Diagnostic Performance of Multidetector Computed Tomography in the Evaluation of Esophageal Varices: A Meta-Analysis Study
-
Hussein Abed Dakhil
,
Suhail Najm Alareer Hayder
,
Hussein Saleh Abdul Mohsen
,
Adam Norrie Hussein
,
Mustafa Sattar Sjil
,
Hassan Khayon Mhlhel
,
Ayat Muhammad Touma
,
Maha Hussein Ali
Abstract
Multidetector Computed Tomography (MDCT) imaging is a noninvasive tool that does not necessitate sedation and allows accurate assessment of the variceal site and size. Patients experience better tolerance when using MDCT than upper GI endoscopy (EGD). The present study aimed to assess the efficacy of MDCT in evaluating esophageal varices. We conducted a thorough search of international databases (Web of Science, PubMed, Embase, and Scopus) and extracted studies using the appropriate keywords to investigate the efficacy of MDCT in evaluating esophageal varices. The collected data were analyzed using the random and fixed-effects model and STATA (version 15). 17 articles aligned with the inclusion criteria, published between 2008 and 2022, were included in the study. The pooled data of 15 articles on MDCT sensitivity and specificity were 0.87 and 0.82, with 95% CI of 0.85-0.89 and 0.81-0.84, respectively. The meta-analysis of the data from fourteen articles showed a pooled PPV of 0.85 and a pooled NPV of 0.84, with 95% CI of 0.83-0.87 and 0.82-0.85, respectively. Also, our meta-analysis of eight surveys that reported accuracy revealed a high pooled accuracy of 0.92 (95% CI: 0.90-0.93), underscoring the reliability of MDCT in evaluating esophageal varices. These findings strongly suggest that MDCT holds considerable potential as a valuable diagnostic tool for clinicians managing patients with liver cirrhosis and suspected esophageal varices, paving the way for more effective patient care.
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6. Salahshour F, Mehrabinejad MM, Rashidi Shahpasandi MH, Salahshour M, Shahsavari N, Nassiri Toosi M, Ayoobi Yazdi N. Esophageal variceal hemorrhage: the role of MDCT characteristics in predicting the presence of varices and bleeding risk. Abdominal Radiology 2020;45:2305-14.
7. Sartoris R, Rautou PE, Elkrief L, Pollorsi G, Durand F, Valla D, Spahr L, Terraz S, Soubrane O, Cauchy F, Vilgrain V. Quantification of liver surface nodularity at CT: utility for detection of portal hypertension. Radiol 2018;289:698-707.
8. Schwarz F, Ruzsics B, Schoepf UJ, Bastarrika G, Chiaramida SA, Abro JA, Brothers RL, Vogt S, Schmidt B, Costello P, Zwerner PL. Dual-energy CT of the heart—principles and protocols. Eur J Radiol 2008; 68:423-33.
9. Tseng Y-J, Zeng X-q, Chen J, Li N, Xu P-j, Chen S-y. Computed tomography in evaluating gastroesophageal varices in patients with portal hypertension: a meta-analysis. Dig Liver Dis 2016;48:695-702.
10. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals of internal medicine 2009;151:65-94.
11. Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute 2011;2:1-12.
12. Cansu A, Ahmetoglu A, Kul S, Yukunc G, Fidan S, Arslan M, et al. Diagnostic performance of using effervescent powder for detection and grading of esophageal varices by multi-detector computed tomography. Eur J Radiol 2014;83:497-502.
13. Karatzas A, Triantos C, Kalafateli M, Marzigie M, Labropoulou-Karatza C, Thomopoulos K, et al. Multidetector computed tomography versus platelet/spleen diameter ratio as methods for the detection of gastroesophageal varices. Ann Gastroenterol 2016;29:71.
14. Perri RE, Chiorean MV, Fidler JL, Fletcher JG, Talwalkar JA, Stadheim L, et al. A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices. Hepatology 2008;47:1587-94.
15. Kim H, Choi D, Gwak G-Y, Lee JH, Lee SJ, Kim SH, et al. High-risk esophageal varices in patients treated with locoregional therapies for hepatocellular carcinoma: evaluation with regular follow-up liver CT. Dig Dis Sci 2009;54:2247-52.
16. Zhu K, Meng X, Pang P, Qian J, Shen M, Hu B, et al. Gastric varices in patients with portal hypertension: evaluation with multidetector row CT. J Clin Gastroenterol 2010;44:108-15.
17. Yu NC, Margolis D, Hsu M, Raman SS, Lu DS. Detection and grading of esophageal varices on liver CT: comparison of standard and thin-section multiplanar reconstructions in diagnostic accuracy. Am J Roentgenol 2011;197:643-9.
18. Lipp MJ, Broder A, Hudesman D, Suwandhi P, Okon SA, Horowitz M, et al. Detection of esophageal varices using CT and MRI. Dig Dis Sci 2011;56:2696-700.
19. Shah SZ, Ajmal U, Siddiqui S. Accuracy of Multi-Detector Computed Tomography in Detection of Esophageal Varices in Chronic Liver Disease. J Islamabad Med Dental Coll 2020;9:6-11.
