The diagnostic accuracy of triphasic abdominal CT in detecting esophageal varices

The diagnostic accuracy of triphasic abdominal CT in detecting esophageal varices | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The diagnostic accuracy of triphasic abdominal CT in detecting esophageal varices Suzana Lukoo, Balowa Musa, Lilian Salingwa, Gerard Mpemba, Ahmed Jusabani This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4555053/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Aug, 2024 Read the published version in BMC Medical Imaging → Version 1 posted 11 You are reading this latest preprint version Abstract Background In Tanzania, triphasic abdominal Computed Tomography (CT) is a more accessible and non-invasive alternative for diagnosing esophageal varices, though its accuracy has not been thoroughly evaluated, therefore this study aimed to determine the diagnostic accuracy of triphasic abdominal CT in detecting esophageal varices using esophagogastroduodenoscopy (OGD) as the gold standard among patients with upper gastrointestinal bleeding at Muhimbili National Hospital (MNH). Methods This cross-sectional study was conducted at MNH from January 2021 to May 2023. We sampled upper gastrointestinal bleeding patients who underwent both OGD and triphasic abdominal CT using non-probability consecutive sampling. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of triphasic abdominal CT were assessed against OGD findings. Results In a study of 200 participants, esophageal varices were detected in 54% by OGD and 53.5% by CT. We observed 105 true positives, 2 false positives, 90 true negatives, and 3 false negatives. Triphasic abdominal CT demonstrated a sensitivity of 97.2%, specificity of 97.8%, PPV of 98.1%, NPV of 96.8%, and an accuracy of 97.5%. Extraluminal findings included splenic collaterals, ascites, hepatocellular carcinoma, and periportal fibrosis. Conclusion Triphasic abdominal CT is a reliable and non-invasive modality for diagnosing and screening esophageal varices in resource-limited settings. Esophageal varices Triphasic abdominal CT Oesophagoduodenoscopy Background Upper gastrointestinal bleeding (UGIB) is a serious global emergency, with esophageal varices being a significant cause, especially in Tanzania where it accounts for 57% of cases( 1 – 3 ). Esophageal varices, from portal hypertension, affect up to 40% of cirrhotic patients, with a 10%-30% annual hemorrhage risk and a 20%-35% mortality rate at first bleeding( 4 – 7 ). Liver cirrhosis from Hepatitis B, alcohol, and schistosomiasis are major risk factors for portal hypertension( 2 , 3 , 8 – 11 ). Oesophaphagoduodenoscopy (OGD) is a gold standard tool for diagnosing and treating esophageal varices in upper gastrointestinal bleeding( 12 – 14 ). However, restricted access to OGD correlates with unfavorable disease outcomes ( 3 , 15 , 16 ). Several studies have reported that triphasic abdominal CT showed a non-invasive alternative diagnostic modality to detect esophageal varices and other related pathologies that may impact patient management ( 6 , 17 – 19 ). Esophageal varices are a major cause of morbidity and mortality in patients with upper gastrointestinal bleeding, particularly in regions like Tanzania where liver cirrhosis is prevalent ( 1 , 2 ). This study addresses a critical gap by evaluating the effectiveness of a more accessible diagnostic tool triphasic abdominal CT. Demonstrating high diagnostic accuracy of triphasic abdominal CT can Improve patient outcomes, enhance resource utilization and guide clinical practice. This study is innovative in several key aspects including its comprehensive evaluation in resource limited settings, blinded assessment ensuring objective comparison of the two imaging modalities and paving way for further prospective, multi-center studies, and contribute to the global body of knowledge on non-invasive diagnostic techniques for esophageal varices, potentially influencing international clinical practices. Material and methods This diagnostic accuracy study was part of a broader study on UGIB profiles at MNH. We included 200 participants aged 18 years and above, with UGIB history who underwent both OGD and triphasic abdominal CT. Exclusion criteria included patients without retrievable CT or endoscopic records. Diagnostic Triphasic Abdominal CT and OGD Axial triphasic abdominal CT scans were independently reviewed by a principal investigator and an experienced radiologist. Varices were identified as linear or nodular enhancing lesions near or within the esophageal lumen( 20 ). Assessments were blinded to endoscopic results, which served as the gold standard. Data Management and Analysis Data were collected using structured forms and analyzed using SPSS version 26. Sensitivity, specificity, PPV, and NPV of triphasic abdominal CT were calculated against OGD results. A P-value of < 0.05 