title: Esophageal varices: diagnosis with gadolinium-enhanced MR imaging of the liver for patients with chronic liver damage.
abstract: OBJECTIVE
  The purpose of our study was to evaluate the value of gadolinium-enhanced MR imaging of the liver in the detection and grading of esophageal varices in patients with chronic liver damage.
  
  
  METHODS
  Three independent off-site radiologists retrospectively reviewed MR images of the liver obtained in 72 patients with chronic liver damage, including 49 patients with untreated esophageal varices. All patients had undergone gastrointestinal endoscopy within 2 weeks of MR imaging. Both MR and endoscopic images were reviewed to determine whether esophageal varices were present and, if so, to determine the grade of the varices. Observer performances were tested with receiver operating characteristic curve analysis using the jackknife dispersion test. Correlations between the grades of the varices determined using MR images and those determined using endoscopic images were tested.
  
  
  RESULTS
  Sensitivity for detection of esophageal varices was significantly (p < 0.01) higher for the combination of unenhanced and gadolinium-enhanced MR images (81%) than for the unenhanced MR images alone (51%). The receiver operating characteristic curve analysis (area under the curve, [A(z)]) showed that performance using the combination of the unenhanced and gadolinium-enhanced MR images (A(z) = 0.641) was superior to that using unenhanced MR images alone (A(z) = 0.586). A statistically significant positive correlation (p < 0.05) was found between the grades determined using MR imaging and the grades determined using endoscopy.
  
  
  CONCLUSIONS
  Our results suggest the potential value of diagnosing the presence and grade of esophageal varices on MR imaging of the liver for patients with chronic liver damage. Gadolinium-enhanced MR imaging may increase the potential value.
authors.affiliation: Department of Radiology, Gifu University School of Medicine, 40 Tsukasamachi, Gifu 500-8705, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Matsuo
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kanematsu
authors.forename: Tonsok
authors.initials: T
authors.lastname: Kim
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Hori
authors.forename: Manabu
authors.initials: M
authors.lastname: Takamura
authors.forename: Takamichi
authors.initials: T
authors.lastname: Murakami
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kondo
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Moriyama
authors.forename: Hironobu
authors.initials: H
authors.lastname: Nakamura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hoshi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D002908:Chronic Disease; D003287:Contrast Media; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis*; D004945:Esophagoscopy; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA