Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2020; 8(5): 887-899
Published online Mar 6, 2020. doi: 10.12998/wjcc.v8.i5.887
Computed tomography-based score model/nomogram for predicting technical and midterm outcomes in transjugular intrahepatic portosystemic shunt treatment for symptomatic portal cavernoma
Xiang-Ke Niu, Sushant Kumar Das, Hong-Lin Wu, Yong Chen
Xiang-Ke Niu, Hong-Lin Wu, Department of Radiology, Affiliated Hospital of Chengdu University, Chengdu 610081, Sichuan Province, China
Sushant Kumar Das, Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
Yong Chen, Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Author contributions: Chen Y designed the research; Niu XK and Das SK performed the research; Niu XK analyzed the data; Niu XK and Wu HL wrote the paper; Das SK revised the paper.
Supported by Health and Family Planning Commission of Chengdu, China, No. 2015080; Health and Family Planning Commission of Sichuan Province, China, No. 17PJ430.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Nanfang Hospital, Southern Medical University, Guangzhou, China.
Informed consent statement: This is a retrospective study, and informed written consent was thus waived.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this study.
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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Yong Chen, MD, Chief Doctor, Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou 510515, Guangdong Province, China. 820158699@qq.com
Received: November 19, 2019
Peer-review started: November 19, 2019
First decision: December 23, 2015
Revised: January 19, 2020
Accepted: February 12, 2020
Article in press: February 12, 2020
Published online: March 6, 2020
Abstract
BACKGROUND

Transjugular intrahepatic portosystemic shunt (TIPS) may be technically difficult in patients with cavernous transformation of the portal vein (CTPV). Computed tomography (CT) is widely used for assessing the situation of the portal vein and its tributaries before TIPS, and an ultrasound-based Yerdel grading system has been developed, which is deemed useful for liver transplantation. Therefore, we hypothesized that a CT-based CTPV scoring system could be useful for predicting technical and midterm outcomes in TIPS treatment for symptomatic portal cavernoma.

AIM

To investigate the clinical significance of a CT-based score model/nomogram for predicting technical success and midterm outcome in TIPS treatment for symptomatic CTPV.

METHODS

Patients with symptomatic CTPV who had undergone TIPS from January 2010 to June 2017 were retrospectively analysed. The CTPV was graded with a score of 1-4 based on contrast-CT imaging findings of the diseased vessel. Outcome measures were technical success rate, stent patency rate, and midterm survival. Cohen’s kappa statistic, the Kaplan-Meier and log-rank tests, and uni- and multivariable analyses were performed. A nomogram was constructed and verified by calibration and decision curve analysis.

RESULTS

A total of 76 patients (45 men and 31 women; mean age, 52.3 ± 14.7 years) were enrolled in the study. The inter-reader agreement (κ) of the CTPV score was 0.81. TIPS was successfully placed in 78% of patients (59/76). The independent predictor of technical success was CTPV score (odds ratio [OR] = 5.56, 95% confidence interval [CI]: 3.55-9.67, P = 0.002). The independent predictors of primary TIPS patency were CTPV score and splenectomy (OR = 9.22, 95%CI: 4.78-13.45, P = 0.009; OR = 4.67, 95%CI: 2.59-7.44, P = 0.017). The survival rates differed significantly between the TIPS success and failure groups. The clinical nomogram was made up of patient age, model for end-stage liver disease score, and CTPV score. The calibration curves and decision curve analysis verified the usefulness of the CTPV score-based nomogram for clinical practice.

CONCLUSION

TIPS should be considered a safe and feasible therapy for patients with symptomatic CTPV. Furthermore, the CT-based score model/nomogram might aid interventional radiologists in therapeutic decision-making.

Keywords: Portosystemic shunt, Transjugular intrahepatic, Liver cirrhosis, Portal hypertension, Oesophageal and gastric varices, Bleeding, Shunt dysfunction

Core tip: We studied a relatively large cohort of patients with symptomatic cavernous transformation of the portal vein who underwent transjugular intrahepatic portosystemic shunt (TIPS) and found that technical success, stent patency rates, and midterm survival were closely associated with the cavernous transformation of the portal vein score. Compared to patients with TIPS failure, those with technical success had a longer midterm survival. After internal verification, we believe that this simple computed tomography-based score model/nomogram could be useful in decision-making for interventional radiologists, who could perform the TIPS procedure on patients with symptomatic portal cavernoma.