The Role Of Spectral CT In Assessing The Risk Of Variceal Bleeding In Cirrhotic Patients

Objectives:To study the haemodynamic changes in cirrhotic patients by Spectral CT and their relationship with the grading of esophageal varices?EV?via endoscopy and to evaluate whether these Spectral parameters might predict variceal bleeding.Materials and Methods:91 patients with cirrhosis?Child-Pugh class A/B/C:n=44/34/13?were retrospectively selected for the study.They all underwent three-phase spectral CT imaging and 42 of cirrhotic patients underwent endoscopy.Iodine concentrations in liver parenchyma,spleen parenchyma,left gastric vein,portal vein and aorta were measured from the spectral CT material decomposition images with water and iodine as basis material pairs.Normalized Iodine concentration?NIC?,Iodine concentration ratio?ICratio?,Left gastric vein index?LGI?were derived.LSA/V were devived by NICliver?AP/PVP?and NICspleen?AP/PVP?.The relationship between the spectral CT parameters and the grading of EV evaluated by endoscopy was investigated.Independent risk factors of esophageal varices bleeding?EVB?were analyzed by binary logistic regression using spectral CT parameters,liver function,age and sex as variables.Results:ICration was significantly higher in Child–Pugh C class?0.20±0.10?in cirrhotic patients than in those in Child–Pugh B class?0.14±0.06?and Child–Pugh A class?0.12±0.06?.NIC_liver?AP?,LSA were significantly higher in Child–Pugh C class in cirrhotic patients than in those in Child–Pugh B class and Child–Pugh A class.Patients with severe EV/gastric varices?GV?had higher LGI than those with non-severe EV/GV.The cut-off value of LGI was 0.86 for severe EV,0.95 for severe GV.Age[odds ratio?OR?=2.379;95%confidence interval?CI?:1.060-5.336;P=0.036];LGI?OR=6.075;95%CI:1.976-18.674;P=0.002?;NIC_liver?PVP??OR=0.119;95%CI:0.029-0.488;P=0.003?were selected as independent predictors of EVB.Conclusions:Left gastric vein index?LGI?obtained non-invasively by spectral CT imaging could be a useful parameter to determine the grading of EV and the risk of variceal bleeding so as to avoid repeated endoscopic monitoring.