spleen extracellular volume fraction on computed tomography as a noninvasive predictor of high-risk esophageal varices in patients with cirrhosis

Background: bleeding esophago-gastric junction varices (egv) represent a life-threatening complication of chronic liver disease. endoscopic screening remains the standard for variceal risk assessment but is not universally accessible or feasible. the extracellular volume (ecv) fraction derived from contrast-enhanced computed tomography (ct) has demonstrated utility in identifying patients at risk for high-grade egv and may serve as a predictive imaging biomarker for the high-risk variceal group (hrg). patients and methods: this retrospective analysis included patients with cirrhosis who underwent abdominal ct and esophagogastroduodenoscopy between 2019 and 2024 at a tertiary referral center in tehran. a total of 62 patients (mean age, 50.2 ± 11.5 years; 62.9% male) were evaluated to differentiate between high-risk and non-high-risk variceal group (nhrg). results: spleen ecv, ct-based detection of varices, and child-pugh score were significantly associated with hrg. a spleen ecv threshold of 38.5 (95% ci, 0.896 - 1.000) demonstrated strong predictive performance. increased splenic ecv correlated with an elevated risk of hrg. conclusion: splenic ecv is a significant noninvasive marker for identifying high-risk esophageal varices in cirrhotic patients. this parameter can be integrated into routine imaging evaluation without additional cost, time, or procedural risk.