Skip to main content
SpringerLink
Log in

Hepatic artery diameter predicts bleeding risk after gastroesophageal varices treatment: a contrast-enhanced CT study

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Objective

Portal hypertension leads to hepatic artery dilatation and a higher risk of bleeding. We tried to identify the bleeding risk after gastroesophageal varices (GOV) treatment using hepatic artery diameter of contrast-enhanced CT.

Methods

Retrospective retrieval of 258 patients with cirrhosis who underwent contrast-enhanced CT from January 2022 to May 2023 and endoscopy within one month thereafter at Hainan Affiliated Hospital of Hainan Medical University. Cirrhotic patients before GOV treatment were used as the test cohort (n = 199), and cirrhotic patients after GOV treatment were used as the validation cohort (n = 59). The grading and bleeding risk was classified according to the endoscopic findings. Arterial-phase images of contrast-enhanced CT were used for coronal reconstruction, and the midpoint diameter of the hepatic artery was measured on coronal images. The optimal cutoff value for identifying bleeding risk was analyzed and calculated in the test cohort, and its diagnostic performance was evaluated in the validation cohort.

Results

In the test cohort, hepatic artery diameters were significantly higher in high-risk GOV than in low-risk GOV [4.69 (4.31, 5.56) vs. 3.10 (2.59, 3.77), P < 0.001]. With a hepatic artery diameter cutoff value of 4.06 mm, the optimal area under the operating characteristic curve was 0.940 (95% confidence interval: 0.908–0.972), with a sensitivity of 0.887, a specificity of 0.892, a positive predictive value of 0.904, and a negative predictive value of 0.874 for identifying bleeding risk in the test cohort, while in the validation cohort, the sensitivity was 0.885, specificity was 0.939, positive predictive value was 0.920, and negative predictive value was 0.912.

Conclusion

Hepatic artery diameter has high diagnostic performance in identifying bleeding risk after GOV treatment.

Graphical abstract

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Franchis R de, Bosch J, Garcia-Tsao G, et al. Baveno VII – Renewing consensus in portal hypertension. Journal of Hepatology. 2022;76(4):959-974. https://doi.org/10.1016/j.jhep.2021.12.022

    Article  PubMed  Google Scholar 

  2. Chinese Society of Hepatology, Chinese Society of Gastroenterology, and Chinese Society of Digestive Endoscopology of Chinese Medical Association. [Guidelines on the management of esophagogastric variceal bleeding in cirrhotic portal hypertension]. Zhonghua Gan Zang Bing Za Zhi. 2022;30(10):1029–1043. https://doi.org/10.3760/cma.j.cn501113-20220824-00436

  3. Carbonell N, Pauwels A, Serfaty L, Fourdan O, Lévy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology. 2004;40(3):652-659. https://doi.org/10.1002/hep.20339

    Article  PubMed  Google Scholar 

  4. Rogal SS, Hansen L, Patel A, et al. AASLD Practice Guidance: Palliative care and symptom-based management in decompensated cirrhosis. Hepatology. 2022;76(3):819-853. https://doi.org/10.1002/hep.32378

    Article  PubMed  Google Scholar 

  5. European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018;69(2):406–460. https://doi.org/10.1016/j.jhep.2018.03.024

  6. Assy N, Rosser BG, Grahame GR, Minuk GY. Risk of sedation for upper GI endoscopy exacerbating subclinical hepatic encephalopathy in patients with cirrhosis. Gastrointest Endosc. 1999;49(6):690-694. https://doi.org/10.1016/s0016-5107(99)70283-x

    Article  CAS  PubMed  Google Scholar 

  7. Vasudevan AE, Goh KL, Bulgiba AM. Impairment of psychomotor responses after conscious sedation in cirrhotic patients undergoing therapeutic upper GI endoscopy. Am J Gastroenterol. 2002;97(7):1717-1721. https://doi.org/10.1111/j.1572-0241.2002.05831.x

