Clinical Trials Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2023; 15(4): 664-673
Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.664
Computed tomography perfusion in differentiating portal hypertension: A correlation study with hepatic venous pressure gradient
Jian Dong, Yu Zhang, Yi-Fan Wu, Zhen-Dong Yue, Zhen-Hua Fan, Chun-Yan Zhang, Fu-Quan Liu, Lei Wang
Jian Dong, Chun-Yan Zhang, Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Yu Zhang, Yi-Fan Wu, Zhen-Dong Yue, Zhen-Hua Fan, Fu-Quan Liu, Lei Wang, Department of Interventional 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, and Fan ZH collected the clinical data; Wang L and Zhang CY analyzed the data and wrote the paper; Dong J and Liu FQ performed quality control; Liu FQ contributed to administrative and financial support.
Supported by the National Natural Science Foundation of China General Program, No. 81871461.
Institutional review board statement: This study was approved by the Ethics Committee of the Beijing Shijitan Hospital, Capital Medical University (No. 201801).
Clinical trial registration statement: This study is registered at ClinicalTrials.gov, registration number ChiCTR1800015268 (https://www.chictr.org.cn/showproj.aspx?proj=26048).
Informed consent statement: Written informed consent was obtained from each patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
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: Lei Wang, MD, Doctor, Department of Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Street, Haidian District, Beijing 100038, China. wanglei800212@126.com
Received: December 20, 2022
Peer-review started: December 20, 2022
First decision: January 9, 2023
Revised: January 11, 2023
Accepted: March 23, 2023
Article in press: March 23, 2023
Published online: April 27, 2023
ARTICLE HIGHLIGHTS
Research background

The gold standard for diagnosis of portal hypertension (PH) is the value of hepatic venous pressure gradient (HVPG), which is also widely used in risk stratification for these patients. However, HVPG were limited for the potential risks and invasiveness during the acquisitions, so it is necessary to develop a non-invasive method to assess HVPG. In our study, computed tomography (CT) perfusion was applied to evaluate the blood supply changes before and after transjugular intrahepatic portosystemic shunt (TIPS) surgery, and to investigate the feasibility in non-invasive evaluation of HVPG.

Research motivation

We explore this research to evaluate the feasibility of CT perfusion as the non-invasive surrogate for HVPG, and assess the liver blood supply changes after TIPS, which had the potential application in predicting the occurrence of complications.

Research objectives

The aiming of this study is to investigate the correlation of CT perfusion parameters with HVPG in PH, and quantitatively assess the blood supply changes in liver and spleen parenchyma before and after TIPS.

Research methods

We prospectively recruited 24 PH patients who were performed TIPS surgery for treatment of gastroesophageal bleeding in our hospital. All the patients underwent CT perfusion before and after TIPS surgery. Quantitative parameters, including liver blood volume (LBV), liver blood flow (LBF), hepatic arterial fraction (HAF), spleen blood volume (SBV) and spleen blood flow (SBF), were compared before and after TIPS, and the correlation with HVPG was also analyzed.

Research results

After TIPS, decreased LBV, increased HAF, SBV and SBF were found. HAF before TIPS showed positive correlation with HVPG (r = 0.530, P = 0.008).

Research conclusions

HAF demonstrated potential use in discriminating clinically significant PH (CSPH) than non-CSPH before TIPS. While increased HAF, SBF and SBV, and decreased LBV were found after TIPS, which accommodates a potential non-invasive imaging tool for evaluation of PH.

Research perspectives

Multi-modality research of baseline assessment for PH, including anatomical information, lab results, ultrasonography and functional magnetic resonance imaging should be explored in the future.