was considered statistically significant. Results Out of 200 participants, 60% were men with a mean age of 49.4 ± 15.85 years. Significant risk factors included Hepatitis B, alcohol liver disease, non-alcohol fatty liver disease, and hepatic schistosomiasis. Esophageal varices were detected by OGD in 54% and by CT in 53.5% of participants. Triphasic abdominal CT also detected other conditions such as gastric varices, liver cirrhosis, and hepatocellular carcinoma. Among the 200 participants, esophageal varices by OGD were found in more than half of them 108(54%). Triphasic abdominal CT neared the OGD findings where it revealed esophageal varices in patients 107(53.5%) and absent in 93(46.5%) of the studied participants. In addition to esophageal varices, triphasic abdominal CT also showed evidence of gastric varices in 53 patients (26.5%), liver cirrhosis in 49(24.5%), portal venous thrombosis in 44(22%), para esophageal varices in 39(19.5%), and splenic varices in 103 (51.5%), Periportal fibrosis in 64(32%) and Hepatocellular carcinoma (HCC)26(13%). There were 105 true positive, 2 false positive, 90 true negative, and 3 false cases on triphasic abdominal CT with endoscopy taken as a gold standard for the diagnosis of esophageal varices. (Table 1 ). Table 1 Cross tabulation of triphasic abdominal CT in detecting esophageal varices using OGD as a gold standard. (N = 200) Triphasic Abdominal CT findings Oesophagoduodenoscopy (OGD) findings Total Esophageal varices(+ ve) Esophageal varices (-ve) Esophageal varices (+ ve) 105 2 107(53.5%) Esophageal varices(-ve) 3 90 93(46.5%) Total 108(54%) 92(46%) 200 Based on these findings, triphasic abdominal CT has a sensitivity of 97.2%, specificity of 97.8%, PPV of 98.1%, and NPV of 96.8% in the detection of esophageal varices. The overall diagnostic accuracy of triphasic abdominal CT in detecting esophageal varices was 97.5%. Discussions Our study demonstrated that triphasic abdominal CT has a high diagnostic accuracy in detecting esophageal varices. These findings are in line with a study conducted at Kot Khawaja Saeed Teaching Hospital, Lahore in Pakistan, which reported similar findings with high sensitivity (98.4%), specificity (97.6%), and accuracy (98.1%)( 6 ).The similarity in sampling technique and imaging protocol could explain the observed performance. However, these findings were slightly lower than those reported at Aga Khan University Hospital, in Pakistan and Egypt and in Pakistan where abdominal CT has an accuracy of range of 99%to 100% ( 5 , 17 , 19 ). The variations observed could be clarified by the inclusion of exclusively cirrhotic patients in the studies mentioned, alongside the utilization of CT esophagography in the Egyptian study, which is a highly effective protocol for detecting esophageal varices. Also, our study findings were higher than those reported in the United States, Iran, and China where the sensitivity, specificity and diagnostic accuracy ranged from 63.49–90%; 50–72.58% and 72.58 and 83.5% respectively ( 13 , 21 , 22 ) The observed differences could be attributed to the small sample sizes and the exclusive inclusion of cirrhotic patients in the abovementioned studies. Our study identified portosystemic collaterals, liver cirrhosis, periportal fibrosis, and hepatocellular carcinoma, consistent with other studies(5,6,23). Triphasic abdominal CT, unlike OGD, detects these extra-esophageal abnormalities, highlighting its additional benefit, especially in chronic liver disease which helps guide treatment and projecting the prognosis in the managed patients. Our study has a limitation. It was a retrospective design of the study hence selection bias. A single-center study at a tertiary hospital. This limits its generalizability. Conclusions Triphasic abdominal CT can be used as an alternative modality for diagnosing as well as screening tool for esophageal varices, especially in resource-limited settings. Its high diagnostic accuracy makes it valuable in healthcare facilities with CT availability where access to OGD is limited. Further, prospective multi-center studies of triphasic abdominal CT for detection of esophageal varices are needed for the findings to be generalized to the general population. Abbreviations CT: Computed Tomography, OGD: Oesophagoduodensoscopy, MNH: Muhimbili National Hospital, PPV: Positive predictive value, NPV: Negative predictive value, UGIB: Upper gastrointestinal bleeding, HCC: Hepatocellular carcinoma. Declarations Ethics approval and consent to participate The research proposal underwent a comprehensive review and obtained ethical approval from the MUHAS Institutional Review Board (MUHAS-REC-04-2023-1617). Due to the retrospective design of the study, a waiver for informed consent was requested. Permission to collect data was also obtained from the director-general of MNH. The confidentiality of all information