Accurate computed tomography-based portal pressure assessment in patients with hepatocellular carcinoma

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• 作者：Pouya Iranmanesh¹ ; ^{Pouya.Iranmanesh@hcuge.ch" class="auth_mail} ; Oscar Vazquez¹ ; Sylvain Terraz² ; Pietro Majno¹ ; Laurent Spahr³ ; Antoine Poncet⁴ ; Philippe Morel¹ ; Gilles Mentha¹ ; Christian Toso¹ ; ^{Christian.Toso@hcuge.ch" class="auth_mail}
• 关键词：HCC ; hepatocellular carcinoma ; HVPG ; hepatic venous pressure gradient ; CT ; computed tomography ; ROI ; region of interest ; WHVP ; wedged hepatic venous pressure ; FHVP ; free hepatic venous pressure ; ICC ; intra-class correlation coefficient ; ROC ; receiver operator characteristic ; AUC ; area under the curve ; HCV ; hepatitis C virus ; PPV ; positive predictive value ; NPV ; negative predictive value
• 刊名：Journal of Hepatology
• 出版年：May, 2014
• 年：2014
• 卷：60
• 期：5
• 页码：969-974
• 全文大小：675 K

文摘

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Background & Aims

Liver resection is generally restricted to patients without clinically significant portal hypertension (Hepatic Venous Pressure Gradient - HVPG - 猢?0 mmHg) and several teams perform transjugular HVPG measurements as part of the pre-operative work-up. The present study investigates whether a non-invasive Computed Tomography (CT)-based assessment could be as accurate as the invasive transjugular measurement.

Methods

A cohort of patients with hepatocellular carcinoma (HCC) treated by resection (n = 36) or transplantation (n = 39) was selected (mean age: 61 卤 9.2 years, male/female ratio: 4/1). Pre-operative CTs were read by two independent investigators, and potential CT-based HVPG predictors were compared to the transjugular HVPG measurements. A validation was conducted on another cohort of 70 non-surgical patients.

Results

HVPG score=17.37-4.91鈭條n(Liver/Spleen volume ratio)+3.8[if presence of peri-hepatic ascites]

Conclusions

The proposed CT-based model showed a high accuracy in the prediction of HVPG and, if further confirmed by prospective validation, could replace the invasive transjugular assessment in patients not requiring a biopsy of the non-tumoral liver.