Prediction of esophageal varices in patients with cirrhosis: Usefulness of three-dimensional MR elastography with echo-planar imaging technique

Sung Ui Shin, Jeong Min Lee, Mi Hye Yu, Jeong Hee Yoon, Joon Koo Han, Byung Ihn Choi, Kevin J. Glaser, Richard Lorne Ehman

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine the diagnostic performance of magnetic resonance (MR) elastography in comparison to spleen length and dynamic contrast material-enhanced (DCE) MR imaging in association with esophageal varices in patients with liver cirrhosis by using endoscopy as the reference standard. Materials and Methods: This retrospective study received institutional review board approval, and informed consent was waived. One hundred thirty-nine patients with liver cirrhosis who underwent liver DCE MR imaging, including MR elastography, were included. Hepatic stiffness (HS) and spleen stiffness (SS) values assessed with MR elastography, as well as spleen length, were correlated with the presence of esophageal varices and high-risk varices by using Spearman correlation analysis. The diagnostic performance of MR elastography was compared with that of DCE MR imaging and combined assessment of MR elastography and DCE MR imaging by using receiver operating characteristic analysis. MR elastography reproducibility was assessed prospectively, with informed consent, in another 15 patients by using intraclass correlation coefficients. Results: There were significant positive linear correlations between HS, SS, and spleen length and the grade of esophageal varices (r = 0.46, r = 0.48, and r = 0.36, respectively; all P < .0001). HS and SS values (>4.81 kPa and >7.60 kPa, respectively) showed better performance than did spleen length in the association with esophageal varices (P = .0306 and P = .0064, respectively). Diagnostic performance of HS and SS in predicting high-risk varices was comparable to that of DCE MR imaging (P = .1282 and P = .1371, respectively). When MR elastography and DCE MR imaging were combined, sensitivity improved significantly (P = .0004). MR elastography was highly reproducible (intraclass correlation coefficient > 0.9). Conclusion: HS and SS are associated with esophageal varices and showed better performance than did spleen length in assessing the presence of esophageal varices. MR elastography is comparable to DCE MR imaging in predicting the presence of esophageal varices and high-risk varices, but, when assessed in combination, sensitivity is higher.

Original languageEnglish (US)
Pages (from-to)143-153
Number of pages11
JournalRadiology
Volume272
Issue number1
DOIs
StatePublished - 2014

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Echo-Planar Imaging
Elasticity Imaging Techniques
Esophageal and Gastric Varices
Fibrosis
Spleen
Contrast Media
Magnetic Resonance Imaging
Varicose Veins
Liver
Informed Consent
Liver Cirrhosis
Research Ethics Committees
ROC Curve
Endoscopy
Retrospective Studies

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Prediction of esophageal varices in patients with cirrhosis : Usefulness of three-dimensional MR elastography with echo-planar imaging technique. / Shin, Sung Ui; Lee, Jeong Min; Yu, Mi Hye; Yoon, Jeong Hee; Han, Joon Koo; Choi, Byung Ihn; Glaser, Kevin J.; Ehman, Richard Lorne.

In: Radiology, Vol. 272, No. 1, 2014, p. 143-153.

Research output: Contribution to journalArticle

Shin, Sung Ui ; Lee, Jeong Min ; Yu, Mi Hye ; Yoon, Jeong Hee ; Han, Joon Koo ; Choi, Byung Ihn ; Glaser, Kevin J. ; Ehman, Richard Lorne. / Prediction of esophageal varices in patients with cirrhosis : Usefulness of three-dimensional MR elastography with echo-planar imaging technique. In: Radiology. 2014 ; Vol. 272, No. 1. pp. 143-153.
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abstract = "Purpose: To determine the diagnostic performance of magnetic resonance (MR) elastography in comparison to spleen length and dynamic contrast material-enhanced (DCE) MR imaging in association with esophageal varices in patients with liver cirrhosis by using endoscopy as the reference standard. Materials and Methods: This retrospective study received institutional review board approval, and informed consent was waived. One hundred thirty-nine patients with liver cirrhosis who underwent liver DCE MR imaging, including MR elastography, were included. Hepatic stiffness (HS) and spleen stiffness (SS) values assessed with MR elastography, as well as spleen length, were correlated with the presence of esophageal varices and high-risk varices by using Spearman correlation analysis. The diagnostic performance of MR elastography was compared with that of DCE MR imaging and combined assessment of MR elastography and DCE MR imaging by using receiver operating characteristic analysis. MR elastography reproducibility was assessed prospectively, with informed consent, in another 15 patients by using intraclass correlation coefficients. Results: There were significant positive linear correlations between HS, SS, and spleen length and the grade of esophageal varices (r = 0.46, r = 0.48, and r = 0.36, respectively; all P < .0001). HS and SS values (>4.81 kPa and >7.60 kPa, respectively) showed better performance than did spleen length in the association with esophageal varices (P = .0306 and P = .0064, respectively). Diagnostic performance of HS and SS in predicting high-risk varices was comparable to that of DCE MR imaging (P = .1282 and P = .1371, respectively). When MR elastography and DCE MR imaging were combined, sensitivity improved significantly (P = .0004). MR elastography was highly reproducible (intraclass correlation coefficient > 0.9). Conclusion: HS and SS are associated with esophageal varices and showed better performance than did spleen length in assessing the presence of esophageal varices. MR elastography is comparable to DCE MR imaging in predicting the presence of esophageal varices and high-risk varices, but, when assessed in combination, sensitivity is higher.",
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T1 - Prediction of esophageal varices in patients with cirrhosis

