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Yoo J, Cho H, Lee DH, Cho EJ, Joo I, Jeon SK. Prognostic role of computed tomography analysis using deep learning algorithm in patients with chronic hepatitis B viral infection. Clin Mol Hepatol 2023; 29:1029-1042. [PMID: 37822214 PMCID: PMC10577347 DOI: 10.3350/cmh.2023.0190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/08/2023] [Accepted: 08/27/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND/AIMS The prediction of clinical outcomes in patients with chronic hepatitis B (CHB) is paramount for effective management. This study aimed to evaluate the prognostic value of computed tomography (CT) analysis using deep learning algorithms in patients with CHB. METHODS This retrospective study included 2,169 patients with CHB without hepatic decompensation who underwent contrast-enhanced abdominal CT for hepatocellular carcinoma (HCC) surveillance between January 2005 and June 2016. Liver and spleen volumes and body composition measurements including subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and skeletal muscle indices were acquired from CT images using deep learning-based fully automated organ segmentation algorithms. We assessed the significant predictors of HCC, hepatic decompensation, diabetes mellitus (DM), and overall survival (OS) using Cox proportional hazard analyses. RESULTS During a median follow-up period of 103.0 months, HCC (n=134, 6.2%), hepatic decompensation (n=103, 4.7%), DM (n=432, 19.9%), and death (n=120, 5.5%) occurred. According to the multivariate analysis, standardized spleen volume significantly predicted HCC development (hazard ratio [HR]=1.01, P=0.025), along with age, sex, albumin and platelet count. Standardized spleen volume (HR=1.01, P<0.001) and VAT index (HR=0.98, P=0.004) were significantly associated with hepatic decompensation along with age and albumin. Furthermore, VAT index (HR=1.01, P=0.001) and standardized spleen volume (HR=1.01, P=0.001) were significant predictors for DM, along with sex, age, and albumin. SAT index (HR=0.99, P=0.004) was significantly associated with OS, along with age, albumin, and MELD. CONCLUSION Deep learning-based automatically measured spleen volume, VAT, and SAT indices may provide various prognostic information in patients with CHB.
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Affiliation(s)
- Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Heejin Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea
| | - Sun Kyung Jeon
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
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Heo S, Lee SS, Choi SH, Kim DW, Park HJ, Kim SY, Lee SJ, Kim KM, Shin YM. CT Rule-in and Rule-out Criteria for Clinically Significant Portal Hypertension in Chronic Liver Disease. Radiology 2023; 309:e231208. [PMID: 37906011 DOI: 10.1148/radiol.231208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Background The value of CT in assessment of clinically significant portal hypertension (CSPH) has not been well determined. Purpose To evaluate the performance of CT features that have been associated with portal hypertension for diagnosing CSPH in patients with chronic liver disease (CLD). Materials and Methods This retrospective study included patients with CLD who underwent contrast-enhanced CT and subsequent hepatic venous pressure gradient (HVPG) measurement within 3 months at two tertiary institutions from January 2001 to December 2019. Two readers independently evaluated the presence of gastroesophageal varix, spontaneous portosystemic shunt (SPSS), and ascites on CT images. Splenomegaly at CT was determined using three methods, as follows: personalized or fixed volume criteria, based on spleen volume as measured by a deep learning algorithm, or manually measured spleen diameter. The diagnostic performance of these findings alone or in combination for detecting CSPH (HVPG ≥10 mm Hg) was evaluated. Results A total of 235 patients (mean age, 53.2 years ± 13.0 [SD]; 155 male patients), including 110 (46.8%) with CSPH, were included. Detection of CSPH according to the presence of both splenomegaly and at least one other CT feature (ie, gastroesophageal varix, SPSS, and ascites) achieved specificities of 94.4%-97.6%, whereas detection of CSPH according to the presence of any feature (ie, splenomegaly, gastroesophageal varix, SPSS, or ascites) achieved sensitivities of 94.5%-98.2%. When employing the former as rule-in criteria with the absence of splenomegaly, gastroesophageal varix, SPSS, and ascites as rule-out criteria for CSPH, 171-185 (range, 72.8%-78.7%) of 235 patients were correctly classified as either having CSPH or not, seven to 13 (range, 3%-5.5%) of 235 patients were incorrectly classified, and 42-54 (range, 17.9%-23%) of 235 patients were unclassified. Conclusion The presence or absence of splenomegaly, gastroesophageal varix, SPSS, and/or ascites on CT images may be useful for ruling in and ruling out CSPH in patients with CLD. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Fraum in this issue.
