ISSN: 1899-0967
Polish Journal of Radiology
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vol. 88
Gastrointestinal and abdominal radiology
Original paper

Computed tomography virtual oesophagography for the grading of oesophageal varices in cirrhotic liver disease patients with upper gastrointestinal endoscopic examination as the gold standard: a diagnostic validation study

Ravinandan Kumar
Khanak K. Nandolia
Pankaj Sharma
Ajeet Singh Bhadoria
Udit Chauhan
Itish Patnaik
Sudhir Saxena

Department of Radiology, All India Institute of Medical Sciences, Rishikesh, India
Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, India
Department of Medical Gastroenterology, All India Institute of Medical Sciences, Rishikesh, India
© Pol J Radiol 2023; 88: e187-e193
Online publish date: 2023/04/05
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Virtual endoscopy is a postprocessing method using three-dimensional computed tomography (CT), which produces views of the inner surfaces of the human body like those produced by fibreoptic endoscopy. To evaluate and categorise patients who require medical or endoscopic band ligation to prevent oesophageal variceal bleed, a less invasive, less expensive, better tolerated, and more sensitive modality is required, as well as to reduce the use of invasive procedures in the follow-up of patients who do not require endoscopic variceal band ligation.

Material and methods
A cross-sectional study was conducted in the Department of Radiodiagnosis in association with the Department of Gastroenterology. The study was conducted over a period of 18 months from July 2020 to January 2022. The sample size was calculated as 62 patients. Patients were recruited on the basis of inclusion and exclusion criteria after giving informed consent. CT virtual endoscopy was performed through a dedicated protocol. Classification of variceal grading was done independently by a radiologist and endoscopist who were blinded to each other’s findings.

The diagnostic performance of oesophageal varices detection by CT virtual oesophagography was good, with sensitivity: 86%, specificity: 90%, PPV: 98%, NPV: 56%, and diagnostic accuracy: 87%. There was substantial agreement between the 2 methods, and this agreement was statistically significant (Cohen’s κ = 0.616, p ≤ 0.001).

Based on our findings, we conclude that the current study has the potential to change the way chronic liver disease is managed, as well as generate similar medical research endeavours. A multicentric study with a large number of patients is needed to improve the experience with this modality.


grading, varices, cirrhosis, endoscopy, CT scan, virtual endoscopy

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