Non-invasive assessment of esophageal and fundic varices in patients with primary biliary cholangitis

作者：Yuan Zhang, Chunyang Huang, Fankun Meng, Xing Hu, Xiaojie Huang, Jing Chang, Xue Han, Tieying Zhang, Jing Han, Huiyu Ge · 发表于：European Radiology · 年份：2024 · DOI：10.1007/s00330-024-11049-z · 被引用次数：4 · 研究领域：Liver Disease and Transplantation、Liver Diseases and Immunity、Gallbladder and Bile Duct Disorders

Abstract Objectives The Baveno VII consensus recommends endoscopic screening for varicose veins in cases of liver stiffness measurement (LSM) ≥ 20 kPa or platelet count ≤ 150 × 10 9 /L. Whether this approach was appropriate for patients with primary biliary cholangitis (PBC) remains uncertain. This study expanded the observed risk factors by adding analysis of ultrasound images as a non-invasive tool to predict the risk of esophageal or fundic varices. Methods We enrolled 111 patients with PBC whose complete ultrasound images, measurement data, and LSM data were available. The value of the periportal hypoechoic band (PHB), splenic area, and LSM in determining the risk of varicose veins and variceal rupture was analyzed. A prospective cohort of 67 patients provided external validation. Results The area under the receiver operating characteristic curve (AUC) for predicting varicose veins using LSM > 12.1 kPa or splenic areas > 41.2 cm 2 was 0.806 (95% confidence interval (CI): 0.720–0.875) and 0.852 (95% CI: 0.772–0.912), respectively. This finding could assist in avoiding endoscopic screening by 76.6% and 83.8%, respectively, with diagnostic accuracy surpassing that suggested by Baveno VII guidelines. The AUCs for predicting variceal rupture using splenic areas > 56.8 cm 2 was 0.717 (95% CI: 0.623–0.798). The diagnostic accuracy of PHB for variceal rupture was higher than LSM and splenic areas (75.7% vs. 50.5% vs. 68.5%). Conclusion We recommend LSM > 12.1 kPa as a...