, pp 6611–6619 | Cite as

Prediction of esophageal varices by liver and spleen MR elastography

  • Hayato Abe
  • Yutaka MidorikawaEmail author
  • Naoki Matsumoto
  • Mitsuhiko Moriyama
  • Kazu Shibutani
  • Masahiro Okada
  • Seiichi Udagawa
  • Shingo Tsuji
  • Tadatoshi Takayama
Magnetic Resonance



We aimed to assess the diagnostic performance of MR elastography (MRE) in predicting esophageal varices (EVs) in patients with chronic liver disease.


We prospectively performed liver (LSM) and spleen stiffness measurements (SSM) using MRE and endoscopic screening for EVs to determine if patients with hepatocellular carcinoma were eligible for resection. We investigated whether LSM, SSM, and other non-invasive preoperative parameters were associated with the presence of EVs. In order to predict EVs, 211 patients were divided into training (n = 140) and test (n = 71) groups. A nomogram was built using independent factors based on logistic regression analysis in the training group and its accuracy was validated using an independent cohort.


Forty-six patients (21.8%) were diagnosed as having EVs (mild, n = 36; severe, n = 10). According to multiple regression analysis, LSM (odds ratio, 2.362; 95% confidence interval [CI], 1.341–4.923; p = 0.001) and SSM (1.489; 1.095–2.235; p = 0.010) were independent predictors of EVs in the training group. The nomogram showed good discrimination, with a C-index of 0.942 (95% CI, 0.892–0.974) through internal validation, and good calibration. Application of the nomogram in the test group still gave good discrimination (C-index, 0.948; 95% CI, 0.868–0.995).


The combination of LSM and SSM using MRE is an accurate tool to identify patients at risk for EVs.

Key Points

Performance of MR elastography can estimate the presence of esophageal varices non-invasively.

Liver and spleen stiffness measurements are independent predictors for esophageal varices.

The nomogram using a combination of liver and spleen stiffness measurements allows for the risk of esophageal varices.


Esophageal varices Liver MR elastography Spleen 



Aspartate aminotransferase-to-platelet ratio index


Aspartate aminotransferase


Area under the curve


Confidence interval


Concordance index


Chronic liver disease


Esophageal varices


Hepatocellular carcinoma


Indocyanine green clearance rate at 15 min


Liver stiffness measurement


MR elastography


Odds ratio


Receiver operating characteristic


Spleen stiffness measurement



This research was supported by Japan Agency for Medical Research and Development (AMED) under Grant Number 18hk0102049s0301 and a grant-in-aid of the 106th Annual Congress of JSS Memorial Surgical Research Fund, Tokyo, Japan.


This research was supported by Japan Agency for Medical Research and Development (AMED) under Grant Number 18hk0102049s0301 and a grant-in-aid of the 106th Annual Congress of JSS Memorial Surgical Research Fund, Tokyo, Japan.

Compliance with ethical standards


The scientific guarantor of this publication is Tadatoshi Takayama, Department of Digestive Surgery, Nihon University School of Medicine.

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

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• diagnostic or prognostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Hayato Abe
    • 1
  • Yutaka Midorikawa
    • 1
    Email author
  • Naoki Matsumoto
    • 2
  • Mitsuhiko Moriyama
    • 2
  • Kazu Shibutani
    • 3
  • Masahiro Okada
    • 3
  • Seiichi Udagawa
    • 4
  • Shingo Tsuji
    • 5
  • Tadatoshi Takayama
    • 1
  1. 1.Department of Digestive SurgeryNihon University School of MedicineTokyoJapan
  2. 2.Department of Gastroenterology and HepatologyNihon University School of MedicineTokyoJapan
  3. 3.Department of RadiologyNihon University School of MedicineTokyoJapan
  4. 4.Department of MathematicsNihon University School of MedicineTokyoJapan
  5. 5.Research Center of Advanced Science and Technology, Genome Science DivisionsUniversity of TokyoTokyoJapan

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