Comparison of multi-slice spiral CT portography and endoscopy in the diagnosis of esophageal and gastric varices in liver cirrhosis

Objective: To study the correlation of multi-slice CT portography (MSCTP) and digestive endoscopy in the diagnosis and evaluation of esophageal and gastric varices (EGV) caused by cirrhosis. Methods: A total of 92 patients with cirrhosis were enrolled in the prospective study. All the patients were examined by endoscopy and 64-slice spiral CT scan in 4 weeks. The types, grading of EGV were observed by endoscopy and MSCTP, and Kappa conformance test was applied with the endoscopic findings as gold standard. The sensitivity, specificity, consistency, and Youden index were evaluated for the diagnosis of esophageal and gastric varices by MSCTP. Results: Sixty-five patients were diagnosed to have EGV by endoscopy and 27 were negative. The positive patients included 45 patients of GOV1, 19 of GOV2 and 1 patient of IGV1. MSCTP diagnosed 67 cases of EGV and 25 patients of negative results. The positive patients included 46 of GOV1, 18 of GOV2 and 3 of IGV1. Two patients of IGV1 varicose veins without positive findings on endoscopy were diagnosed by using MDCTP, which revealed isolated varicose veins under the gastric mucosa. There was high consistency between MSCTP and EGV in the diagnosis of EGV (Kappa=0.732, P<0.01). The sensitivity of MSCTP was 93.8%, specificity was 77.8%, consistency was 89.1%, and Youden index 71.6%. There was high consistency between MSCTP and EGV in the classification of EGV (Kappa values were 0.743 and 0.763, P<0.01). Conclusions: There is high consistency between MSCTP and digestive endoscopic in the diagnosis and classification of EGV in cirrhosis. MSCTP is superior to endoscopy in the detection of gastric varices. (authors)