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Esophageal Varices: Diagnosis with Gadolinium-Enhanced MR Imaging of the Liver for Patients with Chronic Liver Damage

Masayuki Matsuo1, Masayuki Kanematsu1, Tonsok Kim2, Masatoshi Hori2, Manabu Takamura2, Takamichi Murakami2, Hiroshi Kondo1, Noriyuki Moriyama3, Hironobu Nakamura2 and Hiroaki Hoshi1

1 Department of Radiology, Gifu University School of Medicine, 40 Tsukasamachi, Gifu 500-8705, Japan.
2 Department of Radiology, Osaka University School of Medicine, Yamadaoka 2-2, Osaka 565-0871, Japan.
3 Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan.



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  		Fig. 1A. —56-year-old man with cirrhosis and Beppu's [21] grade 2 esophageal varices. Unenhanced T1-weighted gradient-recalled echo axial MR image (TR/TE, 150/1.6) (A) and respiratory-triggered T2-weighted fast spin-echo axial MR image (4285/80) (B) of liver show small area of flow void (arrow) in esophageal walls, which suggests presence of esophageal varices.

 


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  		Fig. 1B. —56-year-old man with cirrhosis and Beppu's [21] grade 2 esophageal varices. Unenhanced T1-weighted gradient-recalled echo axial MR image (TR/TE, 150/1.6) (A) and respiratory-triggered T2-weighted fast spin-echo axial MR image (4285/80) (B) of liver show small area of flow void (arrow) in esophageal walls, which suggests presence of esophageal varices.

 


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  		Fig. 1C. —56-year-old man with cirrhosis and Beppu's [21] grade 2 esophageal varices. Gadolinium-enhanced axial MR image (150/1.6) obtained during portal venous phase shows esophageal varices (arrow) more clearly than A or B.

 


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  		Fig. 1D. —56-year-old man with cirrhosis and Beppu's [21] grade 2 esophageal varices. Endoscopic image shows large and tortuous esophageal varices (arrow) that occupy less than one third of lumen, indicative of Beppu's grade 2 varices.

 


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  		Fig. 2A. —57-year-old man with cirrhosis of liver and Beppu's [21] grade 3 esophageal varices. Axial unenhanced T1-weighted gradient-recalled echo MR image (TR/TE, 150/1.6) (A) and axial respiratory-triggered T2-weighted fast spin-echo MR image (8000/80) (B) of liver show multiple areas of flow void in (straight arrow) and adjacent to (curved arrow) esophageal walls. Although both images depict findings suggestive of esophageal varices, findings on B are more clearly indicative of condition than those on A.

 


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  		Fig. 2B. —57-year-old man with cirrhosis of liver and Beppu's [21] grade 3 esophageal varices. Axial unenhanced T1-weighted gradient-recalled echo MR image (TR/TE, 150/1.6) (A) and axial respiratory-triggered T2-weighted fast spin-echo MR image (8000/80) (B) of liver show multiple areas of flow void in (straight arrow) and adjacent to (curved arrow) esophageal walls. Although both images depict findings suggestive of esophageal varices, findings on B are more clearly indicative of condition than those on A.

 


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  		Fig. 2C. —57-year-old man with cirrhosis of liver and Beppu's [21] grade 3 esophageal varices. Axial gadolinium-enhanced gradient-recalled echo MR image (150/1.6) obtained during hepatic arterial phase shows slightly enhanced esophageal varices (straight arrow) and paraesophageal varices (curved arrow).

 


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  		Fig. 2D. —57-year-old man with cirrhosis of liver and Beppu's [21] grade 3 esophageal varices. Endoscopic image shows large coiled esophageal varices (arrow) that occupy more than one third of the lumen, indicative of Beppu's grade 3 varices.

 


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  		Fig. 3A. —73-year-old man who had cirrhosis of liver but no esophageal varices. Axial unenhanced T1-weighted gradient-recalled echo MR image (TR/TE, 150/1.6) (A) and axial respiratory-triggered T2-weighted fast spin-echo MR image (8571/80) (B) show multiple areas of flow void (straight arrows) around esophagus (curved arrow), suggesting presence of paraesophageal varices.

 


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  		Fig. 3B. —73-year-old man who had cirrhosis of liver but no esophageal varices. Axial unenhanced T1-weighted gradient-recalled echo MR image (TR/TE, 150/1.6) (A) and axial respiratory-triggered T2-weighted fast spin-echo MR image (8571/80) (B) show multiple areas of flow void (straight arrows) around esophagus (curved arrow), suggesting presence of paraesophageal varices.

 


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  		Fig. 3C. —73-year-old man who had cirrhosis of liver but no esophageal varices. Axial gadolinium-enhanced gradient-recalled echo MR image (150/1.6) obtained during portal venous phase shows markedly dilated paraesophageal varices (arrows).

 


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  		Fig. 3D. —73-year-old man who had cirrhosis of liver but no esophageal varices. Endoscopic image shows no esophageal varices are present.

 


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  		Fig. 4. —Diagram shows connections between esophageal and paraesophageal varices via perforating veins with afferent or efferent blood flow. Paraesophageal varices are formed by union of groups of dilated perforating veins, and varices connect with left gastric veins inferiorly and with azygos vein superiorly. Throughout their length, esophageal varices form connections with paraesophageal varices via perforating veins.

 

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