The role of computed tomography for the prediction of esophageal variceal bleeding: Current status and future perspectives

Table 1 Characteristics of the included studies

Ref.	Study design	Country	Study type	Enrollment period
Somsouk et al[28], 2014	R	United States	Unicentric	2002-2007
Ge et al[29], 2015	R	China	Unicentric	2008-2014
Calame et al[30], 2017	R	France	Unicentric	2010-2012
Kim et al[31], 2019	R	South Korea	Unicentric	2003-2015
Salahshour et al[32], 2020	R	Iran	Unicentric	2013-2019
Xie et al[33], 2020	R	China	Unicentric	2015-2018
Peisen et al[34], 2021	R	Germany	Unicentric	2010-2019
Wan et al[35], 2021	R	China	Unicentric	2014-2019
Wan et al[36], 2022	R	China	Unicentric	2017-2020

Table 2 Demographics and clinicopathological features of the included studies

Ref.	Patients, n	Mean age (range), years	Sex male, %	Cirrhosis etiology, %	Child-Pugh class, %	MELD score
Somsouk et al[28], 2014	80 (cases: 27; controls: 53)	Cases: 58 (-); Controls: 55 (-)	Cases: 96; Controls: 96	HCV: 71 (cases); 77 (controls); HBV: 0 (cases); 9 (controls); Alcoholic: 83 (cases); 64 (controls)	-	-1
Ge et al[29], 2015	98 (cases: 57; controls: 41)	Cases: 49.9 (-); Controls: 53.9 (-)	56	HBV: 100	A: 15 (cases); 28 (controls); B: 21 (cases); 12 (controls); C: 5 (cases); 4 (controls)	-
Calame et al[30], 2017	172 (cases: 43; controls: 129)	Cases: 59.6 (12-85); Controls: 60.2 (33-86)	Cases: 77; Controls: 62	Alcoholic: 77 (cases); 70 (controls); NASH: 9 (cases); 13(controls) HCV: 9 (cases); 9 (controls); HBV: 7 (cases); 4 (controls); Other: 5 (cases); 13 (controls)	A: 16 (cases); 43 (controls); B: 46 (cases); 27 (controls); C: 37 (cases); 29 (controls)	-
Kim et al[31], 2019	309 (cases: 37; controls: 272)	Cases: 58 (-); Controls: 58 (-)	Cases: 81; Controls: 72	HBV: 46 (cases); 61 (controls); HCV: 16 (cases); 7 (controls); Non-B/C: 38 (cases); 32 (controls)	A: 57 (cases); 48 (controls); B: 40 (cases); 44 (controls); C: 3 (cases); 8 (controls)	-
Salahshour et al[32], 2020	124 (cases: 50; controls: 74)	Cases: 49.2 (-); Controls: 52.14 (-)	Cases: 46; Controls: 54	HBV: 24.2; HCV: 5.6; BCS: 8.1; Alcoholic: 9.7; NASH: 14.5; ASH: 4.0; PSC: 9.7; Wilson disease: 2.4; PBC: 1.6; Cryptogenic: 10.5; Other: 9.7	-2	-2
Xie et al[33], 2020	264 (cases: 132; controls: 132)	Cases: 54 (30-76); Controls: 54 (25-79)	Cases: 85%; Controls: 88%	HBV: 87 (cases); 95 (controls); Alcoholic: 11 (cases); 1 (controls); HCV: 2 (cases); 4 (controls)	-	-
Peisen et al[34], 2021	66 (cases: 8; controls: 58)	68	89	HCV: 32; Alcoholic: 48; Cryptogenic: 14; HBV: 6	A: 53%; B: 38%; C: 9%	-
Wan et al[35], 2021	217 (cases: 17; controls: 27)	Cases: 52.8; Controls: 52.4	Cases: 53; Controls: 56	Post-hepatic: 53 (cases); 41 (controls); Alcoholic: 18 (cases); 15 (controls); PBC: 29 (cases); 19 (controls); Mixed: 0 (cases); 7 (controls) Other: 0 (cases); 19 (controls)	A: 47 (cases); 33 (controls); B: 35 (cases); 33 (controls); C: 18 (cases); 33 (controls)	-
Wan et al[36], 2022	136 (cases: 89; controls: 47)	-	63	Post-hepatic: 60; Alcoholic: 25; PBC: 9; Mixed: 4; AIH: 1	A: 28; B: 46; C: 26	-

¹No significant difference between case and control groups.

²Significant difference between case and control groups.

MELD: Model for end-stage liver disease; HCV: Hepatitis C virus; HBV: Hepatitis B virus; NASH: Nonalcoholic steatohepatitis; BCS: Budd-Chiari syndrome; AIH: Autoimmune hepatitis; PSC: Primary sclerosing cholangitis; PBC: Primary biliary cirrhosis.

