Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 21, 2012; 18(35): 4905-4911
Published online Sep 21, 2012. doi: 10.3748/wjg.v18.i35.4905
High-risk esophageal varices in patients treated with locoregional therapy for hepatocellular carcinoma: Assessment with liver computed tomography
Hyojin Kim, Dongil Choi, Joon Hyeok Lee, Soon Jin Lee, Hangi Jo, Geum-Youn Gwak, Kwang Cheol Koh, Moon Seok Choi, Seonwoo Kim
Hyojin Kim, Dongil Choi, Soon Jin Lee, Hangi Jo, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea
Joon Hyeok Lee, Geum-Youn Gwak, Kwang Cheol Koh, Moon Seok Choi, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea
Seonwoo Kim, Biostatistics Unit, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, South Korea
Author contributions: Choi D and Lee JH designed research; Choi D, Lee JH, Lee SJ, Jo H, Gwak GY, Koh KC, Choi MS and Kim S analyzed data; Kim H wrote the paper.
Supported by Grant from the Samsung Medical Center Clinical Research Development Program, No. CRS108-12-1
Correspondence to: Dongil Choi, MD, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, South Korea. dichoi@skku.edu
Telephone: +82-2-34102518 Fax: +82-2-34100084
Received: December 15, 2011
Revised: April 24, 2012
Accepted: April 27, 2012
Published online: September 21, 2012
Abstract

AIM: To assess the diagnostic performance of follow-up liver computed tomography (CT) for the detection of high-risk esophageal varices in patients treated with locoregional therapy for hepatocellular carcinoma (HCC).

METHODS: We prospectively enrolled 100 patients with cirrhosis who underwent transcatheter arterial chemoembolization, radiofrequency ablation or both procedures for HCCs. All patients underwent upper endoscopy and subsequently liver CT. Three radiologists independently evaluated the presence of high-risk esophageal varices with transverse images alone and with three orthogonal multiplanar reformation (MPR) images, respectively. With endoscopic grading as the reference standard, diagnostic performance was assessed by using receiver operating characteristic (ROC) curve analysis.

RESULTS: The diagnostic performances (areas under the ROC curve) of three observers with transverse images alone were 0.947 ± 0.031, 0.969 ± 0.024, and 0.916 ± 0.038, respectively. The mean sensitivity, specificity, positive predicative value (PPV), and negative predicative value (NPV) with transverse images alone were 90.1%, 86.39%, 70.9%, and 95.9%, respectively. The diagnostic performances, mean sensitivity, specificity, PPV, and NPV with three orthogonal MPR images (0.965 ± 0.025, 0.959 ± 0.027, 0.938 ± 0.033, 91.4%, 89.5%, 76.3%, and 96.6%, respectively) were not superior to corresponding values with transverse images alone (P > 0.05), except for the mean specificity (P = 0.039).

CONCLUSION: Our results showed excellent diagnostic performance, sensitivity and NPV to detect high-risk esophageal varices on follow-up liver CT after locoregional therapy for HCC.

Keywords: Liver computed tomography; High-risk esophageal varices; Locoregional therapy; Hepatocellular carcinoma; Multiplanar reformation images