20. Abdelmawgoud M, El-Shewi ME-S, Al-Shatouri M, Abouzaid M. Multi-Detector Computed Tomography in Diagnosis of Esophageal and Fundal Varices in Cirrhotic Patients. Benha Med J 2021;38:580-9.
21. BASHIR M, MUGHAL HH, MEHMOOD F, AFTAB MI, ALI M, MOBUSHIR M. Diagnostic Accuracy of Multi-Detector Computed Tomography Esophagography in Grading of Esophageal Varices in Cirrhotic Patients. Methodology 2017.
22. Dessouky BAM. Multidetector CT oesophagography: an alternative screening method for endoscopic diagnosis of oesophageal varices and bleeding risk. Arab J Gastroenterol 2013;14:99-108.
23. Ali MM, Afify MA, Abdelrazek OM, Abdelnaby AM. Multi-detector Computed Tomography Versus Upper Gastrointestinal Endoscopy in Diagnosis and Grading of Esophageal Varices in Egyptian Cirrhotic Patients. Al-Azhar Intern Med J 2022;3:35-43.
24. Wan S, Wei Y, Yu H, Li Y, Yao S, Song B. Computed tomographic portography with esophageal variceal measurements in the evaluation of esophageal variceal severity and assessment of esophageal variceal volume efficacy. Acad Radiol 2020;27:528-35.
25. Butt HA, Nasim R, Javed K, Shahid F, Malik A, Fazli H, et al. Diagnostic accuracy of triphasic CT scan abdomen in the diagnosis of distal esophageal varices taking endoscopic findings as gold standard. Professional Med J 2022;29:1831-7.
26. Solaiman SA, Habba MR, El Kammash TH, Serwah AHA. Computed tomography predictors of gastroesophageal varices in cirrhotic patients: the added value of portosystemic collaterals. Egypt J Radiol Nucl Med 2023;54:64.
27. Kumar R, Nandolia KK, Sharma P, Bhadoria AS, Chauhan U, Patnaik I, et al. Computed tomography virtual oesophagography for the grading of oesophageal varices in cirrhotic liver disease patients with upper gastrointestinal endoscopic examination as the gold standard: a diagnostic validation study. Pol J Radiol 2023;88: 187.
28. Samy M, Gamal D, Othman MH, Ahmed SA. Assessment of variceal bleeding in cirrhotic patients: accuracy of multi-detector computed tomography. Egypt J Radiol Nucl Med 2022;53:1-10.
29. Li J, Zhu Y, Ni J, Wang L, Lei J. Computed tomography for the diagnosis of gastroesophageal varices and risk assessment in patients with cirrhosis: a systematic review and meta-analysis. Diagn Interv Radiol 2024.
2. Pallio S, Melita G, Shahini E, Vitello A, Sinagra E, Lattanzi B, Facciorusso A, Ramai D, Maida M. Diagnosis and management of esophagogastric varices. Diagnostics 2023;13:1031.
3. Cavalin C, Schirr-Bonnans S, Darsonval A, Riche VP, Brunet-Houdard S, Monmousseau F, et al. Cost effectiveness of esophageal varices screening strategies of cirrhotic patients with portal hypertension. Health Policy Technol 2024;13:100925.
4. MOHAMED MM, FATMA A. Comparative Study of Esophageal Varices Grading by Multi-Detector Computed Tomography and Endoscopy. Med J Cairo Univ 2020; 88:1923-31.
5. ELKammash T, ELFiky I, Zaiton F, Khorshed SE. Diagnostic performance of multidetector computed tomography in the evaluation of esophageal varices. Egypt j radiol nucl med 2016;47:43-51.
6. Salahshour F, Mehrabinejad MM, Rashidi Shahpasandi MH, Salahshour M, Shahsavari N, Nassiri Toosi M, Ayoobi Yazdi N. Esophageal variceal hemorrhage: the role of MDCT characteristics in predicting the presence of varices and bleeding risk. Abdominal Radiology 2020;45:2305-14.
7. Sartoris R, Rautou PE, Elkrief L, Pollorsi G, Durand F, Valla D, Spahr L, Terraz S, Soubrane O, Cauchy F, Vilgrain V. Quantification of liver surface nodularity at CT: utility for detection of portal hypertension. Radiol 2018;289:698-707.
8. Schwarz F, Ruzsics B, Schoepf UJ, Bastarrika G, Chiaramida SA, Abro JA, Brothers RL, Vogt S, Schmidt B, Costello P, Zwerner PL. Dual-energy CT of the heart—principles and protocols. Eur J Radiol 2008; 68:423-33.
9. Tseng Y-J, Zeng X-q, Chen J, Li N, Xu P-j, Chen S-y. Computed tomography in evaluating gastroesophageal varices in patients with portal hypertension: a meta-analysis. Dig Liver Dis 2016;48:695-702.
10. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals of internal medicine 2009;151:65-94.
11. Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Ottawa: Ottawa Hospital Research Institute 2011;2:1-12.
12. Cansu A, Ahmetoglu A, Kul S, Yukunc G, Fidan S, Arslan M, et al. Diagnostic performance of using effervescent powder for detection and grading of esophageal varices by multi-detector computed tomography. Eur J Radiol 2014;83:497-502.
