Predictive value of CT for first esophageal variceal bleeding in patients with cirrhosis: Value of para-umbilical vein patency

To evaluate if the presence/size of a para-umbilical vein (PUV) on computed tomography (CT) are associated with a first esophageal variceal hemorrhage (EVH) in patients with cirrhosis and whether imaging features can help identify patients at increased risk of EVH.From January 2010 to June 2012 patients with cirrhosis who underwent CT and upper gastrointestinal endoscopy within six months were included. The presence/size of PUV was noted. PUV5mm were considered large (LPUV). Association with a first EVH was searched for, and validated in a prospective cohort of 55 patients.172 patients (113 men, mean 60±12 yo) were included. Forty-three patients (25%) experienced a first EVH. LPUV were more frequent in the group without EVH (27% vs. 7%, p=0.005). At multivariate analysis, factors associated with a first EVH were spleen size135mm (Odd Ratio [OR]=1.32 [95% confident interval [CI] 1.16-1.51], p0.001), ascites (OR=4.07 [95%CI-1.84-9.01], p=0.001) and small/absent PUV (OR=3.06 [95%CI-1.86-5.05], p0.001). An imaging score combining these factors was significantly associated with first EVH in the study and the validation cohorts (EVH in 0%, 19%, and 33% when score 0-1, 2-3, and 4-5, respectively).A simple imaging score combining the PUV and spleen size, and the presence of ascites could help to identify cirrhotic patients at high-risk for EVH.