Azygos blood flow in cirrhosis: Measurement with MR imaging and correlation with variceal hemorrhage

PURPOSE: To evaluate magnetic resonance (MR) measurement of azygos blood flow (ABF) in assessment of risk of variceal hemorrhage in cirrhosis. MATERIALS AND METHODS: ABF in 50 patients with cirrhosis and 20 healthy control subjects was evaluated with phase-contrast cine MR imaging at the transaxial subcarinal plane. Group 1 included nine patients with cervical- drainage varices draining into brachiocephalic vein; group 2 included 41 patients with varices draining into azygos vein and was subdivided as group 2A, 15 patients with variceal hemorrhage, and group 2B, 26 without variceal hemorrhage. RESULTS: Azygos flow rate and velocity were increased in patients compared with that in control subjects. ABF in group 2A was faster than that in group 2B (cutoff, 15 cm/sec; sensitivity, 80%; specificity, 89%). Group 1 had ABF close to that of group 2B, but variceal hemorrhage occurred in seven of nine patients in group 1 versus 15 of 41 patients in group 2 (78% vs 37%; P = .029). CONCLUSION: Patients with cirrhosis with cervical-drainage varices or ABF greater than 15 cm/sec may have higher risk for variceal hemorrhage.