Hyojin Kim MD, Presenter: Nothing to Disclose

Dongil Choi MD, Abstract Co-Author: Nothing to Disclose

Seong Hyun Kim MD, Abstract Co-Author: Nothing to Disclose

Soon Jin Lee MD, Abstract Co-Author: Nothing to Disclose

Won Jae Lee MD, Abstract Co-Author: Nothing to Disclose

To compare the performances of faculty abdominal radiologists with those of radiology residents and endoscopists in the detection of esophageal varices and high-risk esophageal varices at routine liver multi–detector row CT (MDCT).

One hundred four cirrhotic patients who underwent both upper endoscopy and liver MDCT 4 weeks or less before endoscopy were evaluated. The protocol of liver MDCT for hepatocellular carcinoma (HCC) screening included unenhanced, arterial, portal, and equilibrium phases with a 5-mm slice thickness. Two blinded faculty abdominal radiologists (8 and 5 years’ experience), two radiology residents (four months’ experience of body CT), and two endoscopists (endoscopy experience of more than 100 cases with esophageal varix) independently interpreted all CT images to detect the presence of esophageal varices and high-risk (grade 2 or 3) esophageal varices on a 4-point confidence scale. With an endoscopic grading as the reference standard, their performances were compared by using receiver operating characteristic (ROC) curve analysis.

The areas under the ROC curves for the detection of esophageal varices indicated better performance of faculty abdominal radiologists (Az=0.868) compared with radiology residents (Az=0.798) (p=0.007) and endoscopists (Az=0.784) (p=0.006). For the detection of high-risk esophageal varices, however, the performance of faculty abdominal radiologists (Az=0.914) was similar to the performances of radiology residents (Az=0.900) and endoscopists (Az=0.907) (each p>0.05).

Experienced readers showed better ability to detect esophageal varices at liver MDCT, but no higher performance to estimate high-risk esophageal varices.

As the accuracy of high-risk esophageal varices at liver MDCT is excellent, even by endoscopists, the evaluation of esophageal varices at recent liver MDCT may be useful to avoid low-yield endoscopy.

Kim, H, Choi, D, Kim, S, Lee, S, Lee, W, Evaluation of Esophageal Varices at Liver CT: Receiver Operating Characteristic Analyses of Radiologists’ and Endoscopists’ Performance.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5005698.html