scholarly journals Accuracy of Multi-Detector Computed Tomography in Detection of Esophageal Varices in Chronic Liver Disease

2020 ◽  
Vol 9 (1) ◽  
pp. 4-9
Author(s):  
Syeda Zakia Shah ◽  
Umair Ajmal ◽  
Shahabuddin Siddiqui
Keyword(s):  
Computed Tomography ◽  
Liver Disease ◽  
Diagnostic Accuracy ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Chronic Liver ◽  
Computed Tomography Scan ◽  
Predictive Values ◽  
Tomography Scan ◽  
Multi Detector Computed Tomography

Background: Patients with chronic liver disease should undergo screening endoscopy, but this approach places a heavy burden upon endoscopy units along with other limitations. The aim of this study was to determine the diagnostic accuracy of multi-detector computed tomography scan in detecting esophageal varices taking endoscopy as gold standard.Material and Methods: This cross-sectional study was done from 1st Jan 2018 to 31st Dec 2018 at Department of Radiology, PIMS Hospital Islamabad. A total of 180 patients of both gender with chronic liver disease for at least 12 months were included in this study with an age range of 25-65 years. Patients with active gastrointestinal hemorrhage, hypersensitivity to iodinated contrast agent, chronic renal failure, claustrophobic and pregnant females were excluded. All the patients underwent endoscopy and computed tomography of lower chest and the upper abdomen before and after intravenous contrast administration. Multi detector computed tomography (MDCT) scan findings for esophageal varices were compared with endoscopy findings.Results: In MDCT positive patients (n=102), 98 were true positive and 04 were false positive. Among 78 MDCT negative patients, 07 were false negative, whereas 71 were true negative. Overall sensitivity and specificity were 93.33%, and 94.67% respectively. The positive and negative predictive values were 96.08% and 91.03% respectively, while diagnostic accuracy of MDCT in detecting esophageal varices in chronic liver disease patients was 93.89%, taking endoscopy as gold standard.Conclusions: Multi-detector computed tomography scan is a highly sensitive and accurate non-invasive modality for detecting esophageal varices in chronic liver disease patients.Key words: Accuracy, Chronic liver disease, Esophageal varices, Multi-detector computed tomography

scholarly journals Emphysematous pyelonephritis: A rare cause of sepsis in hepatocellular carcinoma

2021 ◽  
pp. 201010582199280
Author(s):  
Hany Haqimi Wan Hanafi ◽  
Nazri Mustaffa ◽  
Yeong Yeh Lee ◽  
Siti Nurbaya Mohd Nawi
Keyword(s):  
Diabetes Mellitus ◽  
Computed Tomography ◽  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Surgical Intervention ◽  
Computed Tomography Scan ◽  
Emphysematous Pyelonephritis ◽  
Urological Emergency ◽  
Tomography Scan

The association between emphysematous pyelonephritis (EPN) and diabetes mellitus is well known. EPN as the cause of sepsis in hepatocellular carcinoma (HCC) is rare and unreported. We report a case of EPN in a non-diabetic HCC patient, in which the clinical features of decompensated chronic liver disease masked the more sinister urological emergency to a certain degree. A computed tomography scan of the abdomen revealed a mixture of gas and fluid in the left retrorenal space, in keeping with left EPN. Nevertheless, the course of clinical deterioration was rather rapid that any surgical intervention was not feasible.

scholarly journals Diagnostic accuracy of Platelet Count for prediction of Esophageal varices in patients presenting with Chronic Liver disease.

2020 ◽  
Vol 27 (01) ◽  
pp. 16-22
Author(s):  
Siraj ud Din Barech ◽  
Tahir Ullah Khan ◽  
Muhammad Niaz Khan
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Diagnostic Accuracy ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Invasive Procedure ◽  
Cross Sectional Study ◽  
Chronic Liver ◽  
Cross Sectional ◽  
Low Platelet Count

Thrombocytopenia increases the risk of bleeding in CLD patients. The determination of the presence of Esophageal Varices (EV) by endoscopy is an invasive procedure. As a noninvasive tool, low platelet count (PC) can be helpful in prediction of variceal bleed in CLD patients with esophageal varices. Objectives: To assess the diagnostic accuracy of thrombocytopenia in predicting the presence of esophageal varices in patients with chronic liver disease. Study Design: Descriptive Cross sectional study. Setting: Medicine Unit I, Sheikh Zayed Hospital, Lahore. Period: 6 months from 1-07-2015 to 31-12-2015. Material and Methods: About 150 cases were included in our study through Non-Probability, Consecutive sampling method after obtaining written Informed consent. Blood sample was obtained from each patient and were immediately sent to the laboratory for assessment of platelet count. Reports were assessed. Those with low platelet count were referred to endoscopy room for confirmation of esophageal varices. Reports of endoscopy were compared with platelet count. Data was entered and analyzed through SPSS version 23. Results: Mean age of patients was 49.64±11.54 years. There were 97(64.7%) male and 53(35.3%) female patients. Mean duration of chronic liver disease of patients was 3.51±1.39. Mean platelet count of patients was 172.3±81.20. Sensitivity and Specificity of Thrombocytopenia for prediction of esophageal varices in patients presenting with chronic liver disease was 92.63% and 89.09%. While PPV, NPV and Diagnostic accuracy of Thrombocytopenia for prediction of esophageal varices was 93.62%, 87.5% and 91.33% respectively. Conclusion: It has been concluded from the present study that PC has high accuracy for detection of EVs and can be helpful in prediction of EVs in CLD patients.

