Improved Esophageal Varices Assessment from Non-Contrast CT Scans

TL;DR

This paper introduces MOON, a multi-organ analysis framework using non-contrast CT scans to improve the non-invasive diagnosis of esophageal varices, achieving higher accuracy than esophagus-only methods.

Contribution

The study presents the first multi-organ NC-CT analysis framework for EV assessment, integrating esophagus, liver, and spleen features to enhance diagnostic accuracy.

Findings

MOON outperforms esophagus-only methods in AUC for EV severity classification.

Validated on a large dataset with cross-validation and independent testing.

Provides a minimally invasive alternative to endoscopy for EV diagnosis.

Abstract

Esophageal varices (EV), a serious health concern resulting from portal hypertension, are traditionally diagnosed through invasive endoscopic procedures. Despite non-contrast computed tomography (NC-CT) imaging being a less expensive and non-invasive imaging modality, it has yet to gain full acceptance as a primary clinical diagnostic tool for EV evaluation. To overcome existing diagnostic challenges, we present the Multi-Organ-cOhesion-Network (MOON), a novel framework enhancing the analysis of critical organ features in NC-CT scans for effective assessment of EV. Drawing inspiration from the thorough assessment practices of radiologists, MOON establishes a cohesive multiorgan analysis model that unifies the imaging features of the related organs of EV, namely esophagus, liver, and spleen. This integration significantly increases the diagnostic accuracy for EV. We have compiled an extensive NC-CT dataset of 1,255 patients diagnosed with EV, spanning three grades of severity. Each case is corroborated by endoscopic diagnostic results. The efficacy of MOON has been substantiated through a validation process involving multi-fold cross-validation on 1,010 cases and an independent test on 245 cases, exhibiting superior diagnostic performance compared to methods focusing solely on the esophagus (for classifying severe grade: AUC of 0.864 versus 0.803, and for moderate to severe grades: AUC of 0.832 versus 0.793). To our knowledge, MOON is the first work to incorporate a synchronized multi-organ NC-CT analysis for EV assessment, providing a more acceptable and minimally invasive alternative for patients compared to traditional endoscopy.