and data was strictly upheld throughout the study. Patient identities were not collected or utilized, and no identifying information was included in the data analysis. Furthermore, access to the data was restricted to the investigators alone. Consent for publication Not applicable Availability of data and materials We declare that the supporting data can be available upon request from the corresponding author. Competing interests The authors declare that they have no competing interests. Funding No funding was obtained for this study. Authors' contributions SL: Designed the study, acquired and analyzed the data, interpreted the data and did manuscript drafting; BM: assisted in designing the study, data interpretation, and critically reviewed the manuscript for its intellectual content; GM &LS: assisted in acquiring the data and critically reviewed the manuscript for its intellectual content; AJ: assisted with data analysis, and critically reviewed the manuscript for its intellectual content. All Authors read and approved the final Manuscript Acknowledgements The authors would like to acknowledge the support given by all staff members at Muhimbili Radiology department and the medical records department. No funds were received for conducting this research References Chofle AA, Jaka H, Koy M, et al. mortality among patients admitted with hematemesis in Mwanza, Tanzania: a prospective cohort study. Published online 2014:1-10. Moledina SM. Risk factors for mortality among patients admitted with upper gastrointestinal bleeding at a tertiary hospital: a prospective cohort study. Published online 2017:1-11. doi:10.1186/s12876-017-0712-8 Opio CK, Rejani L, Kazibwe F, Ocama P. The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic. Afr Health Sci. 2019;19(4):3225-3234. doi:10.4314/ahs.v19i4.46 Gunda DW, Kilonzo SB, Mamballah Z, et al. The magnitude and correlates of esophageal Varices among newly diagnosed cirrhotic patients undergoing screening fibre optic endoscope before incident bleeding in North-Western Tanzania; A cross-sectional study. BMC Gastroenterol. 2019;19(1):1-9. doi:10.1186/s12876-019-1123-9 Moftah SG, Kamal S, Hanna ATK. ORIGINAL ARTICLE CT esophagography: Non-invasive screening and grading of esophageal varices in cirrhosis. Egypt J Radiol Nucl Med. 2014;45(2):263-270. doi:10.1016/j.ejrnm.2014.03.004 Hira Ashfaq Butt, Rukhsana Nasim, Khalid Javed, et al. Diagnostic accuracy of triphasic CT scan abdomen in the diagnosis of distal esophageal varices taking endoscopic findings as gold standard. Prof Med J. 2022;29(12):1831-1837. doi:10.29309/tpmj/2022.29.12.7213 Elghezewi A, Hammad M, El-Dallal M, Mohamed M, Sherif A, Frandah W. Trends in Hospitalizations of Esophageal Varices From 2011 to 2018: A United States Nationwide Study. Gastroenterol Res. 2023;16(3):171-183. doi:10.14740/gr1627 Kiringa SK, Quinlan J, Ocama P, Mutyaba I, Kagimu M. Prevalence, short term outcome and factors associated with survival in patients suffering from upper gastrointestinal bleeding in a resource limited setting, the case of mulago hospital in Kampala, Uganda. Afr Health Sci. 2020;20(1):426-436. doi:10.4314/ahs.v20i1.49 Alema ON, Martin DO, Okello TR. Endoscopic findings in upper gastrointestinal bleeding patients at Lacor hospital, northern Uganda. Afr Health Sci. 2012;12(4):518-521. doi:10.4314/ahs.v12i4.19 Ather DM, Sarfraz DM, Zikarya DM. Upper Gastrointestinal Bleeding; Endoscopic Findings in Patients. Prof Med J. 2017;24(02):335-341. doi:10.17957/tpmj/17.3711 Jemilohun AC, Akande KO, Ngubor TD, Oku O, Ogunmola MI, Adesuyi YO. Endoscopic Findings in Patients with Upper Gastrointestinal Bleeding in Ogun State, Nigeria. Cureus. 2022;14(3). doi:10.7759/cureus.23637 Malghani WS, Malik R, Chaudhary FMD, et al. Spectrum of Endoscopic Findings in Patients of Upper Gastrointestinal Bleeding at a Tertiary Care Hospital. Cureus. 2019;11(4):4-10. doi:10.7759/cureus.4562 Deng H, Qi X, Zhang Y, Peng Y, Li J, Guo X. Diagnostic accuracy of contrast-enhanced computed tomography for esophageal varices in liver cirrhosis: a retrospective observational study. J Evid Based Med. 2017;10(1):46-52. doi:10.1111/jebm.12226 Manuscript A. NIH Public Access. 2015;39(2):251-256. doi:10.1007/s00261-013-0057-x Jaka H, Koy M, Liwa A, et al. A Fibreoptic endoscopic study of upper gastrointestinal bleeding at Bugando Medical Centre in northwestern Tanzania: A retrospective review of 240 cases. Published online 2012:1-9. Deng H, Qi X, Guo X. Computed tomography for the diagnosis of varices in liver cirrhosis: a systematic review and meta- analysis of observational studies. Postgrad Med. 2017;0(0). doi:10.1080/00325481.2017.1241664 Hassan M, Husen Y, Abbasi S un nisa, Hussain Z. Diagnostic Accuracy of Multidetector Computed Tomography in Detection of Esophageal Varices. 