Ali Borhani , Harry Luu , Alireza Mohseni , Ziyi Xu , Mohammadreza Shaghaghi , Celestina Tolosa , Mohammad Mirza Aghazadeh Attari , Seyedeh Panid Madani , Haneyeh Shahbazian , Pegah Khoshpouri , Shadi Afyouni , Ghazal Zandieh , Ihab R. Kamel , Amy K. Kim
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引用次数: 0
Abstract
Background & aim
Esophageal varices (EV) screening guidelines have evolved with improved risk stratification to avoid unnecessary esophagogastroduodenoscopy (EGD) in individuals with low bleeding risks. However, uncertainties persist in the recommendations for certain patient groups, particularly those with hepatocellular carcinoma (HCC) and/or receiving non-selective beta-blockers (NSBB) without prior endoscopy. This study assessed the efficacy of imaging in ruling out EVs and their high-risk features associated with bleeding in patients with cirrhosis and with HCC. We also evaluated the impact of NSBB on the detection of these characteristics.
Methods
A total of 119 patients undergoing EGD with CT and/or MRI within 90 days of the procedure were included. 87 patients had HCC. A new imaging grading system was developed utilizing the size of EVs and the extent of their protrusion into the esophagus lumen. The negative predictive value (NPV) of EVimaging(−) versus EVimaging (+) (grades 1–3) in ruling out the presence of EV and/or high-risk features by EGD was calculated. The predictive performance of imaging was determined by logistic regression.
Results
The NPV of imaging for detecting EV and high-risk features was 81 % and 92 %, respectively. Among HCC patients, the NPV for EV and high-risk features was 80 % and 64 %, respectively. Being on NSBB didn't statistically impact the imaging detection of EV. Imaging was a better predictor of high-risk EGD findings than Child-Turcotte-Pugh scores.
Conclusions
Our results suggest that imaging can effectively rule out the presence of EV and high-risk features during EGD, even in patients with HCC and/or receiving NSBB.
期刊介绍:
The mission of Clinical Imaging is to publish, in a timely manner, the very best radiology research from the United States and around the world with special attention to the impact of medical imaging on patient care. The journal''s publications cover all imaging modalities, radiology issues related to patients, policy and practice improvements, and clinically-oriented imaging physics and informatics. The journal is a valuable resource for practicing radiologists, radiologists-in-training and other clinicians with an interest in imaging. Papers are carefully peer-reviewed and selected by our experienced subject editors who are leading experts spanning the range of imaging sub-specialties, which include:
-Body Imaging-
Breast Imaging-
Cardiothoracic Imaging-
Imaging Physics and Informatics-
Molecular Imaging and Nuclear Medicine-
Musculoskeletal and Emergency Imaging-
Neuroradiology-
Practice, Policy & Education-
Pediatric Imaging-
Vascular and Interventional Radiology