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
ARTICLE HIGHLIGHTS
Research background

Portal pressure accurately predicts the risk of peri-operative morbidity and mortality in liver carcinoma. The limitations of HVPG measurement are that it is invasive and impractical for routine clinical practice. Thus, non-invasive measurement methods are urgently needed.

Research motivation

Doppler sonography offers real-time observation of blood flow with qualitative and quantitative assessments, and the application of microbubble-based contrast agents has improved the detectability of peripheral blood flow. The aim of this study was to clarify whether simple, non-invasive US parameters correlate with the invasive transjugular PPG measurement and to develop a formula to estimate PPG.

Research objectives

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

Research 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.

Research 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 x PVV (cm/s) + 0.001x 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).

Research conclusions

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.

Research perspectives

The formula for the prediction of PPG should be verified on a larger and external validation cohort for widespread acceptance.