Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.664
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
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.
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.
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.
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.
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).
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.
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.