Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.
Department of Medical and Surgical Sciences (DIMEC), IRCCS, University of Bologna, Via Massarenti 9, Bologna 40138, Italy.
Eur J Radiol. 2022 Feb;147:110010. doi: 10.1016/j.ejrad.2021.110010. Epub 2021 Oct 30.
The aim of the present study was to propose and validate a standardized CT protocol for evaluating all the types of portosystemic collaterals (P-SC), including gastroesophageal varices and spontaneous portosystemic shunts (SPSS), and to evaluate the prognostic role of portal hypertension CT features for the prediction of the hepatic decompensation risk in cirrhotic patients.
A retrospective cohort study of 184 advanced chronic liver disease who underwent CT scan between January 2014 and December 2017. Patients with an interval > 6 months between the imaging, elastometric, endoscopic and biochemical evaluation were excluded, as well as patients with previous transjugular intrahepatic portosystemic shunt (TIPS), liver transplantation (LT) or terminal medical conditions. Data on liver disease history, co-morbidities, endoscopic and radiologic findings were collected. The incidence of hepatic decompensation and other events, such as portal vein thrombosis, HCC, TIPS placement, LT, death, and its cause, were also recorded. The procedure was performed at baseline and after the administration of contrast agent using a multiphasic technique and bolus tracking. Two senior radiologists working in different centres and a non-expert radiologist reviewed all CT examinations, to evaluate both intra-observer and inter-observer variability of the CT protocol and to obtain an external validation. The radiological variables were evaluated using both univariate and adjusted multivariate competing risk regression models.
Both intra-observer and inter-observer agreement were excellent in detection and measurement of almost all types of P-SC. The presence of SPSS, a spleen diameter > 16 cm, a portal vein diameter > 17 mm and the presence of ascites resulted independent predictors of decompensation-free survival for cirrhotic patients and were incorporated in an easy-to-use score (AUROC = 0.799, p-value = 0.732) which can the risk of decompensation at 5 years, ranking it as low (11.3%), moderate (35.6%) or high (70.8%).
The CT protocol commonly performed during the HCC surveillance program for cirrhotic patients is valid for detecting all types of P-SC. The radiological score identified to predict the decompensation-free survival for cirrhotic patients could be an easy-to-use clinical tool.
本研究旨在提出并验证一种用于评估所有门体侧支循环（P-SC）类型的标准化 CT 方案，包括胃食管静脉曲张和自发性门体分流（SPSS），并评估门脉高压 CT 特征对预测肝硬化患者肝失代偿风险的预后作用。
这是一项回顾性队列研究，纳入了 184 名在 2014 年 1 月至 2017 年 12 月期间接受 CT 扫描的晚期慢性肝病患者。排除了影像学、弹性成像、内镜和生化评估之间间隔时间超过 6 个月的患者，以及先前接受经颈静脉肝内门体分流术（TIPS）、肝移植（LT）或终末期治疗的患者。收集了肝脏疾病史、合并症、内镜和放射学发现的数据。还记录了肝失代偿和其他事件的发生率，如门静脉血栓形成、HCC、TIPS 放置、LT、死亡及其原因。该程序在基线时以及使用多相技术和团注追踪进行造影剂给药后进行。两位在不同中心工作的资深放射科医生和一位非专家放射科医生审查了所有 CT 检查，以评估 CT 方案的观察者内和观察者间可重复性，并获得外部验证。使用单变量和调整后的多变量竞争风险回归模型评估放射学变量。
几乎所有类型的 P-SC 的检测和测量，观察者内和观察者间的一致性均极好。SPSS 的存在、脾脏直径>16cm、门静脉直径>17mm 和腹水的存在是肝硬化患者无失代偿生存的独立预测因子，并被纳入一个易于使用的评分中（AUROC=0.799，p 值=0.732），可预测 5 年内的失代偿风险，将其分为低（11.3%）、中（35.6%）或高（70.8%）。
在肝硬化患者 HCC 监测计划中通常进行的 CT 方案可有效检测所有类型的 P-SC。确定的预测肝硬化患者无失代偿生存的放射学评分可作为一种易于使用的临床工具。
