BACKGROUND Hepatic venous pressure gradient(HVPG)is the gold standard for diagnosis of portal hypertension(PH).However,its use can be limited because it is an invasive procedure.Therefore,it is necessary to explore a ...BACKGROUND Hepatic venous pressure gradient(HVPG)is the gold standard for diagnosis of portal hypertension(PH).However,its use can be limited because it is an invasive procedure.Therefore,it is necessary to explore a non-invasive method to assess PH.AIM To investigate the correlation of computed tomography(CT)perfusion of the liver with HVPG and Child-Pugh score in hepatitis B virus(HBV)-related PH.METHODS Twenty-eight patients(4 female,24 male)with gastroesophageal variceal bleeding induced by HBV-related PH were recruited in our study.All patients received CT perfusion of the liver before transjugular intrahepatic portosystemic stent-shunt(TIPS)therapy.Quantitative parameters of CT perfusion of the liver,including liver blood flow(LBF),liver blood volume(LBV),hepatic artery fraction,splenic blood flow and splenic blood volume were measured.HVPG was recorded during TIPS therapy.Correlation of liver perfusion with Child-Pugh score and HVPG were analyzed,and the receiver operating characteristic curve was analyzed.Based on HVPG(>12 mmHg vs≤12 mmHg),patients were divided into moderate and severe groups,and all parameters were compared.RESULTS Based on HVPG,18 patients were classified into the moderate group and 10 patients were classified into the severe group.The Child-Pugh score,HVPG,LBF and LBV were significantly higher in the moderate group compared to the severe group(all P<0.05).LBF and LBV were negatively associated with HVPG(r=-0.473,P<0.05 and r=-0.503,P<0.01,respectively),whereas splenic blood flow was positively associated with hepatic artery fraction(r=0.434,P<0.05).LBV was negatively correlated with Child-Pugh score.Child-Pugh score was not related to HVPG.Using a cutoff value of 17.85 mL/min/100 g for LBV,the sensitivity and specificity of HVPG≥12 mmHg for diagnosis were 80%and 89%,respectively.CONCLUSION LBV and LBF were negatively correlated with HVPG and Child-Pugh scores.CT perfusion imaging is a potential non-invasive quantitative predictor for PH in HBV-related liver cirrhosis.展开更多
Noninvasive diagnosis of portal hypertension in patients with cirrhosis can be achieved using different methods,including laboratory tests and imaging.The Baveno VII consensus suggested that liver stiffness measuremen...Noninvasive diagnosis of portal hypertension in patients with cirrhosis can be achieved using different methods,including laboratory tests and imaging.The Baveno VII consensus suggested that liver stiffness measurements and platelet counts were sufficient for assessing the presence of clinically significant portal hypertension.However,computed tomography(CT)is frequently performed in patients with cirrhosis,and numerous studies have established the possibility of an opportunistic noninvasive diagnosis of portal hypertension using CT.These studies have utilized radiomics,volumetric changes in the liver and spleen,quantitative assessment of liver surface nodularity,and more advanced techniques based on computational fluid dynamics.This review summarizes the main original studies related to the quantitative CT-based noninvasive diagnosis of portal hypertension.展开更多
