CT 血管造影虚拟肝静脉压力梯度（CHESS 1601）：一项用于门静脉高压症无创诊断的前瞻性多中心研究。
Virtual Hepatic Venous Pressure Gradient with CT Angiography (CHESS 1601): A Prospective Multicenter Study for the Noninvasive Diagnosis of Portal Hypertension.
机构信息
From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li).
出版信息
Radiology. 2019 Feb;290(2):370-377. doi: 10.1148/radiol.2018180425. Epub 2018 Nov 20.
Purpose To develop and validate a computational model for estimating hepatic venous pressure gradient (HVPG) based on CT angiographic images, termed virtual HVPG, to enable the noninvasive diagnosis of portal hypertension in patients with cirrhosis. Materials and Methods In this prospective multicenter diagnostic trial (ClinicalTrials.gov identifier: NCT02842697), 102 consecutive eligible participants (mean age, 47 years [range, 21-75 years]; 68 men with a mean age of 44 years [range, 21-73 years] and 34 women with a mean age of 52 years [range, 24-75 years]) were recruited from three high-volume liver centers between August 2016 and April 2017. All participants with cirrhosis of various causes underwent transjugular HVPG measurement, Doppler US, and CT angiography. Virtual HVPG was developed with a three-dimensional reconstructed model and computational fluid dynamics. Results In the training cohort (n = 29), the area under the receiver operating characteristic curve (AUC) of virtual HVPG in the prediction of clinically significant portal hypertension (CSPH) was 0.83 (95% confidence interval [CI]: 0.58, 1.00). The diagnostic performance was prospectively confirmed in the validation cohort (n = 73), with an AUC of 0.89 (95% CI: 0.81, 0.96). Inter- and intraobserver agreement was 0.88 and 0.96, respectively, suggesting the good reproducibility of virtual HVPG measurements. There was good correlation between virtual HVPG and invasive HVPG (R = 0.61, P < .001), with a satisfactory performance to rule out (7.3 mm Hg) and rule in (13.0 mm Hg) CSPH. Conclusion The accuracy of a computational model of virtual hepatic venous pressure gradient (HVPG) shows significant correlation with invasive HVPG. The virtual HVPG also showed a good performance in the noninvasive diagnosis of clinically significant portal hypertension in cirrhosis. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Malayeri in this issue.
目的 基于 CT 血管造影图像开发并验证一种计算模型以估算肝静脉压力梯度（HVPG），即虚拟 HVPG，从而实现对肝硬化患者门静脉高压症的非侵入性诊断。
材料与方法 本前瞻性多中心诊断试验（ClinicalTrials.gov 标识符：NCT02842697）纳入了 102 例连续纳入的符合条件的参与者（平均年龄 47 岁[范围：21-75 岁]；68 名男性，平均年龄 44 岁[范围：21-73 岁]，34 名女性，平均年龄 52 岁[范围：24-75 岁]），他们于 2016 年 8 月至 2017 年 4 月期间在 3 家大容量肝脏中心招募。所有患有各种病因肝硬化的患者均接受了经颈静脉 HVPG 测量、多普勒超声和 CT 血管造影检查。采用三维重建模型和计算流体动力学方法来建立虚拟 HVPG。
结果 在训练队列（n=29）中，虚拟 HVPG 预测临床显著门静脉高压（CSPH）的受试者工作特征曲线下面积（AUC）为 0.83（95%置信区间[CI]：0.58，1.00）。在验证队列（n=73）中前瞻性地验证了该诊断性能，AUC 为 0.89（95%CI：0.81，0.96）。组内和组间观察者间的一致性分别为 0.88 和 0.96，提示虚拟 HVPG 测量具有良好的可重复性。虚拟 HVPG 与有创 HVPG 之间具有良好的相关性（R=0.61，P<.001），其排除（7.3mmHg）和纳入（13.0mmHg）CSPH 的性能令人满意。
结论 计算模型的虚拟肝静脉压力梯度（HVPG）的准确性与有创 HVPG 显著相关。虚拟 HVPG 还在肝硬化患者的门静脉高压症的非侵入性诊断中表现出良好的性能。
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