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©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Predicting portal venous anomalies by left-sided gallbladder or right-sided ligamentum teres hepatis: A large scale, propensity score-matched study
Hsuan-Yin Lin, Rheun-Chuan Lee, Jyh-Wen Chai, Chiann-Yi Hsu, Yen Chou, Hsuen-En Hwang, Chien An Liu, Nai-Chi Chiu, Ho-Hsian Yen
Hsuan-Yin Lin, Jyh-Wen Chai, Department of Radiology, Taichung Veterans General Hospital, Taichung 407219, Taiwan
Rheun-Chuan Lee, Hsuen-En Hwang, Chien An Liu, Nai-Chi Chiu, Department of Radiology, Taipei Veterans General Hospital, Taipei 11267, Taiwan
Rheun-Chuan Lee, Hsuen-En Hwang, Chien An Liu, Nai-Chi Chiu, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
Chiann-Yi Hsu, Department of Medical Research, Taichung Veterans General Hospital, Taichung 40705, Taiwan
Yen Chou, Department of Radiology, Fu Jen Catholic University Hospital, Taipei 24352, Taiwan
Ho-Hsian Yen, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
Author contributions: Lin HY and Lee RC contributed to the conception and design; all authors contributed to the administrative support; Lin HY, Lee RC and Chai JW contributed to the provision of study materials or patients; all authors contributed to the collection and assembly of data; Lin HY and Hsu CY contributed to the data analysis and interpretation; Lin HY contributed to the manuscript writing and final approval of manuscript.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board I&II of Taichung Veterans General Hospital (Approval No. TCVGH-IRB No. CE22408B).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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: Hsuan-Yin Lin, MD, Attending Doctor, Department of Radiology, Taichung Veterans General Hospital, No. 1650 Taiwan Boulevard Section 4, Taichung 407219, Taiwan. b101096132@tmu.edu.tw
Received: March 29, 2023
Peer-review started: March 29, 2023
First decision: May 23, 2023
Revised: June 6, 2023
Accepted: July 6, 2023
Article in press: July 6, 2023
Published online: July 21, 2023
BACKGROUND
Right-sided ligamentum teres (RSLT) is often associated with portal venous anomalies (PVA) and is regarded as a concerning feature for hepatobiliary intervention. Most studies consider RSLT to be one of the causes of left-sided gallbladder (LGB), leading to the hypothesis that LGB must always be present with RSLT. However, some cases have shown that right-sided gallbladder (RGB) can also be present in livers with RSLT.
AIM
To highlight the rare variation that RSLT may not come with LGB and to determine whether ligamentum teres (LT) or gallbladder location is reliable to predict PVA.
METHODS
This study retrospectively assessed 8552 contrast-enhanced abdominal computed tomography examinations from 2018 to 2021 [4483 men, 4069 women; mean age, 59.5 ± 16.2 (SD) years]. We defined the surrogate outcome as major PVAs. The cases were divided into 4 subgroups according to gallbladder and LT locations. On one hand, we analyzed PVA prevalence by LT locations using gallbladder location as a controlled variable (n = 36). On the other hand, we controlled LT location and computed PVA prevalence by gallbladder locations (n = 34). Finally, we investigated LT location as an independent factor of PVA by using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW).
RESULTS
We found 9 cases of RSLT present with RGB. Among the LGB cases, RSLT is associated with significantly higher PVA prevalence than typical LT [80.0% vs 18.2%, P = 0.001; OR = 18, 95% confidence interval (CI): 2.92-110.96]. When RSLT is present, we found no statistically significant difference in PVA prevalence for RGB and LGB cases (88.9 % vs 80.0%, P > 0.99). Both PSM and IPTW yielded balanced cohorts in demographics and gallbladder locations. The RSLT group had a significantly higher PVA prevalence after adjusted by PSM (77.3% vs 4.5%, P < 0.001; OR = 16.27, 95%CI: 2.25-117.53) and IPTW (82.5% vs 4.7%, P < 0.001).
CONCLUSION
RSLT doesn't consistently coexist with LGB. RSLT can predict PVA independently while the gallbladder location does not serve as a sufficient predictor.
Core Tip: Right-sided ligamentum teres (RSLT) is often associated with intrahepatic anomalies. Most studies hypothesis that left-sided gallbladder (LGB) must exist with RSLT. However, our exploration reveals that RSLT doesn't consistently coexist with LGB. Our analysis further suggests that RSLT can predict poral venous anomalies (PVAs) independently while the gallbladder location does not serve as a sufficient predictor. Therefore, operators, interventional radiologists or interventional gastroenterologists should not use the gallbladder location as an alternative of ligamentum teres location for PVAs prediction.