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Affiliation(s)
- Subin Heo
- From the Department of Radiology, Ajou University School of Medicine, Suwon, South Korea (S.H.); and Department of Radiology and Research Institute of Radiology (S.H., S.S.L., S.H.C., D.W.K., H.J.P., S.Y.K., S.J.L., Y.M.S.) and Department of Gastroenterology, Liver Center (K.M.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Seung Soo Lee
- From the Department of Radiology, Ajou University School of Medicine, Suwon, South Korea (S.H.); and Department of Radiology and Research Institute of Radiology (S.H., S.S.L., S.H.C., D.W.K., H.J.P., S.Y.K., S.J.L., Y.M.S.) and Department of Gastroenterology, Liver Center (K.M.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Sang Hyun Choi
- From the Department of Radiology, Ajou University School of Medicine, Suwon, South Korea (S.H.); and Department of Radiology and Research Institute of Radiology (S.H., S.S.L., S.H.C., D.W.K., H.J.P., S.Y.K., S.J.L., Y.M.S.) and Department of Gastroenterology, Liver Center (K.M.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Dong Wook Kim
- From the Department of Radiology, Ajou University School of Medicine, Suwon, South Korea (S.H.); and Department of Radiology and Research Institute of Radiology (S.H., S.S.L., S.H.C., D.W.K., H.J.P., S.Y.K., S.J.L., Y.M.S.) and Department of Gastroenterology, Liver Center (K.M.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Hyo Jung Park
- From the Department of Radiology, Ajou University School of Medicine, Suwon, South Korea (S.H.); and Department of Radiology and Research Institute of Radiology (S.H., S.S.L., S.H.C., D.W.K., H.J.P., S.Y.K., S.J.L., Y.M.S.) and Department of Gastroenterology, Liver Center (K.M.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - So Yeon Kim
- From the Department of Radiology, Ajou University School of Medicine, Suwon, South Korea (S.H.); and Department of Radiology and Research Institute of Radiology (S.H., S.S.L., S.H.C., D.W.K., H.J.P., S.Y.K., S.J.L., Y.M.S.) and Department of Gastroenterology, Liver Center (K.M.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - So Jung Lee
- From the Department of Radiology, Ajou University School of Medicine, Suwon, South Korea (S.H.); and Department of Radiology and Research Institute of Radiology (S.H., S.S.L., S.H.C., D.W.K., H.J.P., S.Y.K., S.J.L., Y.M.S.) and Department of Gastroenterology, Liver Center (K.M.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Kang Mo Kim
- From the Department of Radiology, Ajou University School of Medicine, Suwon, South Korea (S.H.); and Department of Radiology and Research Institute of Radiology (S.H., S.S.L., S.H.C., D.W.K., H.J.P., S.Y.K., S.J.L., Y.M.S.) and Department of Gastroenterology, Liver Center (K.M.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
| | - Yong Moon Shin
- From the Department of Radiology, Ajou University School of Medicine, Suwon, South Korea (S.H.); and Department of Radiology and Research Institute of Radiology (S.H., S.S.L., S.H.C., D.W.K., H.J.P., S.Y.K., S.J.L., Y.M.S.) and Department of Gastroenterology, Liver Center (K.M.K.), Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea
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Müller L, Gairing SJ, Foerster F, Weinmann A, Mittler J, Stoehr F, Graafen D, Düber C, Galle PR, Kloeckner R, Hahn F. Portal hypertension in patients with hepatocellular carcinoma and immunotherapy: prognostic relevance of CT-morphologic estimates. Cancer Imaging 2023; 23:40. [PMID: 37098584 PMCID: PMC10127076 DOI: 10.1186/s40644-023-00558-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/17/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Clinically significant portal hypertension (CSPH) has been identified as an important prognostic factor in patients with hepatocellular carcinoma (HCC) undergoing curative treatment. This study aimed to assess PH estimates as prognostic factors in patients with HCC treated with immunotherapy. METHODS All patients with HCC treated with an immunotherapeutic agent in first or subsequent lines at our tertiary care center between 2016 and 2021 were included (n = 50). CSPH was diagnosed using the established PH score for non-invasive PH estimation in pre-treatment CT data (cut-off ≥ 4). Influence of PH on overall survival (OS) and progression-free survival (PFS) was assessed in uni- and multivariable analyses. RESULTS Based on the PH score, 26 patients (52.0%) were considered to have CSPH. After treatment initiation, patients with CSPH had a significantly impaired median OS (4.1 vs 33.3 months, p < 0.001) and a significantly impaired median PFS (2.7 vs 5.3 months, p = 0.02). In multivariable Cox regression, CSPH remained significantly associated with survival (HR 2.9, p = 0.015) when adjusted for established risk factors. CONCLUSIONS Non-invasive assessment of CSPH using routine CT data yielded an independent prognostic factor in patients with HCC and immunotherapy. Therefore, it might function as an additional imaging biomarker to detect high-risk patients with poor survival and possibly for treatment decision making.
