title: Prediction of esophageal varices in patients with cirrhosis: usefulness of three-dimensional MR elastography with echo-planar imaging technique.
abstract: OBJECTIVE
  To determine the diagnostic performance of magnetic resonance (MR) elastography in comparison to spleen length and dynamic contrast material-enhanced (DCE) MR imaging in association with esophageal varices in patients with liver cirrhosis by using endoscopy as the reference standard.
  
  
  METHODS
  This retrospective study received institutional review board approval, and informed consent was waived. One hundred thirty-nine patients with liver cirrhosis who underwent liver DCE MR imaging, including MR elastography, were included. Hepatic stiffness (HS) and spleen stiffness (SS) values assessed with MR elastography, as well as spleen length, were correlated with the presence of esophageal varices and high-risk varices by using Spearman correlation analysis. The diagnostic performance of MR elastography was compared with that of DCE MR imaging and combined assessment of MR elastography and DCE MR imaging by using receiver operating characteristic analysis. MR elastography reproducibility was assessed prospectively, with informed consent, in another 15 patients by using intraclass correlation coefficients.
  
  
  RESULTS
  There were significant positive linear correlations between HS, SS, and spleen length and the grade of esophageal varices (r = 0.46, r = 0.48, and r = 0.36, respectively; all P < .0001). HS and SS values (>4.81 kPa and >7.60 kPa, respectively) showed better performance than did spleen length in the association with esophageal varices (P = .0306 and P = .0064, respectively). Diagnostic performance of HS and SS in predicting high-risk varices was comparable to that of DCE MR imaging (P = .1282 and P = .1371, respectively). When MR elastography and DCE MR imaging were combined, sensitivity improved significantly (P = .0004). MR elastography was highly reproducible (intraclass correlation coefficient > 0.9).
  
  
  CONCLUSIONS
  HS and SS are associated with esophageal varices and showed better performance than did spleen length in assessing the presence of esophageal varices. MR elastography is comparable to DCE MR imaging in predicting the presence of esophageal varices and high-risk varices, but, when assessed in combination, sensitivity is higher.
authors.affiliation: From the Department of Radiology, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea (S.U.S., J.M.L., M.H.Y., J.H.Y., J.K.H., B.I.C.); MR Imaging Research Laboratory, Mayo Foundation/Clinic, Rochester, Minn (K.J.G., R.L.E.); and Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, South Korea (M.H.Y.).
authors.forename: Sung Ui
authors.initials: SU
authors.lastname: Shin
authors.forename: Jeong-Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Mi Hye
authors.initials: MH
authors.lastname: Yu
authors.forename: Jeong Hee
authors.initials: JH
authors.lastname: Yoon
authors.forename: Joon Koo
authors.initials: JK
authors.lastname: Han
authors.forename: Byung-Ihn
authors.initials: BI
authors.lastname: Choi
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Glaser
authors.forename: Richard L
authors.initials: RL
authors.lastname: Ehman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D017352:Echo-Planar Imaging / Q000379:methods; D054459:Elasticity Imaging Techniques / Q000379:methods*; D016145:Endoscopy, Digestive System; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000209:etiology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
chemical_list: D003287:Contrast Media