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Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 14, 2022; 28(42): 6068-6077
Published online Nov 14, 2022. doi: 10.3748/wjg.v28.i42.6068
Computed tomography perfusion in liver and spleen for hepatitis B virus-related portal hypertension: A correlation study with hepatic venous pressure gradient
Lei Wang, Yu Zhang, Yi-Fan Wu, Zhen-Dong Yue, Zhen-Hua Fan, Chun-Yan Zhang, Fu-Quan Liu, Jian Dong
Lei Wang, Department of Intervention Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Yu Zhang, Yi-Fan Wu, Zhen-Dong Yue, Zhen-Hua Fan, Fu-Quan Liu, Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Chun-Yan Zhang, Jian Dong, Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Author contributions: Dong J, Liu FQ, and Wang L designed the report; Zhang Y, Wu YF, Yue ZD, Fan ZH, and Zhang CY collected the clinical data; Wang L and Zhang Y analyzed and wrote the paper; Dong J and Liu FQ performed quality control; Liu FQ contributed to administrative and financial support; all authors have read and approved the final version of the manuscript.
Supported by the National Natural Science Foundation of China General Program, No. 81871461.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Beijing Shijitan Hospital, Capital Medical University (Approval No. 201801).
Clinical trial registration statement: This study is registered at ClinicalTrials.gov: http://www.chictr.org.cn/edit.aspx?pid=26048&htm=4. The registration identification number is ChiCTR1800015268.
Informed consent statement: Written informed consent was obtained from each patient.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian Dong, MD, Doctor, Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Street, Haidian District, Beijing 100038, China. dongjianradiology@163.com
Received: August 7, 2022
Peer-review started: August 7, 2022
First decision: August 31, 2022
Revised: October 14, 2022
Accepted: October 31, 2022
Article in press: October 31, 2022
Published online: November 14, 2022
Processing time: 95 Days and 7.1 Hours
Abstract
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.

Keywords: Hepatic venous pressure gradient; Portal hypertension; Computed tomography perfusion; Hepatitis B; Liver cirrhosis

Core Tip: Hepatic venous pressure gradient (HVPG) is the gold standard for the diagnosis of portal hypertension (PH), but its use is limited because it is an invasive procedure. Non-invasive assessment of HVPG requires further research. Computed tomography perfusion of the liver may be a useful tool for the evaluation of HVPG. Our results showed that a cutoff of 17.85 mL/min/100 g for liver blood volume yielded an 80% sensitivity and 89% specificity for severe PH. Therefore, computed tomography perfusion of the liver has the potential as a non-invasive quantitative predictor for PH in hepatitis B virus-related liver cirrhosis.