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Affiliation(s)
- Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Simon J Gairing
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Friedrich Foerster
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Jens Mittler
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Fabian Stoehr
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Dirk Graafen
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Peter R Galle
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Roman Kloeckner
- Institute of Interventional Radiology, University Hospital Schleswig-Holstein-Campus Luebeck, Luebeck, Germany
| | - Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany.
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Rao C, Chen J, Wang W, Xue C, Wu L, Huang X, Chen S, Rao S, Li F. Computed tomography imaging features to evaluate the severity of portal hypertension and predict the rebleeding risk after endoscopic treatment in cirrhotic patients with variceal hemorrhage. Eur J Radiol 2023; 163:110841. [PMID: 37104896 DOI: 10.1016/j.ejrad.2023.110841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/10/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE To investigate the association of computed tomography (CT) imaging features and severity of portal hypertension (PH) and develop a nomogram to predict high-risk PH in cirrhotic patients with gastroesophageal variceal hemorrhage (GVH). METHODS The study retrospectively enrolled 158 cirrhotic patients with a history of endoscopic treatment for GVH. Hepatic vein pressure gradient (HVPG) was measured and the patients were classified into high-risk (HVPG > 16 mmHg) or low-risk (HVPG ≤ 16 mmHg) PH group. Pre-treatment CT features, including cavernous transformation of portal vein (CTPV), hilar periportal space (a distance between right portal vein and posterior edge of segment IV of the liver), and depth of right posterior hepatic notch sign (a sharp indentation in the right medial posterior liver surface), were evaluated. Risk factors associated with high-risk PH were analyzed, and a nomogram based on the imaging features was developed. RESULTS High-risk PH group showed a higher rebleeding rate after treatment than that of the low-risk (P = 0.029). Multivariate analysis indicated that larger hilar periportal space (P < 0.001), less frequencies of CTPV (P = 0.044) and deeper right posterior hepatic notch (P < 0.001) were independent risk factors associated with high-risk PH. A nomogram based on the three CT imaging features was established to predict high-risk PH with an excellent discrimination (c-statistic 0.854). CONCLUSION The nomogram based on CT features of hilar periportal space, depth of right posterior hepatic notch and CTPV can help to distinguish cirrhotic patients with high-risk PH, who are more vulnerable of variceal rebleeding after endoscopic treatment.
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Affiliation(s)
- Chenyi Rao
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Jiejun Chen
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Wentao Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Chunyan Xue
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ling Wu
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiaoquan Huang
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Shiyao Chen
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Shenxiang Rao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
| | - Feng Li
- Department of Gastroenterology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
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Numerical prediction of portal hypertension by a hydrodynamic blood flow model combing with the fractal theory. J Biomech 2023; 150:111504. [PMID: 36871430 DOI: 10.1016/j.jbiomech.2023.111504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/25/2023] [Accepted: 02/13/2023] [Indexed: 02/27/2023]
Abstract
Portal hypertension (PH) can cause a series of complications, therefore, early prediction of PH is important. Traditional diagnostic methods are harmful to the human body, while other non-invasive methods are inaccurate and lack physical meaning. Combining various fractal theories and flow laws, we establish a complete portal system blood flow model from the Computed Tomography (CT) and angiography images. The portal vein pressure (PP) is obtained by the flow rate data from the Doppler ultrasound and the pressure-velocity relationship is established by the model. Three normal participants and 12 patients with portal hypertension were divided into three groups. For the three normal participants (Group A), their mean PP calculated by the model is 1752 Pa, falling into the normal range of PP. The mean PP of three patients with portal vein thrombosis (Group B) is 2357 Pa; and for the 9 patients with cirrhosis (Group C), their mean PP is 2915 Pa. These results validate the classification performance of the model. Moreover, the blood flow model can give early warning parameters of the corresponding portal vein trunk and portal vein microtubules for thrombosis and liver cirrhosis. This model presents the complete process of blood flow from sinusoids to the portal vein, adapts to the diagnosis of portal hypertension of thrombosis and liver cirrhosis, and provides a new method for noninvasive portal vein pressure detection from the perspective of biomechanics.
