Pouya Iranmanesh1, Oscar Vazquez2, Sylvain Terraz3, Pietro Majno2, Laurent Spahr4, Antoine Poncet5, Philippe Morel2, Gilles Mentha2, Christian Toso6. 1. Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland. Electronic address: Pouya.Iranmanesh@hcuge.ch. 2. Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland. 3. Department of Radiology, Geneva University Hospitals and Faculty of Medicine, Switzerland. 4. Department of Gastroenterology and Hepatology, Geneva University Hospitals and Faculty of Medicine, Switzerland. 5. Department of Clinical Epidemiology, Geneva University Hospitals and Faculty of Medicine, Switzerland. 6. Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland. Electronic address: Christian.Toso@hcuge.ch.
Abstract
BACKGROUND & AIMS: Liver resection is generally restricted to patients without clinically significant portal hypertension (Hepatic Venous Pressure Gradient - HVPG - ⩽10mmHg) and several teams perform transjugular HVPG measurements as part of the pre-operative work-up. The present study investigates whether a non-invasive Computed Tomography (CT)-based assessment could be as accurate as the invasive transjugular measurement. METHODS: A cohort of patients with hepatocellular carcinoma (HCC) treated by resection (n=36) or transplantation (n=39) was selected (mean age: 61±9.2years, male/female ratio: 4/1). Pre-operative CTs were read by two independent investigators, and potential CT-based HVPG predictors were compared to the transjugular HVPG measurements. A validation was conducted on another cohort of 70 non-surgical patients. RESULTS: The invasive HVPG values were significantly correlated to liver/spleen volume ratio, spleen volume, platelet count, and peri-hepatic ascites (p<0.001), which all showed high inter-observer agreements (intra-class correlation coefficients ⩾0.927, Kappa ⩾0.945). The presence of a HVPG >10mmHg was best predicted by the liver/spleen volume ratio (AUC: 0.883 [0.805-0.960]) and the peri-hepatic ascites (p<0.001). These two variables were combined into an accurate model for predicting HVPG >10mmHg (AUC: 0.911 [0.847-0.975]), with sensitivity, specificity, and positive and negative predictive values of 92%, 79%, 91%, and 81%. The model was also accurate in the validation cohort with an AUC of 0.820 [0.719-0.921]. The computed formula was: CONCLUSIONS: The proposed CT-based model showed a high accuracy in the prediction of HVPG and, if further confirmed by prospective validation, could replace the invasive transjugular assessment in patients not requiring a biopsy of the non-tumoral liver.
BACKGROUND & AIMS: Liver resection is generally restricted to patients without clinically significant portal hypertension (Hepatic Venous Pressure Gradient - HVPG - ⩽10mmHg) and several teams perform transjugular HVPG measurements as part of the pre-operative work-up. The present study investigates whether a non-invasive Computed Tomography (CT)-based assessment could be as accurate as the invasive transjugular measurement. METHODS: A cohort of patients with hepatocellular carcinoma (HCC) treated by resection (n=36) or transplantation (n=39) was selected (mean age: 61±9.2years, male/female ratio: 4/1). Pre-operative CTs were read by two independent investigators, and potential CT-based HVPG predictors were compared to the transjugular HVPG measurements. A validation was conducted on another cohort of 70 non-surgical patients. RESULTS: The invasive HVPG values were significantly correlated to liver/spleen volume ratio, spleen volume, platelet count, and peri-hepatic ascites (p<0.001), which all showed high inter-observer agreements (intra-class correlation coefficients ⩾0.927, Kappa ⩾0.945). The presence of a HVPG >10mmHg was best predicted by the liver/spleen volume ratio (AUC: 0.883 [0.805-0.960]) and the peri-hepatic ascites (p<0.001). These two variables were combined into an accurate model for predicting HVPG >10mmHg (AUC: 0.911 [0.847-0.975]), with sensitivity, specificity, and positive and negative predictive values of 92%, 79%, 91%, and 81%. The model was also accurate in the validation cohort with an AUC of 0.820 [0.719-0.921]. The computed formula was: CONCLUSIONS: The proposed CT-based model showed a high accuracy in the prediction of HVPG and, if further confirmed by prospective validation, could replace the invasive transjugular assessment in patients not requiring a biopsy of the non-tumoral liver.
Authors: Naaventhan Palaniyappan; Eleanor Cox; Christopher Bradley; Robert Scott; Andrew Austin; Richard O'Neill; Greg Ramjas; Simon Travis; Hilary White; Rajeev Singh; Peter Thurley; Indra Neil Guha; Susan Francis; Guruprasad Padur Aithal Journal: J Hepatol Date: 2016-07-27 Impact factor: 25.083
Authors: Lukas Haider; Mattias Mandorfer; Zeynep Güngören; Thomas Reiberger; Nina Bastati; Jacqueline C Hodge; David Chromy; Michael Trauner; Christian Herold; Markus Peck-Radosavljevic; Ahmed Ba-Ssalamah Journal: Contrast Media Mol Imaging Date: 2018-07-12 Impact factor: 3.161