Dong J, Zhang Y, Wu YF, Yue ZD, Fan ZH, Zhang CY, Liu FQ, Wang L. Computed tomography perfusion in differentiating portal hypertension: A correlation study with hepatic venous pressure gradient. World J Gastrointest Surg 2023; 15(4): 664-673 [PMID: 37206083 DOI: 10.4240/wjgs.v15.i4.664]
Corresponding Author of This Article
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
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Clinical Trials Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
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 bythe 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).
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 Processing time: 123 Days and 21.7 Hours
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.