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Romero-Cristóbal M, Clemente-Sánchez A, Ramón E, Téllez L, Canales E, Ortega-Lobete O, Velilla-Aparicio E, Catalina MV, Ibáñez-Samaniego L, Alonso S, Colón A, Matilla AM, Salcedo M, Albillos A, Bañares R, Rincón D. CT-derived liver and spleen volume accurately diagnose clinically significant portal hypertension in patients with hepatocellular carcinoma. JHEP Rep 2022; 5:100645. [PMID: 36691569 PMCID: PMC9860348 DOI: 10.1016/j.jhepr.2022.100645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/12/2022] [Indexed: 12/05/2022] Open
Abstract
Background & Aims Clinically significant portal hypertension (CSPH) is a landmark in the natural history of cirrhosis, influencing clinical decisions in patients with hepatocellular carcinoma (HCC). Previous small series suggested that splanchnic volume measurements may predict portal hypertension. We aimed to evaluate whether volumetry obtained by standard multidetector computerised tomography (MDCT) can predict CSPH in patients with HCC. Methods We included 175 patients with HCC, referred for hepatic venous pressure gradient (HVPG) evaluation, in whom contemporary MDCT was available. Liver volume, spleen volume (SV) and liver segmental volume ratio (LSVR: volume of the segments I-III/volume of the segments IV-VIII) were calculated semi-automatically from MDCT. Other non-invasive tests (NITs) were also employed. Results Volume parameters could be measured in almost 100% of cases with an excellent inter-observer agreement (intraclass correlation coefficient >0.950). SV and LSVR were independently associated with CSPH (HVPG ≥10 mmHg) and did not interact with aetiology. The volume Index (VI), calculated as the product of SV and LSVR, predicted CSPH (AUC 0.83; 95% CI 0.77-0.89). Similar results were observed in an external cohort (n = 23) (AUC 0.87; 95% CI 0.69-1.00). Setting a sensitivity and specificity of 98%, VI could have avoided 35.9% of HVPG measurements. The accuracy of VI was similar to that of other NITs. VI also accurately predicted HVPG greater than 12, 14, 16 and 18 mmHg (AUC 0.81 [95% CI 0.74-0.88], 0.84 [95% CI 0.77-0.91], 0.85 [95% CI 0.77-0.92] and 0.87 [95% CI 0.79-0.94], respectively). Conclusions Quantification of liver and spleen volumes by MDCT is a simple, accurate and reliable method of CSPH estimation in patients with compensated cirrhosis and HCC. Impact and implications An increase in portal pressure strongly impacts outcomes after surgery in patients with early hepatocellular carcinoma (HCC). Direct measurement through hepatic vein catheterization remains the reference standard for portal pressure assessment, but its invasiveness limits its application. Therefore, we evaluated the ability of CT scan-based liver and spleen volume measurements to predict portal hypertension in patients with HCC. Our results indicate that the newly described index, based on quantification of liver and spleen volume, accurately predicts portal hypertension. These results suggest that a single imaging test may be used to diagnose and stage HCC, while providing an accurate estimation of portal hypertension, thus helping to stratify surgical risks.
