Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jan-Mar;29(1):71-8.

Multidetector computed tomography versus platelet/spleen diameter ratio as methods for the detection of gastroesophageal varices

Andreas Karatzas  1 , Christos Triantos  2 , Maria Kalafateli  2 , Misiel Marzigie  2 , Chryssoula Labropoulou-Karatza  3 , Konstantinos Thomopoulos  2 , Theodoros Petsas  1 , Christina Kalogeropoulou  1
Affiliations

Multidetector computed tomography versus platelet/spleen diameter ratio as methods for the detection of gastroesophageal varices

Andreas Karatzas et al. Ann Gastroenterol. 2016 Jan-Mar.

Abstract

Background: All patients with liver cirrhosis should undergo screening endoscopy, but there are limitations and this approach places a heavy burden upon endoscopy units. The aim of this study was to compare multidetector computed tomography (MDCT) and the platelet/spleen diameter ratio as non-invasive methods for the detection of gastroesophageal varices.

Methods: The study included 38 cirrhotics who underwent upper gastrointestinal (GI) endoscopy and MDCT within one month. Two radiologists reviewed the scans, in order to determine the presence and the size of varices. Blood tests and measurement of the spleen maximum diameter were also carried out and the platelet/spleen diameter ratio was calculated. Endoscopy was considered the gold standard and the results of the two methods were compared to it.

Results: Varices were detected by upper GI endoscopy in 24 of 38 patients. The mean sensitivity and specificity of MDCT for the two observers was 86.1% and 57.1% respectively. In patients with large varices (>5 mm), the sensitivity was 100% (4/4). Using 909 as a cut-off value of the platelet/spleen diameter ratio this method yielded a sensitivity of 56.5% and a specificity of 35.7%. The difference in sensitivity and specificity between the two methods was statistically significant P<0.05.

Conclusion: MDCT was accurate for the detection of gastroesophageal varices, especially those with clinically significant size (>5 mm), and superior to platelet/spleen diameter ratio. MDCT could replace, in selected patients, upper GI endoscopy as a method for detecting gastroesophageal varices in cirrhotic patients.

Keywords: Varices; endoscopy; multidetector computed tomography; platelet/spleen ratio.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
True positive computed tomography scans for esophageal varices. (A) Small submucosal (thin arrow) and subserosal (thick arrow) esophageal varices. (B) Big submucosal esophageal varices
Figure 2
Figure 2
False positive computed tomography (CT) scans for gastric and esophageal varices. (A) Large varices are demonstrated within the stomach, although the endoscopy was negative. (B) False positive CT for esophageal varices. Subserosal varices are clearly viewed (thick arrow). The small hyperdense dots (thin arrows) were thought to be submucosal varices but the endoscopy did not confirm the diagnosis
See this image and copyright information in PMC

References

    1. Merli M, Nicolini G, Angeloni S, et al. Incidence and natural history of small esophageal varices in cirrhotic patients. J Hepatol. 2003;38:266–272. - PubMed
    1. De Franchis R, Dell’Era A. Non-invasive diagnosis of cirrhosis and the natural history of its complications. Best Pract Res Clin Gastroenterol. 2007;21:3–18. - PubMed
    1. Burroughs AK, Triantos CK. Predicting failure to control bleeding and mortality in acute variceal bleeding. J Hepatol. 2008;48:185–188. - PubMed
    1. D’Amico G, De Franchis R, Cooperative Study Group Upper digestive bleeding in cirrhosis. Post-therapeutic outcome and prognostic indicators. Hepatology. 2003;38:599–612. - PubMed
    1. North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med. 1988;319:983–989. - PubMed

LinkOut - more resources