Somsouk Ma, To'o Katherine, Ali Mujtaba, Vittinghoff Eric, Yeh Benjamin M, Yee Judy, Monto Alex, Inadomi John M, Aslam Rizwan
Division of Gastroenterology, Department of Medicine, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, USA,
Abdom Imaging. 2014 Apr;39(2):251-6. doi: 10.1007/s00261-013-0057-x.
Endoscopy is recommended to screen for esophageal varices in patients with cirrhosis. The objective of this study was to identify features on abdominal CT imaging associated variceal hemorrhage (VH).
A case-control study was performed among patients with cirrhosis who had a CT scan. Consecutive patients who experienced VH were included as cases, and patients without VH served as controls. Two radiologists recorded the maximal esophageal varix diameter in addition to other measures of portal hypertension at CT.
The most powerful CT parameter associated with VH was the esophageal varix diameter (5.8 vs. 2.7 mm, p < 0.001; adjusted OR 1.84 per mm, p = 0.009). 63% of individuals with VH had a maximal varix diameter ≥5 mm compared to 7.5% of cirrhotic patients without VH (p < 0.001). In contrast, the proportion of individuals whose largest varix was <3 mm was 7.4% among VH cases compared to 54.7% among controls (p = 0.001). The varix diameter powerfully discriminated those with and without VH (C-statistic 0.84).
A large esophageal varix diameter is strongly associated with subsequent VH. A threshold of <3 and ≥5 mm appears to identify patients with cirrhosis at low and high risk for hemorrhage.
推荐内镜检查用于筛查肝硬化患者的食管静脉曲张。本研究的目的是确定腹部CT成像上与静脉曲张出血（VH）相关的特征。
对进行了CT扫描的肝硬化患者开展一项病例对照研究。连续发生VH的患者纳入病例组，未发生VH的患者作为对照组。两名放射科医生除记录CT上其他门静脉高压指标外，还记录最大食管静脉曲张直径。
与VH相关的最有力的CT参数是食管静脉曲张直径（5.8对2.7mm，p<0.001；校正比值比为每毫米1.84，p=0.009）。发生VH的患者中63%的最大静脉曲张直径≥5mm，而未发生VH的肝硬化患者中这一比例为7.5%（p<0.001）。相比之下，VH病例中最大静脉曲张<3mm的个体比例为7.4%，而对照组中为54.7%（p=0.001）。静脉曲张直径能有效区分有无VH（C统计量为0.84）。
大的食管静脉曲张直径与随后的VH密切相关。<3mm和≥5mm的阈值似乎可识别出血风险低和高的肝硬化患者。