目的 :探讨正常肝脏和肝硬化门静脉高压患者增强扫描参数对图像质量的影响。方法 :收集正常志愿者(60例)和肝硬化门静脉高压患者(90例),依据对比剂剂量、扫描时间,将正常志愿者分为常规组(A组)和大剂量组(B组),将肝硬化门静脉高压患者...目的 :探讨正常肝脏和肝硬化门静脉高压患者增强扫描参数对图像质量的影响。方法 :收集正常志愿者(60例)和肝硬化门静脉高压患者(90例),依据对比剂剂量、扫描时间,将正常志愿者分为常规组(A组)和大剂量组(B组),将肝硬化门静脉高压患者分为常规剂量常规扫描组(C组)、大剂量常规扫描组(D组)、大剂量延时扫描组(E组),每组各30例。获得双期图像后,测量动脉期肝动脉CT值,门静脉期门静脉、肝实质、肝静脉CT值及门静脉肝实质CT值差值,并对双期图像质量进行双盲目测评分。结果:A组与B组肝动脉、门静脉、肝静脉CT值及门静脉与肝实质CT值差值比较差异均有统计学意义(P<0.05),肝实质CT值2组间比较差异无统计学意义;A组、B组图像质量评分差异无统计学意义。C组与D组比较,肝动脉、门静脉、肝实质、肝静脉CT值、门静脉与肝实质CT值差值差异有统计学意义(P<0.05)。E组与D组比较,肝动脉、门静脉强化程度差异无统计学意义;肝静脉CT值、肝实质CT值上升,门静脉与肝实质CT值差值减小,差异有统计学意义(P<0.05);C组、D组、E组图像质量评分差异有统计学意义(P<0.05)。结论:当对比剂注射速率为3 m L/s时,正常人对比剂剂量为1.5 m L/kg体质量,动脉期扫描起始时间28 s,门静脉期扫描起始时间60 s,可获得较满意图像;肝硬化门静脉高压患者对比剂剂量为2.0 m L/kg体质量,动脉期扫描起始时间33 s,门静脉期扫描起始时间70 s,可获得较满意图像。展开更多
目的探讨CT门静脉血管成像(CT portography,CTP)指标在评估肝硬化门静脉高压患者食管胃底静脉曲张中的临床应用价值。方法回顾性分析复旦大学附属中山医院2019年4月—2022年3月确诊收治的167名肝硬化患者,根据上消化道内镜检查结果将其...目的探讨CT门静脉血管成像(CT portography,CTP)指标在评估肝硬化门静脉高压患者食管胃底静脉曲张中的临床应用价值。方法回顾性分析复旦大学附属中山医院2019年4月—2022年3月确诊收治的167名肝硬化患者,根据上消化道内镜检查结果将其分为需要治疗干预的静脉曲张(varices need treatment,VNT)组和非VNT组。对血常规、肝功能、Child-Pugh分级、肝静脉压力梯度和CTP定量参数(包括脾最大横径、胃左静脉直径、门静脉直径、脾静脉直径、肝脏和脾脏体积)进行单因素分析和二元Logistic回归分析,筛选出可以诊断VNT的无创指标,并在此基础上构建诊断模型。通过ROC曲线评价模型的诊断效能,并用DeLong方法比较不同诊断模型的诊断效能。结果单因素和二元Logistic回归分析显示胃左静脉直径和脾体积在VNT分组中差异有统计学意义(P<0.05)。用脾体积与胃左静脉直径的乘积建立诊断模型,当模型截止值>358.69时,其诊断VNT的敏感性为72.99%,特异性为83.33%,ROC曲线下面积为0.799(95%CI:0.730~0.857),其诊断效能优于用血小板计数与脾最大横径的比值(platelet count to spleen diameter ratio,PSDR)诊断模型(P<0.05)。结论应用CTP测得的胃左静脉直径增宽和脾体积增大是肝硬化门静脉高压患者发生VNT的独立危险因素,以二者的乘积建立的无创诊断模型对评估VNT有一定的临床价值。展开更多
目的探讨CT门静脉成像（CTPV）分型个体化手术治疗在肝硬化门静脉高压症中的应用价值。方法本前瞻性研究对象为2010年6月至2014年12月在安徽医科大学附属省立医院行手术治疗的156例肝硬化门静脉高压症患者。根据手术方式的不同分为CTPV...目的探讨CT门静脉成像（CTPV）分型个体化手术治疗在肝硬化门静脉高压症中的应用价值。方法本前瞻性研究对象为2010年6月至2014年12月在安徽医科大学附属省立医院行手术治疗的156例肝硬化门静脉高压症患者。根据手术方式的不同分为CTPV分型个体化手术组（分型组）和传统手术组（传统组）。其中分型组84例,男56例,女28例;年龄19~67岁,中位年龄45岁。传统组72例,男47例,女25例;年龄23~62岁,中位年龄43岁。所有患者均签署知情同意书,符合医学伦理学规定。分型组患者根据术前CTPV分型采取个体化手术方式,传统组行脾切除术＋贲门周围血管离断术。观察两种手术方式对患者门静脉高压症、术中和术后情况以及术后生存率的影响。两组观察指标比较采用t检验,生存分析采用Kaplan-Meier法和Log-rank检验。结果分型组患者术后自由门静脉压（FPP）为（27±3）cm H_2O（1 cm H2O=0.098 k Pa）,明显低于传统组的（33±8）cm H2O（t=-3.355,P〈0.05）;手术前后FPP下降幅度为（13±6）cm H_2O,明显大于传统组的（9±5）cm H_2O（t=3.016,P〈0.05）。分型组的手术时间、术中出血量为（188±84）min、（378±49）ml,明显少于传统组的（240±76）min、（463±57）ml（t=-2.687,-3.015;P〈0.05）。分型组的术后住院时间、住院费用为（12±4）d、（3.1±1.5）万元,明显低于传统组的（15±5）d、（3.6±1.5）万元（t=-2.061,-2.104;P〈0.05）。分型组的1、3年累积生存率分别为94.05%、85.71%,传统组分别为87.50%、68.05%,分型组的总体生存率明显高于传统组（χ~2=7.000,P〈0.05）。结论对肝硬化门静脉高压症患者进行术前CTPV分型并采取个体化手术治疗,能有效降低门静脉压力,且具有创伤较小、预后较好等优点。展开更多
基金the National Natural Science Foundation of China General Program,No.81871461.
