Kim Se Hyung, Kim Yoon Jun, Lee Jeong Min, Choi Kee Don, Chung Young Jin, Han Joon Koo, Lee Jae Young, Lee Min Woo, Han Chang Jin, Choi Joon Il, Shin Kyung-Sook, Choi Byung Ihn
Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
Radiology. 2007 Mar;242(3):759-68. doi: 10.1148/radiol.2423050784. Epub 2007 Jan 17.
To evaluate the use of multidetector computed tomographic (CT) esophagography to grade esophageal varices and differentiate between varices at low risk and those at high risk for bleeding, with endoscopy as the reference standard.
This study was approved by the institutional review board; all subjects gave informed consent. Ninety patients with cirrhosis (65 men, 25 women; mean age, 54.8 years; range, 21-77 years) were prospectively enrolled and underwent endoscopy and CT esophagography. Esophageal varices were graded independently at endoscopy by two endoscopists. CT esophagograms were interpreted retrospectively with a four-point scale by two radiologists blinded to other findings. Interobserver agreement between each radiologist and endoscopist was determined; endoscopic and CT esophagographic grades of esophageal varices were correlated. Radiologist performance for differentiation between low- and high-risk varices for bleeding on the basis of morphology at endoscopy was evaluated with receiver operating characteristic analysis. Patients were interviewed to determine acceptance at both examinations.
Thirty-seven of 90 patients had grade 0, 23 had grade 1, 18 had grade 2, and 12 had grade 3 esophageal varices. Thus, 60 patients were determined to be in a low-risk group and 30 in a high-risk group for variceal bleeding at endoscopy. There was almost perfect agreement in grading esophageal varices between endoscopists. There was close correlation (P < .001) and substantial agreement between endoscopic and CT esophagographic grades. Radiologist performance for differentiating between low- and high-risk varices was 0.931-0.958 (area under receiver operating characteristic curve). Patient interview results revealed that CT esophagography had better acceptance than did endoscopy (P < .001).
Use of CT esophagography allows grading of esophageal varices and differentiation between low- and high-risk varices and shows better patient acceptance than does endoscopy.
以内镜检查为参考标准，评估多排螺旋计算机断层扫描（CT）食管造影术对食管静脉曲张进行分级以及区分低出血风险和高出血风险静脉曲张的应用价值。
本研究经机构审查委员会批准；所有受试者均签署知情同意书。前瞻性纳入90例肝硬化患者（男性65例，女性25例；平均年龄54.8岁；范围21 - 77岁），并接受内镜检查和CT食管造影术。两名内镜医师在内镜检查时独立对食管静脉曲张进行分级。两名对其他检查结果不知情的放射科医师采用四分制对CT食管造影图像进行回顾性解读。确定每位放射科医师与内镜医师之间的观察者间一致性；将内镜检查和CT食管造影检查的食管静脉曲张分级进行相关性分析。采用受试者操作特征分析评估放射科医师根据内镜下形态区分低风险和高风险出血性静脉曲张的表现。对患者进行访谈以确定其对两种检查的接受程度。
90例患者中，37例食管静脉曲张为0级，23例为1级，18例为2级，12例为3级。因此，在内镜检查中，60例患者被确定为静脉曲张出血低风险组，30例为高风险组。内镜医师之间在食管静脉曲张分级方面几乎完全一致。内镜检查和CT食管造影分级之间存在密切相关性（P <.001）且一致性良好。放射科医师区分低风险和高风险静脉曲张的表现为0.931 - 0.958（受试者操作特征曲线下面积）。患者访谈结果显示，CT食管造影术比内镜检查具有更好的接受度（P <.001）。
CT食管造影术可对食管静脉曲张进行分级并区分低风险和高风险静脉曲张，且与内镜检查相比，患者接受度更高。