2019;11(1):8-13. doi:10.7759/cureus.3933 Yu NC, Margolis D, Hsu M, Raman SS, Lu DSK. Detection and grading of esophageal varices on liver CT: Comparison of standard and thin section multiplanar reconstructions in diagnostic accuracy. Am J Roentgenol. 2011;197(3):643-649. doi:10.2214/AJR.10.5458 Abdel B, Dessouky M, Sayed E, Abdel M. Multidetector CT oesophagography: An alternative screening method for endoscopic diagnosis of oesophageal varices and bleeding risk Multidetector CT oesophagography: An alternative screening method for endoscopic diagnosis of oesophageal varices and ble. Arab J Gastroenterol. 2015;14(3):99-108. doi:10.1016/j.ajg.2013.08.006 Kim H, Choi D, Gwak GY, et al. Evaluation of esophageal varices on liver computed tomography: Receiver operating characteristic analyses of the performance of radiologists and endoscopists. J Gastroenterol Hepatol. 2009;24(9):1534-1540. doi:10.1111/j.1440-1746.2009.05849.x Perri RE, Chiorean M V., Fidler JL, et al. A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices. Hepatology. 2008;47(5):1587-1594. doi:10.1002/hep.22219 Salahshour F, Mehrabinejad MM, Rashidi Shahpasandi MH, et al. Esophageal variceal hemorrhage: the role of MDCT characteristics in predicting the presence of varices and bleeding risk. Abdom Radiol. 2020;45(8):2305-2314. doi:10.1007/s00261-020-02585-5 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 14 Aug, 2024 Read the published version in BMC Medical Imaging → Version 1 posted Editorial decision: Revision requested 17 Jul, 2024 Reviews received at journal 14 Jul, 2024 Reviews received at journal 05 Jul, 2024 Reviewers agreed at journal 24 Jun, 2024 Reviewers agreed at journal 24 Jun, 2024 Reviewers agreed at journal 24 Jun, 2024 Reviewers invited by journal 17 Jun, 2024 Editor invited by journal 17 Jun, 2024 Editor assigned by journal 12 Jun, 2024 Submission checks completed at journal 12 Jun, 2024 First submitted to journal 09 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4555053","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":318441647,"identity":"4d842235-1d63-4fbd-97a0-489e647010e2","order_by":0,"name":"Suzana Lukoo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYDCCAxCKh5+9AUgZWBCvRU6yB8QykCBei7HBjQQQTYQWvtvHn0n+qLmTOHPm86sbfhRIMPC3dyfg1SJ5LsdMQuLYs8R+6Zyymz1Ah0mcObsBrxaDMzxsEgZshxNnzs5Ju8ED1GIgkUtIC/sziYR/hxM33DyTdvMPcVoYzCQOth0Gep/92G2ibJE8w2Ns2dh3GBjIOWy3ZQwkeAj6he8M+8ObP74dBkbl8Wc33/yxkeNv78WvBQnwGIBJYpWDAPsDUlSPglEwCkbBCAIA5+FLNw/5Q3UAAAAASUVORK5CYII=","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":true,"prefix":"","firstName":"Suzana","middleName":"","lastName":"Lukoo","suffix":""},{"id":318441649,"identity":"5f52e179-1498-4b37-b74b-c7d9914566d3","order_by":1,"name":"Balowa Musa","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Balowa","middleName":"","lastName":"Musa","suffix":""},{"id":318441650,"identity":"9e85eb1c-f754-48c8-88c9-8a64f2b69c98","order_by":2,"name":"Lilian Salingwa","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Lilian","middleName":"","lastName":"Salingwa","suffix":""},{"id":318441652,"identity":"fabb77bb-5052-41f9-a2fc-b7ef1c11f036","order_by":3,"name":"Gerard Mpemba","email":"","orcid":"","institution":"Muhimbili National Hospital","correspondingAuthor":false,"prefix":"","firstName":"Gerard","middleName":"","lastName":"Mpemba","suffix":""},{"id":318441656,"identity":"39df7320-88d6-4aca-b78e-75bca1a090b5","order_by":4,"name":"Ahmed Jusabani","email":"","orcid":"","institution":"Muhimbili University of Health and Allied Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Jusabani","suffix":""}],"badges":[],"createdAt":"2024-06-09 21:25:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4555053/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4555053/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12880-024-01388-0","type":"published","date":"2024-08-14T15:58:07+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":63071767,"identity":"c7980180-28f5-4fe4-9ff5-804ec809c48a","added_by":"auto","created_at":"2024-08-22 20:09:32","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":323679,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4555053/v1/d11758e8-8fcc-4311-9049-53305bf590fe.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The diagnostic accuracy of triphasic abdominal CT in detecting esophageal varices","fulltext":[{"header":"Background","content":"\u003cp\u003eUpper gastrointestinal bleeding (UGIB) is a serious global emergency, with esophageal varices being a significant cause, especially in Tanzania where it accounts for 57% of cases(\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Esophageal varices, from portal hypertension, affect up to 40% of cirrhotic patients, with a 10%-30% annual hemorrhage risk and a 20%-35% mortality rate at first bleeding(\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Liver cirrhosis from Hepatitis B, alcohol, and schistosomiasis are major risk factors for