scholarly journals Correction to: Diagnostic accuracy of spleen stiffness to evaluate portal hypertension and esophageal varices in chronic liver disease: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Xing Hu ◽  
Xiaojie Huang ◽  
Jianhua Hou ◽  
Lei Ding ◽  
Chunling Su ◽  
...  
Keyword(s):  
Systematic Review ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Diagnostic Accuracy ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Meta Analysis ◽  
Chronic Liver ◽  
Original Version ◽  
Spleen Stiffness

The original version of this article, published on 24 September 2020, unfortunately contained a mistake.

scholarly journals A72 NON-INVASIVE PREDICTION OF ESOPHAGEAL VARICES BY TRANSIENT ELASTOGRAPHY AND PLATELET COUNT IN PATIENTS WITH HEPATITIS B AND ADVANCED CHRONIC LIVER DISEASE: VALIDATION OF BAVENO VI AND EXPANDED BAVENO VI CRITERIA

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 37-38
Author(s):  
A Zoughlami ◽  
J Serero ◽  
G Sebastiani ◽  
M Deschenes ◽  
P Wong ◽  
...  
Keyword(s):  
Platelet Count ◽  
Liver Disease ◽  
Hepatitis B ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Diagnostic Performance ◽  
Transient Elastography ◽  
Chronic Liver ◽  
Non Invasive ◽  
Chronic Hepatitis B Virus

Abstract Background Patients with compensated advanced chronic liver disease (cACLD) are at higher risk of developing complications from portal hypertension, including esophageal varices (EV). Baveno VI and expanded Baveno VI criteria, based on liver stiffness measurement (LSM) by transient elastography combined with platelet count, have been proposed to avoid unnecessary esophagogastroduodenoscopy (EGD) screening for large esophageal varices needing treatment (EVNT). This approach has not been validated in patients with chronic hepatitis B virus (HBV) infection, who have etiology-specific cut-off of LSM for liver fibrosis. Aims We aimed to validate the Baveno VI and expanded Baveno VI criteria for EVNT in HBV patients with cACLD. Methods We performed a retrospective analysis of HBV patients who underwent LSM in 2014–2020. Inclusion criteria were: a) diagnosis of cACLD, defined as LSM >9 kPa; b) availability of EGD and platelets within 1 year of LSM. Baveno VI (LSM <20 kPa and platelets >150,000) and expanded Baveno VI criteria (LSM <25 kPa and platelets >110,000) were tested for EGD sparing. Diagnostic performance of these criteria against gold standard (EGD) was computed and compared to patients with hepatitis C virus (HCV) infection and nonalcoholic steatohepatitis (NASH) etiologies, where these criteria have been widely validated. In these patients, the threshold for cACLD definition was >10 kPa. Results A total of 287 patients (mean age 56, 95% Child A) were included, comprising of 43 HBV (58% on antiviral therapy), 134 HCV and 110 NASH patients. The prevalence of any grade EV and EVNT was 25% and 8% in the whole cohort, with 19% and 5% in HBV patients, respectively. Table 1 reports diagnostic performance, spared EGD and missed EVNT according to non-invasive criteria and cACLD etiology. Both Baveno VI and expanded Baveno VI criteria performed well in patients with HBV-related cACLD. There was no significant difference on diagnostic performance of these non-invasive criteria across the cACLD etiologies. Conclusions These results support use of non-invasive criteria based on LSM and platelets to spare unnecessary EGD in patients with HBV and cACLD. Baveno VI and expanded Baveno VI criteria can improve resource utilization and avoid invasive testing in context of screening EGD for patients with HBV-related cACLD. Funding Agencies None

scholarly journals Liver stiffness-spleen size-to-platelet ratio risk score detects esophageal varices in chronic liver disease

SpringerPlus ◽  
2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Soichiro Shibata ◽  
Satoru Joshita ◽  
Takeji Umemura ◽  
Tomoo Yamazaki ◽  
Naoyuki Fujimori ◽  
...  
Keyword(s):  
Liver Disease ◽  
Chronic Liver Disease ◽  
Risk Score ◽  
Esophageal Varices ◽  
Liver Stiffness ◽  
Chronic Liver ◽  
Spleen Size

scholarly journals Comparison between shear wave elastography and serological findings for the evaluation of fibrosis in chronic liver disease

