Predictive value of high-risk esophageal varices in cirrhosis based on dual-energy CT combined with clinical and serologic features.

Objective: To investigate the predictive value of dual-energy CT (DECT) in combination with clinical and serologic features for noninvasive assessment of high-risk esophageal variceal (EV) in cirrhosis patients.

Data and methods: 120 patients who had undergone DECT and gastroscopy were retrospectively enrolled. They were categorized into low-risk variceal (LRV) and high-risk variceal (HRV) groups by gastroscopy (LRV: none, mild, HRV: moderate, severe). Clinical data, serologic and DECT parameters were recorded respectively. Multifactorial logistic regression analyses were conducted to develop clinical, serological, DECT, and combined models. AUC was utilized to assess the diagnostic performance. Non-parametric tests were employed to analyze differences in DECT parameters among different grading of EV.

Results: In clinical model, ascites was the independent risk predictor, with 78.3% accuracy,50% sensitivity, 100% specificity, and an AUC of 0.693. The serological model revealed white blood cell count, hematocrit, alanine aminotransferase, and platelet count as predictors for HRV, demonstrating 83.3% accuracy, 90.9% sensitivity, 76.9% specificity, and an AUC of 0.784. The DECT model, identified liver normalized iodine volume (NIV-L) and spleen volume (V-S) as key predictors, with 84% accuracy, 72.7% sensitivity, 92.9% specificity, and an AUC of 0.84. The combined model, integrating NIV-L, V-S, and Ascites, demonstrated superior performance with 82.6% accuracy, 90% sensitivity, 76.9% specificity, and an AUC of 0.878, compared to the other models. Additionally, severe EV had higher V-S and NIV-S values than other grades (p < 0.05), with AUC of 0.874 and 0.864, respectively.

Conclusion: DECT-based NIV-L, V-S, and presence of ascites can predict high-risk esophageal varices.

Clinical relevance statement: Quantitative parameters of DECT can predict high-risk esophageal varices in cirrhotic patients, avoid gastroscopy, if possible, continue hierarchical management.

Trial registration: retrospectively registered.