portal hypertension(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOesophaphagoduodenoscopy (OGD) is a gold standard tool for diagnosing and treating esophageal varices in upper gastrointestinal bleeding(\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, restricted access to OGD correlates with unfavorable disease outcomes (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Several studies have reported that triphasic abdominal CT showed a non-invasive alternative diagnostic modality to detect esophageal varices and other related pathologies that may impact patient management (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEsophageal varices are a major cause of morbidity and mortality in patients with upper gastrointestinal bleeding, particularly in regions like Tanzania where liver cirrhosis is prevalent (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This study addresses a critical gap by evaluating the effectiveness of a more accessible diagnostic tool triphasic abdominal CT. Demonstrating high diagnostic accuracy of triphasic abdominal CT can Improve patient outcomes, enhance resource utilization and guide clinical practice.\u003c/p\u003e \u003cp\u003eThis study is innovative in several key aspects including its comprehensive evaluation in resource limited settings, blinded assessment ensuring objective comparison of the two imaging modalities and paving way for further prospective, multi-center studies, and contribute to the global body of knowledge on non-invasive diagnostic techniques for esophageal varices, potentially influencing international clinical practices.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eThis diagnostic accuracy study was part of a broader study on UGIB profiles at MNH. We included 200 participants aged 18 years and above, with UGIB history who underwent both OGD and triphasic abdominal CT. Exclusion criteria included patients without retrievable CT or endoscopic records.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDiagnostic Triphasic Abdominal CT and OGD\u003c/strong\u003e \u003cp\u003eAxial triphasic abdominal CT scans were independently reviewed by a principal investigator and an experienced radiologist. Varices were identified as linear or nodular enhancing lesions near or within the esophageal lumen(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). Assessments were blinded to endoscopic results, which served as the gold standard.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData Management and Analysis\u003c/strong\u003e \u003cp\u003eData were collected using structured forms and analyzed using SPSS version 26. Sensitivity, specificity, PPV, and NPV of triphasic abdominal CT were calculated against OGD results. A P-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOut of 200 participants, 60% were men with a mean age of 49.4\u0026thinsp;\u0026plusmn;\u0026thinsp;15.85 years. Significant risk factors included Hepatitis B, alcohol liver disease, non-alcohol fatty liver disease, and hepatic schistosomiasis. Esophageal varices were detected by OGD in 54% and by CT in 53.5% of participants. Triphasic abdominal CT also detected other conditions such as gastric varices, liver cirrhosis, and hepatocellular carcinoma.\u003c/p\u003e \u003cp\u003e Among the 200 participants, esophageal varices by OGD were found in more than half of them 108(54%). Triphasic abdominal CT neared the OGD findings where it revealed esophageal varices in patients 107(53.5%) and absent in 93(46.5%) of the studied participants. In addition to esophageal varices, triphasic abdominal CT also showed evidence of gastric varices in 53 patients (26.5%), liver cirrhosis in 49(24.5%), portal venous thrombosis in 44(22%), para esophageal varices in 39(19.5%), and splenic varices in 103 (51.5%), Periportal fibrosis in 64(32%) and Hepatocellular carcinoma (HCC)26(13%).\u003c/p\u003e \u003cp\u003eThere were 105 true positive, 2 false positive, 90 true negative, and 3 false cases on triphasic abdominal CT with endoscopy taken as a gold standard for the diagnosis of esophageal varices. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCross tabulation of triphasic abdominal CT in detecting esophageal varices using OGD as a gold standard. (N\u0026thinsp;=\u0026thinsp;200)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTriphasic\u003c/p\u003e \u003cp\u003eAbdominal\u003c/p\u003e \u003cp\u003eCT findings\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eOesophagoduodenoscopy (OGD) findings\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEsophageal varices(+\u0026thinsp;ve)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEsophageal varices (-ve)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEsophageal varices (+\u0026thinsp;ve)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e107(53.