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Prediction of esophageal varices by liver and spleen MR elastography

  • Magnetic Resonance
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Abstract

Objectives

We aimed to assess the diagnostic performance of MR elastography (MRE) in predicting esophageal varices (EVs) in patients with chronic liver disease.

Methods

We prospectively performed liver (LSM) and spleen stiffness measurements (SSM) using MRE and endoscopic screening for EVs to determine if patients with hepatocellular carcinoma were eligible for resection. We investigated whether LSM, SSM, and other non-invasive preoperative parameters were associated with the presence of EVs. In order to predict EVs, 211 patients were divided into training (n = 140) and test (n = 71) groups. A nomogram was built using independent factors based on logistic regression analysis in the training group and its accuracy was validated using an independent cohort.

Results

Forty-six patients (21.8%) were diagnosed as having EVs (mild, n = 36; severe, n = 10). According to multiple regression analysis, LSM (odds ratio, 2.362; 95% confidence interval [CI], 1.341–4.923; p = 0.001) and SSM (1.489; 1.095–2.235; p = 0.010) were independent predictors of EVs in the training group. The nomogram showed good discrimination, with a C-index of 0.942 (95% CI, 0.892–0.974) through internal validation, and good calibration. Application of the nomogram in the test group still gave good discrimination (C-index, 0.948; 95% CI, 0.868–0.995).

Conclusions

The combination of LSM and SSM using MRE is an accurate tool to identify patients at risk for EVs.

Key Points

Performance of MR elastography can estimate the presence of esophageal varices non-invasively.

Liver and spleen stiffness measurements are independent predictors for esophageal varices.

The nomogram using a combination of liver and spleen stiffness measurements allows for the risk of esophageal varices.

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Abbreviations

APRI:

Aspartate aminotransferase-to-platelet ratio index

AST:

Aspartate aminotransferase

AUC:

Area under the curve

CI:

Confidence interval

C-index:

Concordance index

CLD:

Chronic liver disease

EVs:

Esophageal varices

HCC:

Hepatocellular carcinoma

ICGR15:

Indocyanine green clearance rate at 15 min

LSM:

Liver stiffness measurement

MRE:

MR elastography

OR:

Odds ratio

ROC:

Receiver operating characteristic

SSM:

Spleen stiffness measurement

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Acknowledgements

This research was supported by Japan Agency for Medical Research and Development (AMED) under Grant Number 18hk0102049s0301 and a grant-in-aid of the 106th Annual Congress of JSS Memorial Surgical Research Fund, Tokyo, Japan.

Funding

This research was supported by Japan Agency for Medical Research and Development (AMED) under Grant Number 18hk0102049s0301 and a grant-in-aid of the 106th Annual Congress of JSS Memorial Surgical Research Fund, Tokyo, Japan.

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Correspondence to Yutaka Midorikawa.

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The scientific guarantor of this publication is Tadatoshi Takayama, Department of Digestive Surgery, Nihon University School of Medicine.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Abe, H., Midorikawa, Y., Matsumoto, N. et al. Prediction of esophageal varices by liver and spleen MR elastography. Eur Radiol 29, 6611–6619 (2019). https://doi.org/10.1007/s00330-019-06230-8

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  • DOI: https://doi.org/10.1007/s00330-019-06230-8

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