Niu Xiang-Ke, Das Sushant Kumar, Wu Hong-Lin, Chen Yong
Department of Radiology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China.
Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China.
World J Clin Cases. 2020 Mar 6;8(5):887-899. doi: 10.12998/wjcc.v8.i5.887.
Transjugular intrahepatic portosystemic shunt (TIPS) may be technically difficult in patients with cavernous transformation of the portal vein (CTPV). Computed tomography (CT) is widely used for assessing the situation of the portal vein and its tributaries before TIPS, and an ultrasound-based Yerdel grading system has been developed, which is deemed useful for liver transplantation. Therefore, we hypothesized that a CT-based CTPV scoring system could be useful for predicting technical and midterm outcomes in TIPS treatment for symptomatic portal cavernoma.
To investigate the clinical significance of a CT-based score model/nomogram for predicting technical success and midterm outcome in TIPS treatment for symptomatic CTPV.
Patients with symptomatic CTPV who had undergone TIPS from January 2010 to June 2017 were retrospectively analysed. The CTPV was graded with a score of 1-4 based on contrast-CT imaging findings of the diseased vessel. Outcome measures were technical success rate, stent patency rate, and midterm survival. Cohen's kappa statistic, the Kaplan-Meier and log-rank tests, and uni- and multivariable analyses were performed. A nomogram was constructed and verified by calibration and decision curve analysis.
A total of 76 patients (45 men and 31 women; mean age, 52.3 ± 14.7 years) were enrolled in the study. The inter-reader agreement () of the CTPV score was 0.81. TIPS was successfully placed in 78% of patients (59/76). The independent predictor of technical success was CTPV score (odds ratio [OR] = 5.56, 95% confidence interval [CI]: 3.55-9.67, = 0.002). The independent predictors of primary TIPS patency were CTPV score and splenectomy (OR = 9.22, 95%CI: 4.78-13.45, = 0.009; OR = 4.67, 95%CI: 2.59-7.44, = 0.017). The survival rates differed significantly between the TIPS success and failure groups. The clinical nomogram was made up of patient age, model for end-stage liver disease score, and CTPV score. The calibration curves and decision curve analysis verified the usefulness of the CTPV score-based nomogram for clinical practice.
TIPS should be considered a safe and feasible therapy for patients with symptomatic CTPV. Furthermore, the CT-based score model/nomogram might aid interventional radiologists in therapeutic decision-making.
对于门静脉海绵样变性（CTPV）患者，经颈静脉肝内门体分流术（TIPS）在技术上可能具有挑战性。计算机断层扫描（CT）广泛用于在TIPS术前评估门静脉及其分支的情况，并且已经开发了基于超声的耶德尔分级系统，该系统被认为对肝移植有用。因此，我们推测基于CT的CTPV评分系统可能有助于预测症状性门静脉海绵样变性TIPS治疗的技术和中期结果。
探讨基于CT的评分模型/列线图对预测症状性CTPV的TIPS治疗技术成功率和中期结果的临床意义。
回顾性分析2010年1月至2017年6月接受TIPS的症状性CTPV患者。根据病变血管的增强CT影像学表现，将CTPV分为1-4分。观察指标为技术成功率、支架通畅率和中期生存率。进行了Cohen's kappa统计、Kaplan-Meier和对数秩检验以及单变量和多变量分析。构建列线图并通过校准和决策曲线分析进行验证。
本研究共纳入76例患者（45例男性和31例女性；平均年龄52.3±14.7岁）。CTPV评分的阅片者间一致性（）为0.81。78%的患者（59/76）成功置入TIPS。技术成功的独立预测因素是CTPV评分（优势比[OR]=5.56，95%置信区间[CI]：3.55-9.67，=0.002）。原发性TIPS通畅的独立预测因素是CTPV评分和脾切除术（OR=9.22，95%CI：4.78-13.45，=0.009；OR=4.67，95%CI：2.59-7.44，=0.017）。TIPS成功组和失败组的生存率差异显著。临床列线图由患者年龄、终末期肝病模型评分和CTPV评分组成。校准曲线和决策曲线分析验证了基于CTPV评分的列线图在临床实践中的有用性。
TIPS应被视为症状性CTPV患者安全可行的治疗方法。此外，基于CT的评分模型/列线图可能有助于介入放射科医生进行治疗决策。
