Predictors of Variceal Bleeding on Contrast-Enhanced Computed Tomography in Patients With Hepatocellular Carcinoma

Ping-Chien Li ； Huan-Wu Chen ； Hao-Tsai Cheng ； Chen-June Seak ； Chien-Cheng Chen

《Journal of Radiological Science》 47卷 (2022/03) Pp. 1-8

https://doi.org/10.6698/JRS.202203_47.0001

摘要

PURPOSE. The purpose of this cross-sectional study was to identify patients with hepatocellular carcinoma (HCC) requiring endoscopic intervention for esophageal varix (EV) bleeding. MATERIALS AND METHODS. Patients who received both emergency endoscopy and abdominal computed tomography (CT) for HCC in the 3 months preceding the study were enrolled. Laboratory data, including platelet count, serum albumin, liver function parameters, and international normalized ratio, were collected. In addition, submucosal EV diameter, portal collateral system diameter, and spleen width were measured using CT. Red signs detected during endoscopic surveillance and subsequent intervention were considered to indicate active EV bleeding. RESULTS. Among 86 patients, 67 men (77.9%) and 19 women (22.1%), whose mean age (standard deviation) was 64 (11.7) years, increased submucosal EV diameter (odds ratio [OR] = 3.263, 95% confidence interval [CI] = 1.930-5.515, p ＜ 0.001) and portal vein thrombosis (OR = 6.314, 95% CI = 1.147-34.762, p = 0.034) were significant predictors of EV bleeding. The area under the receiver operating characteristic curve for predicting EV bleeding from a submucosal EV diameter cutoff of 5.6 mm was 0.954 (95% CI = 0.886-0.987; sensitivity: 94.83%, specificity: 96.43%). CONCLUSION. Patients with HCC and large submucosal EVs measured on CT require endoscopic intervention for variceal bleeding. CT may be employed to screen for high-risk patients before endoscopy.

關鍵字

esophageal varices ； gastrointestinal hemorrhage ； computed tomography ； liver cirrhosis ； hepatocellular carcinoma