DETECTION AND GRADING OF ESOPHAGEAL VARICES ON MULTIDETECTOR COMPUTED TOMOGRAPHY (MDCT) IN PATIENTS WITH CHRONIC LIVER DISEASE AND CORRELATION WITH ENDOSCOPIC GRADING

Dr.Sarita Jilowa; Dr Yashvant Singh; Dr Puran Singh Nalwa; Dr Sohan Kumar

Volume : IX, Issue : VI, June - 2019

DETECTION AND GRADING OF ESOPHAGEAL VARICES ON MULTIDETECTOR COMPUTED TOMOGRAPHY (MDCT) IN PATIENTS WITH CHRONIC LIVER DISEASE AND CORRELATION WITH ENDOSCOPIC GRADING

Dr. Sarita Jilowa, Dr Yashvant Singh, Dr Puran Singh Nalwa, Dr Sohan Kumar

Abstract :

Aim: This prospective study was undertaken to evaluate the role of multidetector computed tomography (MDCT) in detection and grading of oesophageal varices in patients with chronic liver disease and to correlate the MDCT findings with endoscopic grading of oesophageal varices. Material and Methods: A total of 31 patients above 18 years of age were included in the study.Upper gastrointestinal endoscopy was performedwithin 4 weeks of (before/after) of MDCT.MDCT was done in unenhanced, arterial and portal venous phase.The CT images were reviewed for the presence and size of esophageal varices at 3mm sections.Multiplanar reformation images of axial, coronal and sagittal sections were made at 0.9 mm thickness region where varices were visualized. Results:Sensitivity, specificity, positive and negative predictive values of CT in determining characteristics of varices were taken out, with endoscopy regarded as the reference standard.The results of CT were correlated with the presence and grade of esophageal varices documented on endoscopy. Our study revealed a good correlation between the MDCT size of esophageal varices and endoscopic form and the presence of red color sign. The overall sensitivity, specificity, PPV and NPV of MDCT was 88.4%, 80%, 95.8% and 57.1% respectively in detection of esophageal varices. Conclusion:MDCT is an excellent modality for the detection of collaterals including oesophageal varices. The use of CT oesophagography allows grading of oesophageal varices, as well as differentiation between low and high–risk varices. A criterion of a 3–mm diameter on CT for large varices could be useful in identifying high–risk esophageal varices,which is most important given the high morbidity and mortality associated if they bleed.