Paul Calame1, Maxime Ronot2, Sébastien Bouveresse1, Jean-Paul Cervoni3, Valérie Vilgrain4, Éric Delabrousse1. 1. Department of Radiology, University Hospitals of Besançon, France. 2. Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France. Electronic address: maxime.ronot@aphp.fr. 3. Department of Hepatology, University Hospitals of Besançon, France. 4. Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
Abstract
PURPOSE: To evaluate if the presence/size of a para-umbilical vein (PUV) on computed tomography (CT) are associated with a first esophageal variceal hemorrhage (EVH) in patients with cirrhosis and whether imaging features can help identify patients at increased risk of EVH. MATERIALS AND METHODS: From January 2010 to June 2012 patients with cirrhosis who underwent CT and upper gastrointestinal endoscopy within six months were included. The presence/size of PUV was noted. PUV>5mm were considered large (LPUV). Association with a first EVH was searched for, and validated in a prospective cohort of 55 patients. RESULTS: 172 patients (113 men, mean 60±12 yo) were included. Forty-three patients (25%) experienced a first EVH. LPUV were more frequent in the group without EVH (27% vs. 7%, p=0.005). At multivariate analysis, factors associated with a first EVH were spleen size>135mm (Odd Ratio [OR]=1.32 [95% confident interval [CI] 1.16-1.51], p<0.001), ascites (OR=4.07 [95%CI-1.84-9.01], p=0.001) and small/absent PUV (OR=3.06 [95%CI-1.86-5.05], p<0.001). An imaging score combining these factors was significantly associated with first EVH in the study and the validation cohorts (EVH in 0%, 19%, and 33% when score 0-1, 2-3, and 4-5, respectively). CONCLUSIONS: A simple imaging score combining the PUV and spleen size, and the presence of ascites could help to identify cirrhotic patients at high-risk for EVH.
PURPOSE: To evaluate if the presence/size of a para-umbilical vein (PUV) on computed tomography (CT) are associated with a first esophageal variceal hemorrhage (EVH) in patients with cirrhosis and whether imaging features can help identify patients at increased risk of EVH. MATERIALS AND METHODS: From January 2010 to June 2012 patients with cirrhosis who underwent CT and upper gastrointestinal endoscopy within six months were included. The presence/size of PUV was noted. PUV>5mm were considered large (LPUV). Association with a first EVH was searched for, and validated in a prospective cohort of 55 patients. RESULTS: 172 patients (113 men, mean 60±12 yo) were included. Forty-three patients (25%) experienced a first EVH. LPUV were more frequent in the group without EVH (27% vs. 7%, p=0.005). At multivariate analysis, factors associated with a first EVH were spleen size>135mm (Odd Ratio [OR]=1.32 [95% confident interval [CI] 1.16-1.51], p<0.001), ascites (OR=4.07 [95%CI-1.84-9.01], p=0.001) and small/absent PUV (OR=3.06 [95%CI-1.86-5.05], p<0.001). An imaging score combining these factors was significantly associated with first EVH in the study and the validation cohorts (EVH in 0%, 19%, and 33% when score 0-1, 2-3, and 4-5, respectively). CONCLUSIONS: A simple imaging score combining the PUV and spleen size, and the presence of ascites could help to identify cirrhotic patients at high-risk for EVH.