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Esophageal Varices in Cirrhotic Patients: Evaluation with Liver CT

Young Jun Kim1,2, Steven S. Raman1, Nam C. Yu1,3, Katherine J. To'o1, Rome Jutabha4 and David S. K. Lu1

1 Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave., Los Angeles, CA 90095-1721.
2 Present address: Department of Radiology, Konkuk University Hospital, Gwangjin-gu, Seoul, Korea.
3 Medical Imaging Informatics Group, UCLA Biomedical Informatics Center, Los Angeles, CA.
4 Division of Digestive Diseases and Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.


Figure 1
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  		Fig. 1A —69-year-old woman with liver cirrhosis and large esophageal varices. Portal phase dominant axial MDCT image of lower esophagus shows multiple nodular, enhancing, intraluminally protruding lesions (arrows) within esophagus wall. In this patient, largest varix was measured as 8.2 and 9.1 mm in short diameter, respectively, by two observers.

 

Figure 2
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  		Fig. 1B —69-year-old woman with liver cirrhosis and large esophageal varices. Endoscopic image shows multiple large varices.

 

Figure 3
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  		Fig. 2A —68-year-old man with liver cirrhosis and large esophageal varices. Portal phase dominant axial single-detector CT image of lower esophagus shows nodular thickening of esophageal wall, but without any discrete enhancing lesions. Thus, this patient was considered to have no varix by both observers.

 

Figure 4
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  		Fig. 2B —68-year-old man with liver cirrhosis and large esophageal varices. Endoscopic image shows, however, multiple large variceal columns.

 

Figure 5
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  		Fig. 3A —54-year-old woman with liver cirrhosis and small esophageal varices. Portal phase dominant axial MDCT image of lower esophagus shows enhancing lesion (arrows) protruding into luminal space; lesion was measured as 3.6 and 3.8 mm in short diameter, respectively, by two observers.

 

Figure 6
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  		Fig. 3B —54-year-old woman with liver cirrhosis and small esophageal varices. Endoscopic image shows small esophageal varix (arrows).

 

Figure 7
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  		Fig. 4 —Scattergram shows correlation between short-diameter measurements of perceived esophageal varices in positive CT cases and actual grade on endoscopy (none, small, and large varices) for each observer. Note that data points in small and large esophageal varices groups represent true-positive fraction, whereas those in none group correspond to false-positive fraction.

 

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