13. Karatzas A, Triantos C, Kalafateli M, Marzigie M, Labropoulou-Karatza C, Thomopoulos K, et al. Multidetector computed tomography versus platelet/spleen diameter ratio as methods for the detection of gastroesophageal varices. Ann Gastroenterol 2016;29:71.
14. Perri RE, Chiorean MV, Fidler JL, Fletcher JG, Talwalkar JA, Stadheim L, et al. A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices. Hepatology 2008;47:1587-94.
15. Kim H, Choi D, Gwak G-Y, Lee JH, Lee SJ, Kim SH, et al. High-risk esophageal varices in patients treated with locoregional therapies for hepatocellular carcinoma: evaluation with regular follow-up liver CT. Dig Dis Sci 2009;54:2247-52.
16. Zhu K, Meng X, Pang P, Qian J, Shen M, Hu B, et al. Gastric varices in patients with portal hypertension: evaluation with multidetector row CT. J Clin Gastroenterol 2010;44:108-15.
17. Yu NC, Margolis D, Hsu M, Raman SS, Lu DS. Detection and grading of esophageal varices on liver CT: comparison of standard and thin-section multiplanar reconstructions in diagnostic accuracy. Am J Roentgenol 2011;197:643-9.
18. Lipp MJ, Broder A, Hudesman D, Suwandhi P, Okon SA, Horowitz M, et al. Detection of esophageal varices using CT and MRI. Dig Dis Sci 2011;56:2696-700.
19. Shah SZ, Ajmal U, Siddiqui S. Accuracy of Multi-Detector Computed Tomography in Detection of Esophageal Varices in Chronic Liver Disease. J Islamabad Med Dental Coll 2020;9:6-11.
20. Abdelmawgoud M, El-Shewi ME-S, Al-Shatouri M, Abouzaid M. Multi-Detector Computed Tomography in Diagnosis of Esophageal and Fundal Varices in Cirrhotic Patients. Benha Med J 2021;38:580-9.
21. BASHIR M, MUGHAL HH, MEHMOOD F, AFTAB MI, ALI M, MOBUSHIR M. Diagnostic Accuracy of Multi-Detector Computed Tomography Esophagography in Grading of Esophageal Varices in Cirrhotic Patients. Methodology 2017.
22. Dessouky BAM. Multidetector CT oesophagography: an alternative screening method for endoscopic diagnosis of oesophageal varices and bleeding risk. Arab J Gastroenterol 2013;14:99-108.
23. Ali MM, Afify MA, Abdelrazek OM, Abdelnaby AM. Multi-detector Computed Tomography Versus Upper Gastrointestinal Endoscopy in Diagnosis and Grading of Esophageal Varices in Egyptian Cirrhotic Patients. Al-Azhar Intern Med J 2022;3:35-43.
24. Wan S, Wei Y, Yu H, Li Y, Yao S, Song B. Computed tomographic portography with esophageal variceal measurements in the evaluation of esophageal variceal severity and assessment of esophageal variceal volume efficacy. Acad Radiol 2020;27:528-35.
25. Butt HA, Nasim R, Javed K, Shahid F, Malik A, Fazli H, et al. Diagnostic accuracy of triphasic CT scan abdomen in the diagnosis of distal esophageal varices taking endoscopic findings as gold standard. Professional Med J 2022;29:1831-7.
26. Solaiman SA, Habba MR, El Kammash TH, Serwah AHA. Computed tomography predictors of gastroesophageal varices in cirrhotic patients: the added value of portosystemic collaterals. Egypt J Radiol Nucl Med 2023;54:64.
27. Kumar R, Nandolia KK, Sharma P, Bhadoria AS, Chauhan U, Patnaik I, et al. Computed tomography virtual oesophagography for the grading of oesophageal varices in cirrhotic liver disease patients with upper gastrointestinal endoscopic examination as the gold standard: a diagnostic validation study. Pol J Radiol 2023;88: 187.
28. Samy M, Gamal D, Othman MH, Ahmed SA. Assessment of variceal bleeding in cirrhotic patients: accuracy of multi-detector computed tomography. Egypt J Radiol Nucl Med 2022;53:1-10.
29. Li J, Zhu Y, Ni J, Wang L, Lei J. Computed tomography for the diagnosis of gastroesophageal varices and risk assessment in patients with cirrhosis: a systematic review and meta-analysis. Diagn Interv Radiol 2024.
| Files | ||
| Issue | Vol 63 No 2 (2025) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/acta.v63i2.18960 | |
| Keywords | ||
| Multidetector computed tomography Esophageal varices Sensitivity Specificity Efficacy | ||
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How to Cite
1.
Dakhil HA, Alareer Hayder SN, Abdul Mohsen HS, Norrie Hussein A, Sjil MS, Khayon Mhlhel H, Touma AM, Hussein Ali M. Diagnostic Performance of Multidetector Computed Tomography in the Evaluation of Esophageal Varices: A Meta-Analysis Study. Acta Med Iran. 2025;63(2):64-72.