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEsophageal\u003c/p\u003e \u003cp\u003evarices(-ve)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93(46.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108(54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e92(46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e\u003cp\u003eBased on these findings, triphasic abdominal CT has a sensitivity of 97.2%, specificity of 97.8%, PPV of 98.1%, and NPV of 96.8% in the detection of esophageal varices. The overall diagnostic accuracy of triphasic abdominal CT in detecting esophageal varices was 97.5%.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eOur study demonstrated that triphasic abdominal CT has a high diagnostic accuracy in detecting esophageal varices. These findings are in line with a study conducted at Kot Khawaja Saeed Teaching Hospital, Lahore in Pakistan, which reported similar findings with high sensitivity (98.4%), specificity (97.6%), and accuracy (98.1%)(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).The similarity in sampling technique and imaging protocol could explain the observed performance. However, these findings were slightly lower than those reported at Aga Khan University Hospital, in Pakistan and Egypt and in Pakistan where abdominal CT has an accuracy of range of 99%to 100% (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The variations observed could be clarified by the inclusion of exclusively cirrhotic patients in the studies mentioned, alongside the utilization of CT esophagography in the Egyptian study, which is a highly effective protocol for detecting esophageal varices.\u003c/p\u003e \u003cp\u003eAlso, our study findings were higher than those reported in the United States, Iran, and China where the sensitivity, specificity and diagnostic accuracy ranged from 63.49\u0026ndash;90%; 50\u0026ndash;72.58% and 72.58 and 83.5% respectively (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) The observed differences could be attributed to the small sample sizes and the exclusive inclusion of cirrhotic patients in the abovementioned studies.\u003c/p\u003e \u003cp\u003eOur study identified portosystemic collaterals, liver cirrhosis, periportal fibrosis, and hepatocellular carcinoma, consistent with other studies(5,6,23). Triphasic abdominal CT, unlike OGD, detects these extra-esophageal abnormalities, highlighting its additional benefit, especially in chronic liver disease which helps guide treatment and projecting the prognosis in the managed patients.\u003c/p\u003e \u003cp\u003eOur study has a limitation. It was a retrospective design of the study hence selection bias. A single-center study at a tertiary hospital. This limits its generalizability.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eTriphasic abdominal CT can be used as an alternative modality for diagnosing as well as screening tool for esophageal varices, especially in resource-limited settings. Its high diagnostic accuracy makes it valuable in healthcare facilities with CT availability where access to OGD is limited. Further, prospective multi-center studies of triphasic abdominal CT for detection of esophageal varices are needed for the findings to be generalized to the general population.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eCT: Computed Tomography, OGD: Oesophagoduodensoscopy, MNH: Muhimbili National Hospital, PPV: Positive predictive value, NPV: Negative predictive value, UGIB: Upper gastrointestinal bleeding, HCC: Hepatocellular carcinoma.\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research proposal underwent a comprehensive review and obtained ethical approval from the MUHAS Institutional Review Board (MUHAS-REC-04-2023-1617). Due to the retrospective design of the study, a waiver for informed consent was requested. Permission to collect data was also obtained from the director-general of MNH. The confidentiality of all information and data was strictly upheld throughout the study. Patient identities were not collected or utilized, and no identifying information was included in the data analysis. Furthermore, access to the data was restricted to the investigators alone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe declare that the supporting data can be available upon request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSL: Designed the study, acquired and analyzed the data, interpreted the data and did manuscript drafting; BM: assisted in designing the study, data interpretation, and critically reviewed the manuscript for its intellectual content; GM \u0026amp;LS: assisted in acquiring the data and critically reviewed the manuscript for its intellectual content; AJ: assisted with data analysis, and critically reviewed the manuscript for its intellectual content. All Authors read and approved the final Manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to acknowledge the support given by all staff members at Muhimbili Radiology department and the medical records department. No funds were received for conducting this research\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChofle AA, Jaka H, Koy M, et al. mortality among patients admitted with hematemesis in Mwanza, Tanzania: a prospective cohort study. Published online 2014:1-10.