Detection and grading for esophageal varices in patients with chronic liver damage: comparison of gadolinium-enhanced and unenhanced steady-state coherent MR images.
The purpose of this study was to compare observer interpreted steady-state coherent coronal images and gadolinium-enhanced axial images in terms of the detection and grading of esophageal varices. Magnetic resonance imaging (MRI) and gastrointestinal endoscopy were performed within 2 weeks in 90 patients with chronic liver damage, including 55 with untreated esophageal varices, for periodic screening purposes. Two blinded readers retrospectively reviewed T1- and T2-weighted images with gadolinium-enhanced (gadolinium image set) and steady-state coherent (coherent image set) images. Sensitivity for the detection of esophageal varices was higher (P<.001) in the gadolinium image set (76%) than in the coherent image set (35%); on the other hand, specificity was higher (P<.001) in the coherent image set (91%) than in the gadolinium image set (66%). Furthermore, area under the ROC curve was higher for the gadolinium image set (Az=0.823) than the coherent image set (Az=0.761) (P=.48). Moderate and weak positive correlations with endoscopic grades were found for the gadolinium image (r=0.48, P<.01) and coherent image sets (r=0.34, P=.018). The addition of steady-state coherent imaging to the current routine liver imaging protocol did not improve the detection or grading of esophageal varices, whereas gadolinium-enhanced imaging was found to be potentially valuable. Nevertheless, endoscopy was confirmed to be mandatory in patients with esophageal varices suspected by MRI of the liver.
Goshima
Satoshi
S
Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1193, Japan.
Kanematsu
Masayuki
M
Kondo
Hiroshi
H
Tsuge
Yusuke
Y
Watanabe
Haruo
H
Shiratori
Yoshimune
Y
Onozuka
Minoru
M
Moriyama
Noriyuki
N
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000494:pharmacology*; D004724:Endoscopy / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D005682:Gadolinium / Q000494:pharmacology*; D006801:Humans; D008099:Liver / Q000293:injuries; D008107:Liver Diseases / Q000150:complications* / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve
D003287:Contrast Media; D005682:Gadolinium