Esophageal varices in patients with cirrhosis: Multidetector CT esophagography - Comparison with endoscopy

Purpose: To evaluate the use of multidetector computed tomographic ( CT) esophagography to grade esophageal varices and differentiate between varices at low risk and those at high risk for bleeding, with endoscopy as the reference standard. Materials and Methods: This study was approved by the institutional review board; all subjects gave informed consent. Ninety patients with cirrhosis ( 65 men, 25 women; mean age, 54.8 years; range, 21-77 years) were prospectively enrolled and underwent endoscopy and CT esophagography. Esophageal varices were graded independently at endoscopy by two endoscopists. CT esophagograms were interpreted retrospectively with a four-point scale by two radiologists blinded to other findings. Interobserver agreement between each radiologist and endoscopist was determined; endoscopic and CT esophagographic grades of esophageal varices were correlated. Radiologist performance for differentiation between low- and high-risk varices for bleeding on the basis of morphology at endoscopy was evaluated with receiver operating characteristic analysis. Patients were interviewed to determine acceptance at both examinations. Results: Thirty-seven of 90 patients had grade 0, 23 had grade 1, 18 had grade 2, and 12 had grade 3 esophageal varices. Thus, 60 patients were determined to be in a low- risk group and 30 in a high-risk group for variceal bleeding at endoscopy. There was almost perfect agreement in grading esophageal varices between endoscopists. There was close correlation ( P < .001) and substantial agreement between endoscopic and CT esophagographic grades. Radiologist performance for differentiating between low- and high-risk varices was 0.931-0.958 ( area under receiver operating characteristic curve). Patient interview results revealed that CT esophagography had better acceptance than did endoscopy ( P < .001). Conclusion: Use of CT esophagography allows grading of esophageal varices and differentiation between low- and high-risk varices and shows better patient acceptance than does endoscopy.