    Article  CAS  PubMed  Google Scholar 

  8. Manchec B, Pham E, Noor M, et al. Contrast-Enhanced CT May Identify High-Risk Esophageal Varices in Patients With Cirrhosis. American Journal of Roentgenology. 2020;215(3):617-623. https://doi.org/10.2214/AJR.19.22474

    Article  PubMed  Google Scholar 

  9. Kim SH, Kim YJ, Lee JM, et al. Esophageal varices in patients with cirrhosis: multidetector CT esophagography--comparison with endoscopy. Radiology. 2007;242(3):759-768. https://doi.org/10.1148/radiol.2423050784

    Article  PubMed  Google Scholar 

  10. Han X, An W, Cao Q, Liu C, Shang S, Zhao L. Noninvasive evaluation of esophageal varices in cirrhotic patients based on spleen hemodynamics: a dual-energy CT study. Eur Radiol. 2020;30(6):3210-3216. https://doi.org/10.1007/s00330-020-06680-5

    Article  PubMed  Google Scholar 

  11. Lennartz S, Parakh A, Cao J, Zopfs D, Große Hokamp N, Kambadakone A. Inter-scan and inter-scanner variation of quantitative dual-energy CT: evaluation with three different scanner types. Eur Radiol. 2021;31(7):4438-4451. https://doi.org/10.1007/s00330-020-07611-0

    Article  PubMed  Google Scholar 

  12. Peng Y, Li R, Tang G, Wang K, Sun M, Guan J. Correlation of Riolan’s arch diameter to treatment choice in patients with isolated superior mesenteric artery dissection. Abdom Radiol (NY). 2022;47(10):3628-3637. https://doi.org/10.1007/s00261-022-03622-1

    Article  PubMed  Google Scholar 

  13. Guan J, Peng Y, Ouyang L, et al. Evaluation of Therapeutic Effects on Collateral Circulation in Patients with Chronic Leriche Syndrome: a Case-Control Study of Intraluminal Stent Implantation and Surgical Bypass Grafting. Cardiovasc Intervent Radiol. 2021;44(4):550-557. https://doi.org/10.1007/s00270-020-02766-1

    Article  PubMed  Google Scholar 

  14. Toni R, Bolondi L, Gaiani S, et al. Accessory ultrasonographic findings in chronic liver disease: diameter of splenic and hepatic arteries, fasting gallbladder volume, and course of left portal vein. J Clin Ultrasound. 1985;13(9):611-618.

    Article  CAS  PubMed  Google Scholar 

  15. Aoki H, Hasumi A, Hashizume M, Kato H, Moriyasu F, Idezuki Y. Hemodynamic analysis of findings in patients with portal hypertension: multicenter analysis in Japan. Japan Portal Hypertension Study Group. Hepatogastroenterology. 1995;42(6):1030-1038.

    CAS  Google Scholar 

  16. Iwakiri Y. Pathophysiology of portal hypertension. Clin Liver Dis. 2014;18(2):281-291. https://doi.org/10.1016/j.cld.2013.12.001

    Article  PubMed  PubMed Central  Google Scholar 

  17. Iwakiri Y. The molecules: mechanisms of arterial vasodilatation observed in the splanchnic and systemic circulation in portal hypertension. J Clin Gastroenterol. 2007;41 Suppl 3:S288-294. https://doi.org/10.1097/MCG.0b013e3181468b4c

    Article  CAS  PubMed  Google Scholar 

  18. Michels NA. Newer anatomy of the liver and its variant blood supply and collateral circulation. Am J Surg. 1966;112(3):337-347. https://doi.org/10.1016/0002-9610(66)90201-7

    Article  CAS  PubMed  Google Scholar 

  19. Hiatt JR, Gabbay J, Busuttil RW. Surgical anatomy of the hepatic arteries in 1000 cases. Ann Surg. 1994;220(1):50-52. https://doi.org/10.1097/00000658-199407000-00008

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Tajiri T, Yoshida H, Obara K, et al. General rules for recording endoscopic findings of esophagogastric varices (2nd edition). Dig Endosc. 2010;22(1):1–9. https://doi.org/10.1111/j.1443-1661.2009.00929.x