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Key Words
- CSPH, clinically significant portal hypertension
- DAAs, direct-acting antivirals agents
- HCC, hepatocellular carcinoma
- HVPG, hepatic venous pressure gradient
- LSPS, liver stiffness-spleen size-to-platelet ratio score
- LSVR, liver segmental volume
- LV, liver volume
- LV/SV, liver/spleen volume ratio
- MAFLD, metabolic dysfunction-associated fatty liver disease
- MDCT, multidetector computerised tomography
- NITs, non-invasive tests
- PSR, platelet count to spleen diameter ratio
- SV, spleen volume
- TE, transient elastography
- VI, volume index
- cirrhosis
- cross-sectional imaging
- hepatocellular carcinoma
- non-invasive test
- organ size
- portal hypertension
- predictive model
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Affiliation(s)
| | - Ana Clemente-Sánchez
- Liver Unit and Digestive Department, H.G.U. Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Ramón
- Department of Radiology, H.G.U. Gregorio Marañón, Madrid, Spain
| | - Luis Téllez
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Elena Canales
- Department of Radiology, H. U. Ramón y Cajal, Madrid, Spain
| | - Olga Ortega-Lobete
- Liver Unit and Digestive Department, H.G.U. Gregorio Marañón, Madrid, Spain
| | | | - María-Vega Catalina
- Liver Unit and Digestive Department, H.G.U. Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Luis Ibáñez-Samaniego
- Liver Unit and Digestive Department, H.G.U. Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Sonia Alonso
- Liver Unit and Digestive Department, H.G.U. Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Arturo Colón
- Liver Transplant and Hepatobiliary Surgery Unit, H.G.U. Gregorio Marañón, Madrid, Spain
| | - Ana-María Matilla
- Liver Unit and Digestive Department, H.G.U. Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
| | - Magdalena Salcedo
- Liver Unit and Digestive Department, H.G.U. Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Agustín Albillos
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Rafael Bañares
- Liver Unit and Digestive Department, H.G.U. Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
- Corresponding author. Address: Liver Unit, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, Madrid, 28007, Spain..
| | - Diego Rincón
- Liver Unit and Digestive Department, H.G.U. Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto de Salud Carlos III, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
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Heo S, Lee SS, Kim SY, Lim YS, Park HJ, Yoon JS, Suk HI, Sung YS, Park B, Lee JS. Prediction of Decompensation and Death in Advanced Chronic Liver Disease Using Deep Learning Analysis of Gadoxetic Acid-Enhanced MRI. Korean J Radiol 2022; 23:1269-1280. [PMID: 36447415 PMCID: PMC9747270 DOI: 10.3348/kjr.2022.0494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/12/2022] [Accepted: 10/11/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the usefulness of quantitative indices obtained from deep learning analysis of gadoxetic acid-enhanced hepatobiliary phase (HBP) MRI and their longitudinal changes in predicting decompensation and death in patients with advanced chronic liver disease (ACLD). MATERIALS AND METHODS We included patients who underwent baseline and 1-year follow-up MRI from a prospective cohort that underwent gadoxetic acid-enhanced MRI for hepatocellular carcinoma surveillance between November 2011 and August 2012 at a tertiary medical center. Baseline liver condition was categorized as non-ACLD, compensated ACLD, and decompensated ACLD. The liver-to-spleen signal intensity ratio (LS-SIR) and liver-to-spleen volume ratio (LS-VR) were automatically measured on the HBP images using a deep learning algorithm, and their percentage changes at the 1-year follow-up (ΔLS-SIR and ΔLS-VR) were calculated. The associations of the MRI indices with hepatic decompensation and a composite endpoint of liver-related death or transplantation were evaluated using a competing risk analysis with multivariable Fine and Gray regression models, including baseline parameters alone and both baseline and follow-up parameters. RESULTS Our study included 280 patients (153 male; mean age ± standard deviation, 57 ± 7.95 years) with non-ACLD, compensated ACLD, and decompensated ACLD in 32, 186, and 62 patients, respectively. Patients were followed for 11-117 months (median, 104 months). In patients with compensated ACLD, baseline LS-SIR (sub-distribution hazard ratio [sHR], 0.81; p = 0.034) and LS-VR (sHR, 0.71; p = 0.01) were independently associated with hepatic decompensation. The ΔLS-VR (sHR, 0.54; p = 0.002) was predictive of hepatic decompensation after adjusting for baseline variables. ΔLS-VR was an independent predictor of liver-related death or transplantation in patients with compensated ACLD (sHR, 0.46; p = 0.026) and decompensated ACLD (sHR, 0.61; p = 0.023). CONCLUSION MRI indices automatically derived from the deep learning analysis of gadoxetic acid-enhanced HBP MRI can be used as prognostic markers in patients with ACLD.