Table 3 Summary of the included studies reporting on the role of computed tomography in the prediction of esophageal variceal bleeding

Ref.	Inclusion criteria	Exclusion criteria	Study aim	Results
Somsouk et al[28], 2014	Cirrhotic patients with EVB who underwent CT prior to EVB (case group); cirrhotic patients without EVB who underwent CT and EGD within 45 d (control group)	Previous EVB, EVL, or OLT	To identify CT features associated with EVB	Features associated with EVB: EV diameter: 5.8 mm case group vs. 2.7 mm control group (P < 0.001); Maximal EV diameter ≥ 5 mm: 63% case group vs. 7.5% control group (P < 0.001); Maximal EV diameter < 3 mm: 7.4% case group vs. 54.7% control group (P = 0.001); LGV diameter: 2.3 mm case group vs. 1.6 mm control group (P = 0.001); PUV diameter: 1.9 mm case group vs. 1.1 mm control group (P < 0.001); Ascites: 74% case group vs. 25% control group (P < 0.001)
Ge et al[29], 2015	HBV-related cirrhotic patients who underwent CT	HCC, PVT, and non HBV-related cirrhosis	To identify CT features associated with EVB	Features associated with EVB: IMV diameter (P = 0.0528); PGV diameter (P = 0.0283); EV score (P = 0.0221)
Calame et al[30], 2017	Cirrhotic patients who underwent CT and EGD within 6 mo	BB, TIPS, EVL, PVT, liver resection/loco-regional treatment, and esophageal cancer	To evaluate the association between the presence/size of PUV on CT and first EVB	Features associated with first EVB: Small/absent PUV (P < 0.001); Spleen size >135 mm (P < 0.001); Ascites (P = 0.001)
Kim et al[31], 2019	Cirrhotic patients receiving propranolol for the primary prophylaxis of EVB who underwent CT	Duration of propranolol prophylaxis < 6 mo, previous EVB and/or EVL before propranolol therapy, and lack of contrast-enhanced liver CT data within 6 mo before or after first propranolol dosage	To evaluate liver volume for the prediction of EVB during primary prophylaxis	Association of liver volume index with EVB (P = 0.044)
Salahshour et al[32], 2020	Cirrhotic patients who underwent EGD and CT within 6 mo	Liver resection/loco-regional treatment, and esophageal cancer	To identify CT features associated with EVB	Features associated with EVB: EV presence (P = 0.002); Short gastric collateral presence/size (P < 0.001/P < 0.001); Coronary collateral presence (P = 0.02); Paraesophageal collateral presence/size (P = 0.01/P = 0.03); Paraesophageal draining collateral presence/size (P = 0.02/P = 0.02); LGV size (P = 0.03); Gastric fundus varices size (P = 0.001); IMV size (P = 0.04); Ascites (P = 0.04)
Xie et al[33], 2020	Cirrhotic patients with EV who underwent EGD and CT, and were followed-up for 6 mo	Cardiovascular disease, hematologic disease, renal insufficiency, or malignancy; previous shunt, devascularization,EIS, or EVL; use of vasopressin, somatostatin or propranolol within 1 wk before hospitalization; NVUGIB	To evaluate sensitivity and specificity of EV diameter, EV cross-sectional number, and EV total area in the prediction of first EVB	EV diameter: Sensitivity 0.8; specificity 0.52; AUC 0.72; critical point 5.55 mm; EV cross-sectional number: sensitivity 0.73; specificity 0.6; AUC 0.68; critical point 4; EV total cross-sectional area: sensitivity 0.75; specificity 0.73; AUC 0.82; critical point 1.03 cm2
Peisen et al[34], 2021	Cirrhotic patients who underwent PCT and EGD within 3 mo	Diffusely infiltrating HCC, TIPS, and PVT	To evaluate the correlation between PCT-derived variables (HPI, PVP and SBF) and EVB	Weak correlation of HPI, PVP, and SBF with EBV (Eta correlation coefficient 0.126, 0.031, and 0.119, respectively)
Wan et al[35], 2021	Cirrhotic patients with EV who underwent EGD and CT within 4 wk	Prior EV treatment (e.g. BB, EVL); PVT; HCC; splenectomy, hepatectomy or portal-azygous disconnection	To identify CT-derived quantitative parameters of liver lobe associated with first EVB	Features associated with first EVB: CV (P = 0.012); CFV (P = 0.03); CV/TV (P < 0.001); CFV/TFV (P < 0.001)
Wan et al[36], 2022	Cirrhotic patients with EV who underwent contrast-enhanced CT within 4 wk of EGD	Prior EV treatment (e.g., BB, EVL); PVT; HCC; splenectomy, hepatectomy or portal-azygous disconnection	To identify CT quantitative parameters associated with EVB	No significant difference in EV grade, EV diameter, CSA, EV volume, SNV, LGV diameter, PV, SV, and the opening type of LGV between bleeding and non-bleeding groups

EVB: Esophageal variceal bleeding; CT: Computed tomography; EGD: Esophagogastroduodenoscopy; EVL: Endoscopic variceal ligation; OLT: Orthotopic liver transplantation; EV: Esophageal varices; PUV: Paraumbilical vein; HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma; PVT: Portal vein thrombosis; IMV: Inferior mesenteric vein; PGV: Posterior gastric vein; BB: Beta-blockers; TIPS: Transjugular intrahepatic portosystemic shunt; EIS: Endoscopic injection sclerotherapy; NVUGIB: Nonvariceal upper gastrointestinal bleeding; AUC: Area under the curve; PCT: Perfusion computed tomography; HPI: Hepatic perfusion index; PVP: Portal venous perfusion; SBF: Splenic blood flow; CV: Caudate lobe volume; CFV: Caudate lobe functional volume; TV: Total volume; TFV: Total functional volume; CSA: Cross-sectional surface area; SNV: Splenic vein; LGV: Left gastric vein; PV: Portal vein; SV: Spleen volume.