文摘BACKGROUND Hepatic venous pressure gradient(HVPG)is the gold standard for diagnosis of portal hypertension(PH).However,its use can be limited because it is an invasive procedure.Therefore,it is necessary to explore a non-invasive method to assess PH.AIM To investigate the correlation of computed tomography(CT)perfusion of the liver with HVPG and Child-Pugh score in hepatitis B virus(HBV)-related PH.METHODS Twenty-eight patients(4 female,24 male)with gastroesophageal variceal bleeding induced by HBV-related PH were recruited in our study.All patients received CT perfusion of the liver before transjugular intrahepatic portosystemic stent-shunt(TIPS)therapy.Quantitative parameters of CT perfusion of the liver,including liver blood flow(LBF),liver blood volume(LBV),hepatic artery fraction,splenic blood flow and splenic blood volume were measured.HVPG was recorded during TIPS therapy.Correlation of liver perfusion with Child-Pugh score and HVPG were analyzed,and the receiver operating characteristic curve was analyzed.Based on HVPG(>12 mmHg vs≤12 mmHg),patients were divided into moderate and severe groups,and all parameters were compared.RESULTS Based on HVPG,18 patients were classified into the moderate group and 10 patients were classified into the severe group.The Child-Pugh score,HVPG,LBF and LBV were significantly higher in the moderate group compared to the severe group(all P<0.05).LBF and LBV were negatively associated with HVPG(r=-0.473,P<0.05 and r=-0.503,P<0.01,respectively),whereas splenic blood flow was positively associated with hepatic artery fraction(r=0.434,P<0.05).LBV was negatively correlated with Child-Pugh score.Child-Pugh score was not related to HVPG.Using a cutoff value of 17.85 mL/min/100 g for LBV,the sensitivity and specificity of HVPG≥12 mmHg for diagnosis were 80%and 89%,respectively.CONCLUSION LBV and LBF were negatively correlated with HVPG and Child-Pugh scores.CT perfusion imaging is a potential non-invasive quantitative predictor for PH in HBV-related liver cirrhosis.
文摘Noninvasive diagnosis of portal hypertension in patients with cirrhosis can be achieved using different methods,including laboratory tests and imaging.The Baveno VII consensus suggested that liver stiffness measurements and platelet counts were sufficient for assessing the presence of clinically significant portal hypertension.However,computed tomography(CT)is frequently performed in patients with cirrhosis,and numerous studies have established the possibility of an opportunistic noninvasive diagnosis of portal hypertension using CT.These studies have utilized radiomics,volumetric changes in the liver and spleen,quantitative assessment of liver surface nodularity,and more advanced techniques based on computational fluid dynamics.This review summarizes the main original studies related to the quantitative CT-based noninvasive diagnosis of portal hypertension.
