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Esophageal varices on computed tomography and subsequent variceal hemorrhage. 2014

Ma Somsouk, and Katherine To'o, and Mujtaba Ali, and Eric Vittinghoff, and Benjamin M Yeh, and Judy Yee, and Alex Monto, and John M Inadomi, and Rizwan Aslam
Division of Gastroenterology, Department of Medicine, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, USA, ma.somsouk@ucsf.edu.

OBJECTIVE 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.

UI MeSH Term Description Entries
D007472 Iohexol An effective non-ionic, water-soluble contrast agent which is used in myelography, arthrography, nephroangiography, arteriography, and other radiographic procedures. Its low systemic toxicity is the combined result of low chemotoxicity and low osmolality. Compound 545,Exypaque,Iohexol 350,Nycodenz,Omnipaque
D008103 Liver Cirrhosis Liver disease in which the normal microcirculation, the gross vascular anatomy, and the hepatic architecture have been variably destroyed and altered with fibrous septa surrounding regenerated or regenerating parenchymal nodules. Cirrhosis, Liver,Fibrosis, Liver,Hepatic Cirrhosis,Liver Fibrosis,Cirrhosis, Hepatic
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D003287 Contrast Media Substances used to allow enhanced visualization of tissues. Radiopaque Media,Contrast Agent,Contrast Agents,Contrast Material,Contrast Materials,Radiocontrast Agent,Radiocontrast Agents,Radiocontrast Media,Agent, Contrast,Agent, Radiocontrast,Agents, Contrast,Agents, Radiocontrast,Material, Contrast,Materials, Contrast,Media, Contrast,Media, Radiocontrast,Media, Radiopaque
D003973 Diatrizoate A commonly used x-ray contrast medium. As DIATRIZOATE MEGLUMINE and as Diatrizoate sodium, it is used for gastrointestinal studies, angiography, and urography. Amidotrezoate,Amidotrizoate,Benzoic acid, 3,5-bis(acetylamino)-2,4,6-triiodo-,Diatrizoate Sodium,Diatrizoic Acid,Hypaque,Hypaque 50,Sodium Diatrizoate,Sodium-Magnesium Diatrizoate,Urogranoic Acid,Urothrast,Urotrast,Diatrizoate, Sodium,Diatrizoate, Sodium-Magnesium
D003974 Diatrizoate Meglumine A versatile contrast medium used for DIAGNOSTIC X-RAY RADIOLOGY. Diatrizoate Methylglucamine,Diatrizoic Acid Methylglucamine,Meglumine Diatrizoate,Methylglucamine Diatrizoate,Amidotricoic Acid,Amidotrizoic Acid,Angiografin,Gastrograffin,Gastrografin,Gastrographin,Ioxeol,Meglumine Amidotrizoate,Reno 60,Reno M-Dip,Renograffin,Renografin,Renografin M-76,Sinografin,Triombrast,Triombrin,Urografin,Urografin 76,Urovist,Verografin,Amidotrizoate, Meglumine,Diatrizoate, Meglumine,Diatrizoate, Methylglucamine,Meglumine, Diatrizoate,Methylglucamine, Diatrizoate,Methylglucamine, Diatrizoic Acid,Reno M Dip,Reno MDip,Renografin M 76,Renografin M76
D004932 Esophageal and Gastric Varices Dilated blood vessels in the ESOPHAGUS or GASTRIC FUNDUS that shunt blood from the portal circulation (PORTAL SYSTEM) to the systemic venous circulation. Often they are observed in individuals with portal hypertension (HYPERTENSION, PORTAL). Esophageal Varices,Gastric Varices,Esophageal Varix,Gastric Varix,Varices, Esophageal,Varices, Gastric,Varix, Esophageal,Varix, Gastric
D005260 Female Females
D006471 Gastrointestinal Hemorrhage Bleeding in any segment of the GASTROINTESTINAL TRACT from ESOPHAGUS to RECTUM. Hematochezia,Hemorrhage, Gastrointestinal,Gastrointestinal Hemorrhages,Hematochezias

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