T2 - Usefulness of three-dimensional MR elastography with echo-planar imaging technique

AU - Shin, Sung Ui

AU - Lee, Jeong Min

AU - Yu, Mi Hye

AU - Yoon, Jeong Hee

AU - Han, Joon Koo

AU - Choi, Byung Ihn

AU - Glaser, Kevin J.

AU - Ehman, Richard Lorne

PY - 2014

Y1 - 2014

N2 - Purpose: To determine the diagnostic performance of magnetic resonance (MR) elastography in comparison to spleen length and dynamic contrast material-enhanced (DCE) MR imaging in association with esophageal varices in patients with liver cirrhosis by using endoscopy as the reference standard. Materials and Methods: This retrospective study received institutional review board approval, and informed consent was waived. One hundred thirty-nine patients with liver cirrhosis who underwent liver DCE MR imaging, including MR elastography, were included. Hepatic stiffness (HS) and spleen stiffness (SS) values assessed with MR elastography, as well as spleen length, were correlated with the presence of esophageal varices and high-risk varices by using Spearman correlation analysis. The diagnostic performance of MR elastography was compared with that of DCE MR imaging and combined assessment of MR elastography and DCE MR imaging by using receiver operating characteristic analysis. MR elastography reproducibility was assessed prospectively, with informed consent, in another 15 patients by using intraclass correlation coefficients. Results: There were significant positive linear correlations between HS, SS, and spleen length and the grade of esophageal varices (r = 0.46, r = 0.48, and r = 0.36, respectively; all P < .0001). HS and SS values (>4.81 kPa and >7.60 kPa, respectively) showed better performance than did spleen length in the association with esophageal varices (P = .0306 and P = .0064, respectively). Diagnostic performance of HS and SS in predicting high-risk varices was comparable to that of DCE MR imaging (P = .1282 and P = .1371, respectively). When MR elastography and DCE MR imaging were combined, sensitivity improved significantly (P = .0004). MR elastography was highly reproducible (intraclass correlation coefficient > 0.9). Conclusion: HS and SS are associated with esophageal varices and showed better performance than did spleen length in assessing the presence of esophageal varices. MR elastography is comparable to DCE MR imaging in predicting the presence of esophageal varices and high-risk varices, but, when assessed in combination, sensitivity is higher.

AB - Purpose: To determine the diagnostic performance of magnetic resonance (MR) elastography in comparison to spleen length and dynamic contrast material-enhanced (DCE) MR imaging in association with esophageal varices in patients with liver cirrhosis by using endoscopy as the reference standard. Materials and Methods: This retrospective study received institutional review board approval, and informed consent was waived. One hundred thirty-nine patients with liver cirrhosis who underwent liver DCE MR imaging, including MR elastography, were included. Hepatic stiffness (HS) and spleen stiffness (SS) values assessed with MR elastography, as well as spleen length, were correlated with the presence of esophageal varices and high-risk varices by using Spearman correlation analysis. The diagnostic performance of MR elastography was compared with that of DCE MR imaging and combined assessment of MR elastography and DCE MR imaging by using receiver operating characteristic analysis. MR elastography reproducibility was assessed prospectively, with informed consent, in another 15 patients by using intraclass correlation coefficients. Results: There were significant positive linear correlations between HS, SS, and spleen length and the grade of esophageal varices (r = 0.46, r = 0.48, and r = 0.36, respectively; all P < .0001). HS and SS values (>4.81 kPa and >7.60 kPa, respectively) showed better performance than did spleen length in the association with esophageal varices (P = .0306 and P = .0064, respectively). Diagnostic performance of HS and SS in predicting high-risk varices was comparable to that of DCE MR imaging (P = .1282 and P = .1371, respectively). When MR elastography and DCE MR imaging were combined, sensitivity improved significantly (P = .0004). MR elastography was highly reproducible (intraclass correlation coefficient > 0.9). Conclusion: HS and SS are associated with esophageal varices and showed better performance than did spleen length in assessing the presence of esophageal varices. MR elastography is comparable to DCE MR imaging in predicting the presence of esophageal varices and high-risk varices, but, when assessed in combination, sensitivity is higher.

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