\u003c/li\u003e\n\u003cli\u003eMoledina SM. Risk factors for mortality among patients admitted with upper gastrointestinal bleeding at a tertiary hospital: a prospective cohort study. Published online 2017:1-11. doi:10.1186/s12876-017-0712-8\u003c/li\u003e\n\u003cli\u003eOpio CK, Rejani L, Kazibwe F, Ocama P. The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic. Afr Health Sci. 2019;19(4):3225-3234. doi:10.4314/ahs.v19i4.46\u003c/li\u003e\n\u003cli\u003eGunda DW, Kilonzo SB, Mamballah Z, et al. The magnitude and correlates of esophageal Varices among newly diagnosed cirrhotic patients undergoing screening fibre optic endoscope before incident bleeding in North-Western Tanzania; A cross-sectional study. BMC Gastroenterol. 2019;19(1):1-9. doi:10.1186/s12876-019-1123-9\u003c/li\u003e\n\u003cli\u003eMoftah SG, Kamal S, Hanna ATK. ORIGINAL ARTICLE CT esophagography: Non-invasive screening and grading of esophageal varices in cirrhosis. Egypt J Radiol Nucl Med. 2014;45(2):263-270. doi:10.1016/j.ejrnm.2014.03.004\u003c/li\u003e\n\u003cli\u003eHira Ashfaq Butt, Rukhsana Nasim, Khalid Javed, et al. Diagnostic accuracy of triphasic CT scan abdomen in the diagnosis of distal esophageal varices taking endoscopic findings as gold standard. Prof Med J. 2022;29(12):1831-1837. doi:10.29309/tpmj/2022.29.12.7213\u003c/li\u003e\n\u003cli\u003eElghezewi A, Hammad M, El-Dallal M, Mohamed M, Sherif A, Frandah W. Trends in Hospitalizations of Esophageal Varices From 2011 to 2018: A United States Nationwide Study. Gastroenterol Res. 2023;16(3):171-183. doi:10.14740/gr1627\u003c/li\u003e\n\u003cli\u003eKiringa SK, Quinlan J, Ocama P, Mutyaba I, Kagimu M. Prevalence, short term outcome and factors associated with survival in patients suffering from upper gastrointestinal bleeding in a resource limited setting, the case of mulago hospital in Kampala, Uganda. Afr Health Sci. 2020;20(1):426-436. doi:10.4314/ahs.v20i1.49\u003c/li\u003e\n\u003cli\u003eAlema ON, Martin DO, Okello TR. Endoscopic findings in upper gastrointestinal bleeding patients at Lacor hospital, northern Uganda. Afr Health Sci. 2012;12(4):518-521. doi:10.4314/ahs.v12i4.19\u003c/li\u003e\n\u003cli\u003eAther DM, Sarfraz DM, Zikarya DM. Upper Gastrointestinal Bleeding; Endoscopic Findings in Patients. Prof Med J. 2017;24(02):335-341. doi:10.17957/tpmj/17.3711\u003c/li\u003e\n\u003cli\u003eJemilohun AC, Akande KO, Ngubor TD, Oku O, Ogunmola MI, Adesuyi YO. Endoscopic Findings in Patients with Upper Gastrointestinal Bleeding in Ogun State, Nigeria. Cureus. 2022;14(3). doi:10.7759/cureus.23637\u003c/li\u003e\n\u003cli\u003eMalghani WS, Malik R, Chaudhary FMD, et al. Spectrum of Endoscopic Findings in Patients of Upper Gastrointestinal Bleeding at a Tertiary Care Hospital. Cureus. 2019;11(4):4-10. doi:10.7759/cureus.4562\u003c/li\u003e\n\u003cli\u003eDeng H, Qi X, Zhang Y, Peng Y, Li J, Guo X. Diagnostic accuracy of contrast-enhanced computed tomography for esophageal varices in liver cirrhosis: a retrospective observational study. J Evid Based Med. 2017;10(1):46-52. doi:10.1111/jebm.12226\u003c/li\u003e\n\u003cli\u003eManuscript A. NIH Public Access. 2015;39(2):251-256. doi:10.1007/s00261-013-0057-x\u003c/li\u003e\n\u003cli\u003eJaka H, Koy M, Liwa A, et al. A Fibreoptic endoscopic study of upper gastrointestinal bleeding at Bugando Medical Centre in northwestern Tanzania: A retrospective review of 240 cases. Published online 2012:1-9.\u003c/li\u003e\n\u003cli\u003eDeng H, Qi X, Guo X. Computed tomography for the diagnosis of varices in liver cirrhosis: a systematic review and meta- analysis of observational studies. Postgrad Med. 2017;0(0). doi:10.1080/00325481.2017.1241664\u003c/li\u003e\n\u003cli\u003eHassan M, Husen Y, Abbasi S un nisa, Hussain Z. Diagnostic Accuracy of Multidetector Computed Tomography in Detection of Esophageal Varices. 2019;11(1):8-13. doi:10.7759/cureus.3933\u003c/li\u003e\n\u003cli\u003eYu NC, Margolis D, Hsu M, Raman SS, Lu DSK. Detection and grading of esophageal varices on liver CT: Comparison of standard and thin section multiplanar reconstructions in diagnostic accuracy. Am J Roentgenol. 2011;197(3):643-649. doi:10.2214/AJR.10.5458\u003c/li\u003e\n\u003cli\u003eAbdel B, Dessouky M, Sayed E, Abdel M. Multidetector CT oesophagography: An alternative screening method for endoscopic diagnosis of oesophageal varices and bleeding risk Multidetector CT oesophagography: An alternative screening method for endoscopic diagnosis of oesophageal varices and ble. Arab J Gastroenterol. 