Title: Comparison of CT Portography and Color Doppler Ultrasound for Detection of Varices in Cirrhotic Patients
Authors: Dr N. Suriyaprakash, Prof. Dr J. Devimeenal
DOI: https://dx.doi.org/10.18535/jmscr/v9i9.18
Abstract
Background: Cirrhosis is the end result of all chronic liver disease. Most common cause of death in cirrhosis patient is upper gastrointestinal tract bleeding due to development of esophageal varices. Diagnosis of portosystemic collaterals by non-invasive techniques will help to avoid potential complications during interventional procedures and surgery.
Aim of the Study: To compare diagnostic efficacy of CT Portography and Color Doppler Ultrasound for detection of varices in cirrhotic patients.
Materials and Methods: A cross sectional study including 45 patients who presented at medical gastroenterology department with liver cirrhosis based on symptoms and laboratory values from March 2018 to February 2019. Firstly Color Doppler US was performed using GE-Logic S7 and selection of transducer and gain settings varied in each case for optimum demonstration of portal venous anatomy, pathology and venous collaterals. CT was performed with a Toshiba Aquilion Lightning MDCT and Portography images were obtained using the Work Station. All the patients were subjected to Endoscopy and findings were compared with USG and CT using Pearson’s Coefficient test.
Statistical Analysis Used: Statistical analysis for comparing collateral detection was performed using McNemars tests and measurement of agreement was done using Kappa Coefficient.
Results: Of the 45 patients 13, 7, 19 & 6 patients had no varices and Grade I/ II & III oesophageal varices respectively. USG was able to detect 4/6 Grade III varices and Grade I / II varices were not detected in USG. CT detected all 19 cases of grade II varices and 6 cases of Grade III varices. There was strong agreement (Kappa values >0.7) between USG and CT for diagnosis of paraesophageal, splenorenal, anterior abdominal wall, peri-umbilical and peri-cholecystic collaterals. There was no agreement for detection of esophageal , gastric mucosal, perigastric and retroperitoneal collaterals between USG and CT.
Conclusion: USG detects Grade III varices and CT detects Grade II and III varices. CT is better for delineation of all portosystemic collaterals compared to USG. USG is inferior to MDCT portal venous phase in delineating complex collateral pathways. Multislice CT can detect potentially problematic varices by detailing the course of tortuous vessels which is important in liver transplantation surgeries for detection of unexpected varices that can result in significant bleeding.
Keywords: CT Portography, Color Doppler USG, Varices, Liver cirrhosis
Keymessage: MDCT portography can detect problematic varices by detailing the tortuous vessels which is essential in liver transplantation surgeries for detection of unexpected varices that can result in torrential bleeding. CT Portography images can replace the endoscope in the detection of problematic varices.
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