Detection and grading for esophageal varices in patients with chronic liver damage: comparison of gadolinium-enhanced and unenhanced steady-state coherent MR images

Goshima, Satoshi; Kanematsu, Masayuki; Kondo, Hiroshi; Tsuge, Yusuke; Watanabe, Haruo; Shiratori, Yoshimune; Onozuka, Minoru; Moriyama, Noriyuki

doi:10.1016/j.mri.2009.05.030

« Previous Next »Magnetic Resonance Imaging
Volume 27, Issue 9 , Pages 1230-1235, November 2009

Detection and grading for esophageal varices in patients with chronic liver damage: comparison of gadolinium-enhanced and unenhanced steady-state coherent MR images☆

Satoshi Goshima
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1193, Japan
- Corresponding author. Tel.: +81 58 230 6439; fax: +81 58 230 6440.
Masayuki Kanematsu
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1193, Japan
- Department of Radiology Services, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1193, Japan
Hiroshi Kondo
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1193, Japan
Yusuke Tsuge
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1193, Japan
Haruo Watanabe
- Department of Radiology, Gifu University School of Medicine, 1-1 Yanagido, Gifu 501-1193, Japan
Yoshimune Shiratori
- Department of Medical Informatics, Gifu University School of Medicine, Gifu, Japan
Minoru Onozuka
- Department of Physiology and Neuroscience, Kanagawa Dental College, Yokosuka, Japan
Noriyuki Moriyama
- Research Center for Cancer Prevention and Screening, National Cancer Center Hospital, Tsukiji, Japan

Received 11 December 2008; received in revised form 19 March 2009; accepted 7 May 2009. published online 26 June 2009.

Abstract

The purpose of this study was to compare observer interpreted steady-state coherent coronal images and gadolinium-enhanced axial images in terms of the detection and grading of esophageal varices. Magnetic resonance imaging (MRI) and gastrointestinal endoscopy were performed within 2 weeks in 90 patients with chronic liver damage, including 55 with untreated esophageal varices, for periodic screening purposes. Two blinded readers retrospectively reviewed T1- and T2-weighted images with gadolinium-enhanced (gadolinium image set) and steady-state coherent (coherent image set) images. Sensitivity for the detection of esophageal varices was higher (P<.001) in the gadolinium image set (76%) than in the coherent image set (35%); on the other hand, specificity was higher (P<.001) in the coherent image set (91%) than in the gadolinium image set (66%). Furthermore, area under the ROC curve was higher for the gadolinium image set (Az=0.823) than the coherent image set (Az=0.761) (P=.48). Moderate and weak positive correlations with endoscopic grades were found for the gadolinium image (r=0.48, P<.01) and coherent image sets (r=0.34, P=.018). The addition of steady-state coherent imaging to the current routine liver imaging protocol did not improve the detection or grading of esophageal varices, whereas gadolinium-enhanced imaging was found to be potentially valuable. Nevertheless, endoscopy was confirmed to be mandatory in patients with esophageal varices suspected by MRI of the liver.

Keywords: Gadolinium, Liver, MRI