ROLE OF CONTRAST ENHANCED COMPUTED TOMOGRAPHY IN DETECTION AND GRADING OF ESOPHAGEAL VARICES IN PATIENTS WITHLIVER CIRRHOSIS.

Abstract

Background:Purpose is to evaluate the role of contrast enhanced CT in the detection of esophageal varices (OV) and the differentiation of the varices at low risk and those at high risk of bleeding compared to upper GIT endoscopy. Patients and Methods:This study includes 32 patients with liver cirrhosis. These patients were selected from outpatient clinic and inpatient section of internal medicine department, Zagazig university hospitals. Patients with active or previous variceal bleeding, or with history of previous variceal ligation or injection were excluded. OV were best visualized on axial multidetector-CT (MD-CT) images in the post-contrast portal venous phase. upper GIT endoscope and contrast enhanced CT was done to all the patients . Results:The study was conducted on 32 patients with liver cirrhosis; 23 males and 9 females with a mean age 55.97 +/- 9.04 years They were classified according to the CT findings into 3 groups Group I: included (3) patients (9.4%) with no esophageal varices (2) males, (1) female with a mean age (60.5 +/-4.5 ) years. Group II: included (12) patients (37.5%) with small varices (low risk varices) (8) males, (4) females with a mean age (56.08 +/- 12.7) years Group III: included (17) (53.1%) patients with large varices (high risk varices) (13) males, (4) females with a mean age (55.12 +/- 6.5) years. The overall CT sensitivity for detection of OV was 96.7%, specificity 100%, positive predictive value 100% and negative predictive value 66.7%.The CT sensitivity for the high risk OV cases (100%) was higher than that for those with low risk OV (92.3%).There was no significant statistical difference in the distribution of age, sex and extra-esophageal CT findings between the low and high risk OV cases (P-value >0.05). Conclusion: contrast enhanced Computed Tomography is a good alternative diagnostic tool to conventional upper G.I.T endoscopy for detecting and grading of esophageal varices in patients with liver cirrhosis. Key words: esophageal varices-contrast enhanced CT-detection and grading of the OV.