title: Predictive value of CT for first esophageal variceal bleeding in patients with cirrhosis: Value of para-umbilical vein patency.
abstract: OBJECTIVE
  To evaluate if the presence/size of a para-umbilical vein (PUV) on computed tomography (CT) are associated with a first esophageal variceal hemorrhage (EVH) in patients with cirrhosis and whether imaging features can help identify patients at increased risk of EVH.
  
  
  METHODS
  From January 2010 to June 2012 patients with cirrhosis who underwent CT and upper gastrointestinal endoscopy within six months were included. The presence/size of PUV was noted. PUV>5mm were considered large (LPUV). Association with a first EVH was searched for, and validated in a prospective cohort of 55 patients.
  
  
  RESULTS
  172 patients (113 men, mean 60±12 yo) were included. Forty-three patients (25%) experienced a first EVH. LPUV were more frequent in the group without EVH (27% vs. 7%, p=0.005). At multivariate analysis, factors associated with a first EVH were spleen size>135mm (Odd Ratio [OR]=1.32 [95% confident interval [CI] 1.16-1.51], p<0.001), ascites (OR=4.07 [95%CI-1.84-9.01], p=0.001) and small/absent PUV (OR=3.06 [95%CI-1.86-5.05], p<0.001). An imaging score combining these factors was significantly associated with first EVH in the study and the validation cohorts (EVH in 0%, 19%, and 33% when score 0-1, 2-3, and 4-5, respectively).
  
  
  CONCLUSIONS
  A simple imaging score combining the PUV and spleen size, and the presence of ascites could help to identify cirrhotic patients at high-risk for EVH.
authors.affiliation: Department of Radiology, University Hospitals of Besançon, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Calame
authors.affiliation: Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France. Electronic address: maxime.ronot@aphp.fr.
authors.forename: Maxime
authors.initials: M
authors.lastname: Ronot
authors.affiliation: Department of Radiology, University Hospitals of Besançon, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Bouveresse
authors.affiliation: Department of Hepatology, University Hospitals of Besançon, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Cervoni
authors.affiliation: Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, Paris, France; INSERM U1149, centre de recherche biomédicale Bichat-Beaujon, CRB3, Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Vilgrain
authors.affiliation: Department of Radiology, University Hospitals of Besançon, France.
authors.forename: Éric
authors.initials: É
authors.lastname: Delabrousse
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D004932:Esophageal and Gastric Varices / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014471:Umbilical Veins / Q000000981:diagnostic imaging*; D055815:Young Adult
keywords: Ascites; Esophageal varices; Portal hypertension; Prognosis