Park Hee Sun, Kim Young Jun, Choe Won Hyeok, Ko Su Yeon, Bak So Hyeon, Il Jung Sung, Jeon Hae Jeong
Hepatogastroenterology. 2015 Mar-Apr;62(138):333-40.
BACKGROUND/AIMS: The aim of this study was to evaluate the effect of 1 mm, 3 mm, and 5 mm section thicknesses of liver CT on the detection and grading of esophageal varices in cirrhotic patients.
A total of 219 consecutive cirrhotic patients who had undergone both upper endoscopy and 64-channel liver CT were included. Portal phase images of each CT were reconstructed with a section thickness of 1 mm, 3 mm, and 5 mm. Four radiologists independently reviewed the 3 image sets. The observers evaluated the presence of esophageal varices on a 5-point confidence scale and measured the maximal short diameter of the largest varix identified. Sensitivity, specificity and predictive value calculation and receiver operating characteristic analysis were performed. Correlation between CT measurements and endoscopic grading as the reference standard was assessed.
The averaged Az values at 1 mm, 3 mm, and 5 mm image sets were 0.936, 0.946, and 0.935, respectively, and they were not significantly different among the 4 observers. When a 3 mm cut-off criterion for large varices was applied, sensitivity, specificity, and predictive values were comparable among the 3 image datasets.
Routine liver CT protocol is sufficient for evaluation of esophageal varices in cirrhotic patients without adding thin section reconstruction images.
背景/目的：本研究旨在评估肝脏CT中1mm、3mm和5mm层厚对肝硬化患者食管静脉曲张检测及分级的影响。
纳入219例连续接受上消化道内镜检查和64排肝脏CT检查的肝硬化患者。将每次CT的门静脉期图像重建为1mm、3mm和5mm的层厚。四位放射科医生独立评估这三组图像。观察者采用5分置信度量表评估食管静脉曲张的存在情况，并测量所识别出的最大静脉曲张的最大短径。进行敏感性、特异性和预测值计算以及受试者工作特征分析。以内镜分级为参考标准，评估CT测量值与之的相关性。
1mm、3mm和5mm图像组的平均Az值分别为0.936、0.946和0.935，四位观察者之间无显著差异。当采用3mm作为大静脉曲张的截断标准时，三组图像数据集的敏感性、特异性和预测值相当。
常规肝脏CT检查方案足以评估肝硬化患者的食管静脉曲张，无需添加薄层重建图像。
