Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland.
Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland.
J Hepatol. 2014 May;60(5):969-74. doi: 10.1016/j.jhep.2013.12.015. Epub 2013 Dec 19.
BACKGROUND & AIMS: Liver resection is generally restricted to patients without clinically significant portal hypertension (Hepatic Venous Pressure Gradient - HVPG - ⩽10mmHg) 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.
A cohort of patients with hepatocellular carcinoma (HCC) treated by resection (n=36) or transplantation (n=39) was selected (mean age: 61±9.2years, 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.
The invasive HVPG values were significantly correlated to liver/spleen volume ratio, spleen volume, platelet count, and peri-hepatic ascites (p<0.001), which all showed high inter-observer agreements (intra-class correlation coefficients ⩾0.927, Kappa ⩾0.945). The presence of a HVPG >10mmHg was best predicted by the liver/spleen volume ratio (AUC: 0.883 [0.805-0.960]) and the peri-hepatic ascites (p<0.001). These two variables were combined into an accurate model for predicting HVPG >10mmHg (AUC: 0.911 [0.847-0.975]), with sensitivity, specificity, and positive and negative predictive values of 92%, 79%, 91%, and 81%. The model was also accurate in the validation cohort with an AUC of 0.820 [0.719-0.921]. The computed formula was:
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.
肝切除术通常限于无临床显著门脉高压（肝静脉压力梯度-HVPG- ⩽10mmHg）的患者，一些团队在术前评估中进行经颈静脉 HVPG 测量。本研究旨在探讨非侵入性 CT 评估是否与侵入性经颈静脉测量一样准确。
选择接受肝切除术（n=36）或肝移植术（n=39）治疗的肝细胞癌（HCC）患者队列（平均年龄：61±9.2 岁，男/女比例：4/1）。两名独立研究者阅读术前 CT，并将潜在的 CT 基础 HVPG 预测因素与经颈静脉 HVPG 测量进行比较。对另一组 70 例非手术患者进行了验证。
侵入性 HVPG 值与肝/脾体积比、脾体积、血小板计数和肝周腹水显著相关（p<0.001），所有这些均显示出高观察者间一致性（内类相关系数 ⩾0.927，Kappa ⩾0.945）。HVPG>10mmHg 的存在最佳预测指标为肝/脾体积比（AUC：0.883 [0.805-0.960]）和肝周腹水（p<0.001）。这两个变量结合起来可以准确预测 HVPG>10mmHg（AUC：0.911 [0.847-0.975]），敏感性、特异性、阳性和阴性预测值分别为 92%、79%、91%和 81%。该模型在验证队列中也具有准确性，AUC 为 0.820 [0.719-0.921]。计算出的公式为：
提出的 CT 基础模型在 HVPG 预测方面具有很高的准确性，如果通过前瞻性验证得到证实，它可以替代不需要对非肿瘤性肝脏进行活检的患者的侵入性经颈静脉评估。
