Contrast-Enhanced Ultrasonography Diagnostic Evaluation of Esophageal Varices in Patients With Cirrhosis

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The purpose of this study was to clarify the usefulness of contrast-enhanced ultrasonography (CEUS) for the diagnosis of esophageal varices (EVs) in patients with cirrhosis. A total of 81 cases (56 patients with EVs and 25 control subjects without EV) were examined by CEUS and by esophagogastroduodenoscopy. According to the esophagogastroduodenoscopy results, we divided the subjects into 3 groups: G0, G1, and G2. The G0 group had 25 patients who exhibited no liver abnormality other than liver cyst or hemangioma without EVs, G1 comprised 9 patients with small EVs and 13 with medium EVs. G2 was composed of 34 cases of severe EVs. Under CEUS, the following parameters were measured: the thickness of double-layer mucosa and submucosa in the lower esophagus (Tm), the maximum anteroposterior diameter of the lower esophagus (De), and the ratio of Tm to De (Tm/De). Time-intensity curves of the lower esophagus and aorta were drawn using QLAB software. One-factor analysis of variance was used to compare means between the 3 groups. The diagnostic value of CEUS was assessed by receiver operating characteristic curves. Bayes discriminant analysis was adopted for building discriminant equations. Tm, De, Tm/De, Tep, and Iep/Iap were greater in patients with EVs (G1 and G2) than in those without EVs (G0). The Tms for the G0, G1, and G2 groups were 4.16 ± 0.59 mm, 7.06 ± 0.89 mm, and 10.10 ± 1.77 mm (P < 0.01), respectively, with 7.65 mm being the best cutoff value for diagnosing ≥ G2 (sensitivity 96.9%, specificity 90.0%). The area under the receiver operating characteristic curve was 0.987. Three discriminant equations were obtained by Bayes discriminant analysis: y0 = −6.2 + 2.5Tm, y1 = −15.1 + 4.1Tm and y2 = −31.7 + 6.0Tm, respectively. The equations correctly classified 91.7% of cases in the study, making an error rate of 8.3%. Tm attained from CEUS can be a new, convenient, noninvasive parameter for evaluating esophageal varices in patients with liver cirrhosis.

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