Esophageal varices: Diagnosis with gadolinium-enhanced MR imaging of the liver for patients with chronic liver damage

OBJECTIVE. The purpose of our study was to evaluate the value of gadolinium-enhanced MR imaging of the liver in the detection and grading of esophageal varices in patients with chronic liver damage. MATERIALS AND METHODS. Three independent off-site radiologists retrospectively reviewed MR images of the liver obtained in 72 patients with chronic liver damage, including 49 patients with untreated esophageal varices. All patients had undergone gastrointestinal endoscopy within 2 weeks of MR imaging. Both MR and endoscopic images were reviewed to determine whether esophageal varices were present and, if so, to determine the grade of the varices. Observer performances were tested with reciever operating characteristic curve analysis using the jackknife dispersion test. Correlations between the grades of the varices determined using MR images and those determined using endoscopic images were tested. RESULTS. Sensitivity for detection of esophageal varices was significantly (p < 0.01) higher for the combination of unenhanced and gadolinium-enhanced MR images (81%) than for the unenhanced MR images alone (51%). The receiver operating characteristic curve analysis (area under the curve, [A(z)]) showed that performance using the combination of the unenhanced and gadolinium-enhanced MR images (A(z) = 0.641) was superior to that using unenhanced MR images alone (A(z) = 0.586). A statistically significant positive correlation (p < 0.05) was found between the grades determined using MR imaging and the grades determined using endoscopy. CONCLUSION. Our results suggest the potential value of diagnosing the presence and grade of esophageal varices on MR imaging of the liver for patients with chronic liver damage. Gadolinium-enhanced MR imaging may increase the potential value.