2015;14(3):99-108. doi:10.1016/j.ajg.2013.08.006\u003c/li\u003e\n\u003cli\u003eKim H, Choi D, Gwak GY, et al. Evaluation of esophageal varices on liver computed tomography: Receiver operating characteristic analyses of the performance of radiologists and endoscopists. J Gastroenterol Hepatol. 2009;24(9):1534-1540. doi:10.1111/j.1440-1746.2009.05849.x\u003c/li\u003e\n\u003cli\u003ePerri RE, Chiorean M V., Fidler JL, et al. A prospective evaluation of computerized tomographic (CT) scanning as a screening modality for esophageal varices. Hepatology. 2008;47(5):1587-1594. doi:10.1002/hep.22219\u003c/li\u003e\n\u003cli\u003eSalahshour F, Mehrabinejad MM, Rashidi Shahpasandi MH, et al. Esophageal variceal hemorrhage: the role of MDCT characteristics in predicting the presence of varices and bleeding risk. Abdom Radiol. 2020;45(8):2305-2314. doi:10.1007/s00261-020-02585-5\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Esophageal varices, Triphasic abdominal CT, Oesophagoduodenoscopy","lastPublishedDoi":"10.21203/rs.3.rs-4555053/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4555053/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIn Tanzania, triphasic abdominal Computed Tomography (CT) is a more accessible and non-invasive alternative for diagnosing esophageal varices, though its accuracy has not been thoroughly evaluated, therefore this study aimed to determine the diagnostic accuracy of triphasic abdominal CT in detecting esophageal varices using esophagogastroduodenoscopy (OGD) as the gold standard among patients with upper gastrointestinal bleeding at Muhimbili National Hospital (MNH).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted at MNH from January 2021 to May 2023. We sampled upper gastrointestinal bleeding patients who underwent both OGD and triphasic abdominal CT using non-probability consecutive sampling. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and accuracy of triphasic abdominal CT were assessed against OGD findings.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn a study of 200 participants, esophageal varices were detected in 54% by OGD and 53.5% by CT. We observed 105 true positives, 2 false positives, 90 true negatives, and 3 false negatives. Triphasic abdominal CT demonstrated a sensitivity of 97.2%, specificity of 97.8%, PPV of 98.1%, NPV of 96.8%, and an accuracy of 97.5%. Extraluminal findings included splenic collaterals, ascites, hepatocellular carcinoma, and periportal fibrosis.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eTriphasic abdominal CT is a reliable and non-invasive modality for diagnosing and screening esophageal varices in resource-limited settings.\u003c/p\u003e","manuscriptTitle":"The diagnostic accuracy of triphasic abdominal CT in detecting esophageal varices","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-28 13:25:58","doi":"10.21203/rs.3.rs-4555053/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-07-17T09:04:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-14T19:43:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-05T15:57:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"58347910876976144076762976725637220913","date":"2024-06-24T15:38:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"79855056125451439055634084060475677709","date":"2024-06-24T15:20:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"298958881929879727823421722851611413345","date":"2024-06-24T14:43:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-17T14:30:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-17T11:00:00+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-12T19:49:59+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-12T19:49:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Imaging","date":"2024-06-09T21:23:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-imaging","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmim","sideBox":"Learn more about [BMC Medical Imaging](http://bmcmedimaging.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmim/default.aspx","title":"BMC Medical Imaging","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"531ab2b8-bf6e-4fdf-9c17-dee6c962f4a6","owner":[],"postedDate":"June 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-22T19:48:42+00:00","versionOfRecord":{"articleIdentity":"rs-4555053","link":"https://doi.org/10.1186/s12880-024-01388-0","journal":{"identity":"bmc-medical-imaging","isVorOnly":false,"title":"BMC Medical Imaging"},"publishedOn":"2024-08-14 15:58:07","publishedOnDateReadable":"August 14th, 2024"},"versionCreatedAt":"2024-06-28 13:25:58","video":"","vorDoi":"10.1186/s12880-024-01388-0","vorDoiUrl":"https://doi.org/10.1186/s12880-024-01388-0","workflowStages":[]},"version":"v1","identity":"rs-4555053","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4555053","identity":"rs-4555053","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}