Hayato Abe1, Yutaka Midorikawa2, Naoki Matsumoto3, Mitsuhiko Moriyama3, Kazu Shibutani4, Masahiro Okada4, Seiichi Udagawa5, Shingo Tsuji6, Tadatoshi Takayama1. 1. Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan. 2. Department of Digestive Surgery, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan. mido-tky@umin.ac.jp. 3. Department of Gastroenterology and Hepatology, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan. 4. Department of Radiology, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan. 5. Department of Mathematics, Nihon University School of Medicine, 30-1, Oyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan. 6. Research Center of Advanced Science and Technology, Genome Science Divisions, University of Tokyo, Tokyo, Japan.
Abstract
OBJECTIVES: We aimed to assess the diagnostic performance of MR elastography (MRE) in predicting esophageal varices (EVs) in patients with chronic liver disease. METHODS: We prospectively performed liver (LSM) and spleen stiffness measurements (SSM) using MRE and endoscopic screening for EVs to determine if patients with hepatocellular carcinoma were eligible for resection. We investigated whether LSM, SSM, and other non-invasive preoperative parameters were associated with the presence of EVs. In order to predict EVs, 211 patients were divided into training (n = 140) and test (n = 71) groups. A nomogram was built using independent factors based on logistic regression analysis in the training group and its accuracy was validated using an independent cohort. RESULTS: Forty-six patients (21.8%) were diagnosed as having EVs (mild, n = 36; severe, n = 10). According to multiple regression analysis, LSM (odds ratio, 2.362; 95% confidence interval [CI], 1.341-4.923; p = 0.001) and SSM (1.489; 1.095-2.235; p = 0.010) were independent predictors of EVs in the training group. The nomogram showed good discrimination, with a C-index of 0.942 (95% CI, 0.892-0.974) through internal validation, and good calibration. Application of the nomogram in the test group still gave good discrimination (C-index, 0.948; 95% CI, 0.868-0.995). CONCLUSIONS: The combination of LSM and SSM using MRE is an accurate tool to identify patients at risk for EVs. KEY POINTS: • Performance of MR elastography can estimate the presence of esophageal varices non-invasively. • Liver and spleen stiffness measurements are independent predictors for esophageal varices. • The nomogram using a combination of liver and spleen stiffness measurements allows for the risk of esophageal varices.
OBJECTIVES: We aimed to assess the diagnostic performance of MR elastography (MRE) in predicting esophageal varices (EVs) in patients with chronic liver disease. METHODS: We prospectively performed liver (LSM) and spleen stiffness measurements (SSM) using MRE and endoscopic screening for EVs to determine if patients with hepatocellular carcinoma were eligible for resection. We investigated whether LSM, SSM, and other non-invasive preoperative parameters were associated with the presence of EVs. In order to predict EVs, 211 patients were divided into training (n = 140) and test (n = 71) groups. A nomogram was built using independent factors based on logistic regression analysis in the training group and its accuracy was validated using an independent cohort. RESULTS: Forty-six patients (21.8%) were diagnosed as having EVs (mild, n = 36; severe, n = 10). According to multiple regression analysis, LSM (odds ratio, 2.362; 95% confidence interval [CI], 1.341-4.923; p = 0.001) and SSM (1.489; 1.095-2.235; p = 0.010) were independent predictors of EVs in the training group. The nomogram showed good discrimination, with a C-index of 0.942 (95% CI, 0.892-0.974) through internal validation, and good calibration. Application of the nomogram in the test group still gave good discrimination (C-index, 0.948; 95% CI, 0.868-0.995). CONCLUSIONS: The combination of LSM and SSM using MRE is an accurate tool to identify patients at risk for EVs. KEY POINTS: • Performance of MR elastography can estimate the presence of esophageal varices non-invasively. • Liver and spleen stiffness measurements are independent predictors for esophageal varices. • The nomogram using a combination of liver and spleen stiffness measurements allows for the risk of esophageal varices.
Authors: Laurent Huwart; Christine Sempoux; Eric Vicaut; Najat Salameh; Laurence Annet; Etienne Danse; Frank Peeters; Leon C ter Beek; Jacques Rahier; Ralph Sinkus; Yves Horsmans; Bernard E Van Beers Journal: Gastroenterology Date: 2008-04-04 Impact factor: 22.682
Authors: Roberto Santambrogio; Michael D Kluger; Mara Costa; Andrea Belli; Matteo Barabino; Alexis Laurent; Enrico Opocher; Daniel Azoulay; Daniel Cherqui Journal: HPB (Oxford) Date: 2012-10-24 Impact factor: 3.647