title: Multidetector CT oesophagography: an alternative screening method for endoscopic diagnosis of oesophageal varices and bleeding risk.
abstract: OBJECTIVE
  Variceal bleeding is a frequent and life-threatening complication of portal hypertension. The aim of this study was to evaluate multidetector computed tomographic (MDCT) oesophagography as an alternative to endoscopy for screening oesophageal varices (EVs) and predicting bleeding risk.
  
  
  METHODS
  A total of 137 cirrhotic patients underwent MDCT followed by endoscopy and EVs were graded independently. The screening ability of CT for EV was evaluated by comparing the grades of EV at CT and at endoscopy. Prediction of bleeding risk by CT was determined by correlating the CT variceal grades, diameters and palisade vein dilatation with the endoscopic red colour (RC) sign. Extra-oesophageal findings were assessed by CT. Patients' acceptance for both examinations were compared.
  
  
  RESULTS
  At endoscopy, 47 (34%) patients had grade 0 EV, 52 (38%) patients had grade 1 EV, 29 (21%) patients had grade 2 EV and nine (7%) patients had grade 3 EV. The sensitivity, specificity, positive and negative predictive values and accuracy of CT oesophagography for defining EV in all grades were 99%, 98%, 99%, 98% and 99%, respectively. The MDCT variceal grades, diameters and palisade vein dilatation were correlated with the severity of the RC sign. Important extra-oesophageal findings were determined by CT only. The acceptance of patients for CT oesophagography was significantly more than that for endoscopy (p<0.001).
  
  
  CONCLUSIONS
  MDCT is a reliable, preliminary or adjunctive method that can be used for routine screening for EVs and the prediction of variceal bleeding.
authors.affiliation: Department of Radiology, Faculty of Medicine, Menofia University, Shibin Elkom, Egypt.
authors.forename: Basma Abdel Moneim
authors.initials: BA
authors.lastname: Dessouky
authors.forename: El Sayed Mohamed
authors.initials: el SM
authors.lastname: Abdel Aal
mesh_terms: D000368:Aged; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D057240:Patient Preference; D010690:Phlebography; D011237:Predictive Value of Tests; D018570:Risk Assessment
keywords: Bleeding risk; Endoscopy; Multidetector CT oesophagography (MDCT); Oesophageal varices; Variceal bleeding; Variceal grades