Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2020; 12(8): 931-941
Published online Aug 15, 2020. doi: 10.4251/wjgo.v12.i8.931
Accurate ultrasonography-based portal pressure assessment in patients with hepatocellular carcinoma
Yu Zhang, Zhong Wang, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Yi-Fan Wu, Fu-Liang He, Fu-Quan Liu
Yu Zhang, Zhong Wang, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Yi-Fan Wu, Fu-Liang He, Fu-Quan Liu, Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
Author contributions: Zhang Y wrote the manuscript; Liu FQ conceived and designed the study and are the co-corresponding authors; Wang Z, Wu YF, and Fan ZH collected the data; Zhao HW, Yue ZD, and Wang L analyzed the data; all authors made critical revisions to the manuscript and approved the final version.
Supported by Beijing Municipal Science and Technology Commission, No. Z181100001718097; and the Capital Health Development Scientific Research Project, No. 2018-1-2081.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Shijitan Hospital, Capital Medical University.
Informed consent statement: Informed consent was not required as the study was based on an available database in hospital.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to this study.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fu-Quan Liu, BCPS, MD, Director, Professor, Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, No. 10 Tieyi Road, Yangfangdian, Haidian District, Beijing 100038, China. lfuquan@aliyun.com
Received: January 16, 2020
Peer-review started: January 16, 2020
First decision: April 18, 2020
Revised: May 8, 2020
Accepted: July 1, 2020
Article in press: July 1, 2020
Published online: August 15, 2020
Processing time: 208 Days and 18.4 Hours
Abstract
BACKGROUND

Portal pressure is of great significance in the treatment of hepatocellular carcinoma (HCC), but direct measurement is complicated and costly; thus, non-invasive measurement methods are urgently needed.

AIM

To investigate whether ultrasonography (US)-based portal pressure assessment could replace invasive transjugular measurement.

METHODS

A cohort of 102 patients with HCC was selected (mean age: 54 ± 13 years, male/female: 65/37). Pre-operative US parameters were assessed by two independent investigators, and multivariate logistic analysis and linear regression analysis were conducted to develop a predictive formula for the portal pressure gradient (PPG). The estimated PPG predictors were compared with the transjugular PPG measurements. Validation was conducted on another cohort of 20 non-surgical patients.

RESULTS

The mean PPG was 17.32 ± 1.97 mmHg. Univariate analysis identified the association of the following four parameters with PPG: Spleen volume, portal vein diameter, portal vein velocity (PVV), and portal blood flow (PBF). Multiple linear regression analysis was performed, and the predictive formula using the PVV and PBF was as follows: PPG score = 19.336 - 0.312 × PVV (cm/s) + 0.001 × PBF (mL/min). The PPG score was confirmed to have good accuracy with an area under the curve (AUC) of 0.75 (0.68-0.81) in training patients. The formula was also accurate in the validation patients with an AUC of 0.820 (0.53-0.83).

CONCLUSION

The formula based on ultrasonographic Doppler flow parameters shows a significant correlation with invasive PPG and, if further confirmed by prospective validation, may replace the invasive transjugular assessment.

Keywords: Portal pressure gradient; Hepatic vein pressure gradient; Hepatocellular carcinoma; Transjugular; Portal pressure; Portal vein pressure

Core tip: The direct measurement of portal pressure is complicated; therefore, non-invasive measurement methods are urgently needed to guide the treatment of hepatocellular carcinoma. The combined measurements of portal vein velocity and portal blood flow could be clinically and economically useful in estimating portal pressure gradient.