  21. Morishita N, Hiramatsu N, Oze T, et al. 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. 2014;49(7):1175-1182. https://doi.org/10.1007/s00535-013-0877-z

    Article  PubMed  Google Scholar 

  22. Wu L, Fang QQ, Huang XQ, et al. Risk factors associated with failure of endoscopic combined treatment to prevent varices rebleeding in patients with liver cirrhosis. Expert Rev Gastroenterol Hepatol. 2023;17(3):301-308. https://doi.org/10.1080/17474124.2023.2181787

    Article  CAS  PubMed  Google Scholar 

  23. D’Amico G, Pasta L, Morabito A, et al. Competing risks and prognostic stages of cirrhosis: a 25-year inception cohort study of 494 patients. Aliment Pharmacol Ther. 2014;39(10):1180-1193. https://doi.org/10.1111/apt.12721

    Article  PubMed  Google Scholar 

  24. Turco L, Reiberger T, Vitale G, La Mura V. Carvedilol as the new non-selective beta-blocker of choice in patients with cirrhosis and portal hypertension. Liver Int. 2023;43(6):1183-1194. https://doi.org/10.1111/liv.15559

    Article  PubMed  Google Scholar 

  25. Sauerbruch T, Mengel M, Dollinger M, et al. Prevention of Rebleeding From Esophageal Varices in Patients With Cirrhosis Receiving Small-Diameter Stents Versus Hemodynamically Controlled Medical Therapy. Gastroenterology. 2015;149(3):660-668.e1. https://doi.org/10.1053/j.gastro.2015.05.011

    Article  PubMed  Google Scholar 

  26. Attia D, Rodt T, Marquardt S, et al. Shear wave elastography prior to transjugular intrahepatic portosystemic shunt may predict the decrease in hepatic vein pressure gradient. Abdom Radiol (NY). 2019;44(3):1127-1134. https://doi.org/10.1007/s00261-018-1795-6

    Article  PubMed  Google Scholar 

  27. Mattos ÂZ, Schacher FC, John Neto G, Mattos AA. Screening for esophageal varices in cirrhotic patients - Non-invasive methods. Ann Hepatol. 2019;18(5):673-678. https://doi.org/10.1016/j.aohep.2019.06.003

    Article  CAS  PubMed  Google Scholar 

  28. Cankal F, Kaya M, Guner MA. Evaluation of Celiac Trunk, Hepatic Artery Variations, and Their Collateral Arteries by Multi-Slice Computed Tomography. Sisli Etfal Hastan Tip Bul. 2021;55(2):217-223. https://doi.org/10.14744/SEMB.2021.90698

    Article  PubMed  PubMed Central  Google Scholar 

  29. Zeng DB, Dai CZ, Lu SC, He N, Wang W, Li HJ. Abnormal splenic artery diameter/hepatic artery diameter ratio in cirrhosis-induced portal hypertension. World J Gastroenterol. 2013;19(8):1292-1298. https://doi.org/10.3748/wjg.v19.i8.1292

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was supported by Hainan Provincial Natural Science Foundation of China (Grant No. 821RC677); Joint Program on Health Science & Technology Innovation of Hainan Province (SQ2023WSJK0041); and the Hainan Province Clinical Medical Center.

Author information

Authors and Affiliations

  1. Department of Radiology, Hainan Hospital of Hainan Medical University/Hainan General Hospital, Haikou, 570311, Hainan, China

    Guo Li, Qinlei Cai, Xin Qin, Shishi Luo, Shanxi Guo, Yihao Guo, Feng Chen & Weiyuan Huang

Authors
  1. Guo Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qinlei Cai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xin Qin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shishi Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shanxi Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yihao Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Feng Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Weiyuan Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Weiyuan Huang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict interest.

Ethical approval

The institutional ethics committee has approved this retrospective study and has waived the requirement of informed consent.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Li, G., Cai, Q., Qin, X. et al. Hepatic artery diameter predicts bleeding risk after gastroesophageal varices treatment: a contrast-enhanced CT study. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04291-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00261-024-04291-y

Keywords

Search

Navigation