title: Usefulness of MR elastography for predicting esophageal varices in cirrhotic patients.
abstract: OBJECTIVE
  To evaluate the usefulness of magnetic resonance elastography (MRE) as a noninvasive tool for predicting esophageal varices and identifying high-risk varices.
  
  
  METHODS
  In all, 126 patients with liver cirrhosis, and who underwent both MRI including MRE of the liver as well as upper gastrointestinal endoscopy for variceal screening within 1 month before or after the MRI, were included in this study. The relationship between the liver stiffness values measured by MRE and the degree of esophageal varices was assessed using Spearman's correlation analysis. In addition, the diagnostic performance of MRE for predicting the presence of varices or high-risk varices (grade≥II) was evaluated using the receiver-operating characteristics (ROC) curves.
  
  
  RESULTS
  The mean stiffness values of liver parenchyma measured on MRE were well correlated with the grade of esophageal varices (r=0.63). In addition, the MRE-based liver stiffness values were significantly lower in the lower-risk group than in the higher-risk group (P<0.0001). The area under the ROC curve values of MRE for predicting the presence of varices or high-risk varices (grade≥II) were 0.859 and 0.810, respectively. Using a liver stiffness cutoff value of 5.803 kPa, the sensitivity, specificity, positive predictive value, and negative predictive value for predicting high-grade (≥II) esophageal varices were 96%, 60%, 36%, and 98%, respectively.
  
  
  CONCLUSIONS
  The MRE-based liver stiffness value may be useful for noninvasively predicting esophageal varices and identifying high-risk varices in cirrhotic patients.
authors.affiliation: Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hye Young
authors.initials: HY
authors.lastname: Sun
authors.forename: Jeong Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.forename: Byung Ihn
authors.initials: BI
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D015331:Cohort Studies; D054459:Elasticity Imaging Techniques / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index
keywords: MR elastography; esophageal varices; liver cirrhosis