文摘目的 :探讨正常肝脏和肝硬化门静脉高压患者增强扫描参数对图像质量的影响。方法 :收集正常志愿者(60例)和肝硬化门静脉高压患者(90例),依据对比剂剂量、扫描时间,将正常志愿者分为常规组(A组)和大剂量组(B组),将肝硬化门静脉高压患者分为常规剂量常规扫描组(C组)、大剂量常规扫描组(D组)、大剂量延时扫描组(E组),每组各30例。获得双期图像后,测量动脉期肝动脉CT值,门静脉期门静脉、肝实质、肝静脉CT值及门静脉肝实质CT值差值,并对双期图像质量进行双盲目测评分。结果:A组与B组肝动脉、门静脉、肝静脉CT值及门静脉与肝实质CT值差值比较差异均有统计学意义(P<0.05),肝实质CT值2组间比较差异无统计学意义;A组、B组图像质量评分差异无统计学意义。C组与D组比较,肝动脉、门静脉、肝实质、肝静脉CT值、门静脉与肝实质CT值差值差异有统计学意义(P<0.05)。E组与D组比较,肝动脉、门静脉强化程度差异无统计学意义;肝静脉CT值、肝实质CT值上升,门静脉与肝实质CT值差值减小,差异有统计学意义(P<0.05);C组、D组、E组图像质量评分差异有统计学意义(P<0.05)。结论:当对比剂注射速率为3 m L/s时,正常人对比剂剂量为1.5 m L/kg体质量,动脉期扫描起始时间28 s,门静脉期扫描起始时间60 s,可获得较满意图像;肝硬化门静脉高压患者对比剂剂量为2.0 m L/kg体质量,动脉期扫描起始时间33 s,门静脉期扫描起始时间70 s,可获得较满意图像。
文摘目的探讨CT门静脉血管成像(CT portography,CTP)指标在评估肝硬化门静脉高压患者食管胃底静脉曲张中的临床应用价值。方法回顾性分析复旦大学附属中山医院2019年4月—2022年3月确诊收治的167名肝硬化患者,根据上消化道内镜检查结果将其分为需要治疗干预的静脉曲张(varices need treatment,VNT)组和非VNT组。对血常规、肝功能、Child-Pugh分级、肝静脉压力梯度和CTP定量参数(包括脾最大横径、胃左静脉直径、门静脉直径、脾静脉直径、肝脏和脾脏体积)进行单因素分析和二元Logistic回归分析,筛选出可以诊断VNT的无创指标,并在此基础上构建诊断模型。通过ROC曲线评价模型的诊断效能,并用DeLong方法比较不同诊断模型的诊断效能。结果单因素和二元Logistic回归分析显示胃左静脉直径和脾体积在VNT分组中差异有统计学意义(P<0.05)。用脾体积与胃左静脉直径的乘积建立诊断模型,当模型截止值>358.69时,其诊断VNT的敏感性为72.99%,特异性为83.33%,ROC曲线下面积为0.799(95%CI:0.730~0.857),其诊断效能优于用血小板计数与脾最大横径的比值(platelet count to spleen diameter ratio,PSDR)诊断模型(P<0.05)。结论应用CTP测得的胃左静脉直径增宽和脾体积增大是肝硬化门静脉高压患者发生VNT的独立危险因素,以二者的乘积建立的无创诊断模型对评估VNT有一定的临床价值。
文摘目的探讨CT门静脉成像（CTPV）分型个体化手术治疗在肝硬化门静脉高压症中的应用价值。方法本前瞻性研究对象为2010年6月至2014年12月在安徽医科大学附属省立医院行手术治疗的156例肝硬化门静脉高压症患者。根据手术方式的不同分为CTPV分型个体化手术组（分型组）和传统手术组（传统组）。其中分型组84例,男56例,女28例;年龄19~67岁,中位年龄45岁。传统组72例,男47例,女25例;年龄23~62岁,中位年龄43岁。所有患者均签署知情同意书,符合医学伦理学规定。分型组患者根据术前CTPV分型采取个体化手术方式,传统组行脾切除术＋贲门周围血管离断术。观察两种手术方式对患者门静脉高压症、术中和术后情况以及术后生存率的影响。两组观察指标比较采用t检验,生存分析采用Kaplan-Meier法和Log-rank检验。结果分型组患者术后自由门静脉压（FPP）为（27±3）cm H_2O（1 cm H2O=0.098 k Pa）,明显低于传统组的（33±8）cm H2O（t=-3.355,P〈0.05）;手术前后FPP下降幅度为（13±6）cm H_2O,明显大于传统组的（9±5）cm H_2O（t=3.016,P〈0.05）。分型组的手术时间、术中出血量为（188±84）min、（378±49）ml,明显少于传统组的（240±76）min、（463±57）ml（t=-2.687,-3.015;P〈0.05）。分型组的术后住院时间、住院费用为（12±4）d、（3.1±1.5）万元,明显低于传统组的（15±5）d、（3.6±1.5）万元（t=-2.061,-2.104;P〈0.05）。分型组的1、3年累积生存率分别为94.05%、85.71%,传统组分别为87.50%、68.05%,分型组的总体生存率明显高于传统组（χ~2=7.000,P〈0.05）。结论对肝硬化门静脉高压症患者进行术前CTPV分型并采取个体化手术治疗,能有效降低门静脉压力,且具有创伤较小、预后较好等优点。
