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Can “Attenuation Subtraction”, a Computed Tomography Scan-Based Factor, Be Used As a Predictor of High-Risk Esophageal Varices in Cirrhotic Patients? a Retrospective Cohort Study Publisher



Mansouri Tehrani MM1 ; Bahari N2 ; Goudarzi K3 ; Salahshour F4 ; Shekarchi B5 ; Mansouritehrani MM6 ; Nouri M5
Authors
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Authors Affiliations
  1. 1. Radiation Sciences Research Center, Aja University of Medical Sciences, Tehran, Iran
  2. 2. Cancer Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
  3. 3. Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  4. 4. Department of Radiology, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam-Khomeini Hospital Complex, Tehran University of Medical Science, Tehran, Iran
  5. 5. Infectious Diseases Research Center, Aja University of Medical Sciences, Tehran, Iran
  6. 6. Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

Source: Health Science Reports Published:2025


Abstract

Background and Aims: Liver cirrhosis is a severe condition that can result in complications such as portal hypertension and esophageal varices (EVs). While current guidelines recommend screening for EVs, existing procedures are often invasive, costly, and occasionally unreliable. This study aims to develop a CT-based predictor for identifying high-risk esophageal varices group (HRG) in cirrhotic patients, offering a noninvasive, safe, and cost-effective alternative that integrates seamlessly into routine follow-up without requiring additional resources or time. Methods: The study retrospectively analyzed data from 2016 to 2021 of cirrhotic patients referred to a hospital in Tehran. Experienced professionals analyzed factors related to CT scans, and patients were categorized into high-risk and non-high-risk varicose veins groups by endoscopy. The main sample size for the study was 62 patients with an average age of 50.2 ± 11.5 years. Also, we aimed to determine a diagnostic cutoff and externally validated it in a separate statistical population (29 patients). Result: The study found that liver attenuation subtraction, Child-Pugh score, and direct visualization of esophageal varices in CT scans were significant factors in predicting high-risk esophageal varices. The study showed that a liver attenuation subtraction of 14.5 HU (CI 95%: 0.949–1) with an inverse relationship could predict high-risk esophageal varices with high accuracy. Conclusion: The study indicated that liver “Attenuation Subtraction” in CT scans distinguishes high-risk and non-high-risk esophageal varices. Furthermore, external validation demonstrated that this cutoff value is generalizable to other statistical populations. We pinpoint an indicator of high-risk esophageal varices in patients with cirrhosis devoid of invasiveness and peril and do not impose supplementary expenses or time beyond the customary monitoring of cirrhotic patients. © 2025 The Author(s). Health Science Reports published by Wiley Periodicals LLC.