2021 ◽  
Vol 21 (86) ◽  
pp. e186-e193
Author(s):  
Mahjabeen Liaqat ◽  
◽  
Kashif Siddique ◽  
Imran Yousaf ◽  
Raham Bacha ◽  
...  
Keyword(s):  
Liver Disease ◽  
Liver Fibrosis ◽  
Diagnostic Accuracy ◽  
Chronic Liver Disease ◽  
Shear Wave ◽  
Shear Wave Elastography ◽  
Chronic Liver ◽  
Optimal Cutoff ◽  
Cutoff Value ◽  
Cutoff Values

Aim: In this study, we sought to examine the optimal cutoff values for predicting different stages of liver fibrosis, and to determine the level of agreement between shear wave elastography and aspartate aminotransferase to platelet ratio index (APRI) and fibrosis-4 index (FIB-4) scores in patients with chronic liver disease. Methodology: A descriptive, cross-sectional study was performed at the Radiology Department of Shaukat Khanum Memorial Hospital Lahore from 1 Jun 2019 until 1 June 2020. FIB-4 and APRI scores were determined by the following formula: FIB-4 = (age × AST) ÷ (platelet count × (√ (ALT)) and APRI = (AST÷AST upper limit of normal) ÷ platelet × 100. Data was analyzed with the help of SPSS version 24.0 and Microsoft Excel 2013. Results: Eighty individuals were conveniently selected, of which 62.5% were men and 37.5% were women. The mean age of the subjects was 43.47 SD ± 13.85 years. APRI and FIB-4 scores predicted F4 patients using the cutoff values of 0.47 (Sn. 72%, Sp. 70%) and 1.27 (Sn. 78%, Sp. 73%), respectively. The cutoff values of 0.46 for APRI and 1.27 for FIB-4 predicted F3–F4 patients (Sn. 74% and 77%; Sp. 76% and 76%), respectively. To predict F1–F4 compared to F0, the cutoff value was 0.34 (Sn. 68%, Sp. 75%) for APRI, while the cutoff value for FIB was 0.87 (Sn. 72%, Sp. 75%). The findings suggest that FIB-4 shows better diagnostic accuracy than APRI. Conclusion: This study provides optimal cutoff values for different groups of fibrosis patients for both serum markers. Also, the diagnostic accuracy of FIB-4 for predicting liver fibrosis was found to be superior to APRI in all disease stages.

Liver Stiffness Assessed by Ultrasound Shear Wave Elastography from General Electric Accurately Predicts Clinically Significant Portal Hypertension in Patients with Advanced Chronic Liver Disease

2019 ◽  
Vol 41 (05) ◽  
pp. 526-533
Author(s):  
Horia Stefanescu ◽  
Corina Rusu ◽  
Monica Lupsor-Platon ◽  
Oana Nicoara Farcau ◽  
Petra Fischer ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Diagnostic Accuracy ◽  
Chronic Liver Disease ◽  
Shear Wave ◽  
Liver Stiffness ◽  
Shear Wave Elastography ◽  
Chronic Liver ◽  
General Electric ◽  
Clinically Significant

Abstract Purpose Clinically significant portal hypertension (CSPH) is responsible for most of the complications in patients with cirrhosis. Liver stiffness (LS) measurement by vibration-controlled transient elastography (VCTE) is currently used to evaluate CSPH. Bi-dimensional shear wave elastography from General Electric (2D-SWE.GE) has not yet been validated for the diagnosis of PHT. Our aims were to test whether 2D-SWE.GE-LS is able to evaluate CSPH, to determine the reliability criteria of the method and to compare its accuracy with that of VCTE-LS in this clinical setting. Materials and Methods Patients with chronic liver disease referred to hepatic catheterization (HVPG) were consecutively enrolled. HVPG and LS by both VCTE and 2D-SWE.GE were performed on the same day. The diagnostic performance of each LS method was compared against HVPG and between each other. Results 2D-SWE.GE-LS was possible in 123/127 (96.90 %) patients. The ability to record at least 5 LS measurements by 2D-SWE.GE and IQR < 30 % were the only features associated with reliable results. 2D-SWE.GE-LS was highly correlated with HVPG (r = 0.704; p < 0.0001), especially if HVPG < 10 mmHg and was significantly higher in patients with CSPH (15.52 vs. 8.14 kPa; p < 0.0001). For a cut-off value of 11.3 kPa, the AUROC of 2D-SWE.GE-LS to detect CSPH was 0.91, which was not inferior to VCTE-LS (0.92; p = 0.79). The diagnostic accuracy of LS by 2D-SWE.GE-LS to detect CSPH was similar with the one of VCTE-LS (83.74 % vs. 85.37 %; p = 0.238). The diagnostic accuracy was not enhanced by using different cut-off values which enhanced the sensitivity or the specificity. However, in the subgroup of compensated patients with alcoholic liver disease, 2D-SWE.GE-LS classified CSPH better than VCTE-LS (93.33 % vs. 85.71 %, p = 0.039). Conclusion 2D-SWE.GE-LS has good accuracy, not inferior to VCTE-LS, for the diagnosis of CSPH.

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