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Affiliation(s)
- Subin Heo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Suk Lim
- Department of Gastroenterology, Liver Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyo Jung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Seok Yoon
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
| | - Heung-Il Suk
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea.,Department of Artificial Intelligence, Korea University, Seoul, Korea
| | - Yu Sub Sung
- Clinical Research Center, Asan Medical Center, Seoul, Korea
| | - Bumwoo Park
- Health Innovation Big Data Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Ji Sung Lee
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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8
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Gadoxetic acid-enhanced MRI-derived functional liver imaging score (FLIS) and spleen diameter predict outcomes in ACLD. J Hepatol 2022; 77:1005-1013. [PMID: 35525337 DOI: 10.1016/j.jhep.2022.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND & AIMS Functional liver imaging score (FLIS) - derived from gadoxetic acid-enhanced MRI - correlates with liver function and independently predicts liver-related mortality in patients with chronic liver disease (CLD), while splenic craniocaudal diameter (SCCD) is a marker of portal hypertension. The aim of this study was to investigate the accuracy of a combination of FLIS and SCCD for predicting hepatic decompensation, acute-on-chronic liver failure (ACLF), and mortality in patients with advanced CLD (ACLD). METHODS We included 397 patients with CLD who underwent gadoxetic acid-enhanced liver MRI. The FLIS was calculated by summing the points (0-2) of 3 hepatobiliary-phase features: hepatic enhancement, biliary excretion, and portal vein signal intensity. Patients were stratified into 3 groups according to liver fibrosis severity and presence/history of hepatic decompensation: non-ACLD, compensated ACLD (cACLD), and decompensated ACLD (dACLD). RESULTS SCCD showed excellent intra- and inter-reader agreement. Importantly, SCCD was an independent risk factor for hepatic decompensation in patients with cACLD (per cm; adjusted hazard ratio [aHR] 1.13; 95% CI 1.04-1.23; p = 0.004). Patients with cACLD and a FLIS of 0-3 points and/or a SCCD of >13 cm were at increased risk of hepatic decompensation (aHR 3.07; 95% CI 1.43-6.59; p = 0.004). In patients with dACLD, a FLIS of 0-3 was independently associated with an increased risk of ACLF (aHR 2.81; 95% CI 1.16-6.84; p = 0.02), even after adjusting for other prognostic factors. Finally, a FLIS and SCCD-based algorithm was independently predictive of transplant-free mortality and stratified the probability of transplant-free survival (TFS) in ACLD (p <0.001): FLIS 4-6 and SCCD ≤13 cm (5-year TFS of 84%) vs. FLIS 4-6 and SCCD >13 cm (5-year TFS of 70%) vs. FLIS 0-3 (5-year TFS of 24%). CONCLUSION The FLIS and SCCD are simple imaging markers that provide complementary information for risk stratification in patients with compensated and decompensated ACLD. LAY SUMMARY Magnetic resonance imaging (MRI) can be used to assess the state of the liver. Previously the functional liver imaging score, which is based on MRI criteria, was developed as a measure of liver function and to predict the risk of liver-related complications or death. By combining this score with a measurement of spleen diameter, also using MRI, we generated an algorithm that could predict the risk of adverse liver-related outcomes in patients with advanced chronic liver disease.
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9
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Rajakannu M, Coilly A, Cherqui D, Cunha AS, Castaing D, Adam R, Samuel D, Vibert E. Liver stiffness-based model predicts hepatic venous pressure gradient in patients with liver disease. HPB (Oxford) 2022; 24:1796-1803. [PMID: 35504833 DOI: 10.1016/j.hpb.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/31/2021] [Accepted: 11/07/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim was to develop a model to predict clinically significant portal hypertension, hepatic venous pressure gradient (HVPG) ≥10 mmHg using pre-operative noninvasive makers. METHODS Patients who have been programmed for liver resection/transplantation were enrolled prospectively. Preoperative liver stiffness measurement (LSM), liver function test (LFT), and intraoperative HVPG were assessed. A probability score model to predict HVPG≥10 mmHg called HVPG10 score was developed and validated. RESULTS A total of 161 patients [66% men, median age of 63 years] were recruited for the study. Median LSM, and HVPG were 9.5 kPa, and 5 mmHg respectively. HVPG10 score was developed using independent predictors of HVPG≥10 mmHg in the training set were LSM, total bilirubin, alkaline phosphatase, and international normalized ratio. Area under receiver operating curve of HVPG10 score in the training and validation sets were 0.91 and 0.93 respectively with a cutoff of 15. In the overall cohort, HVPG10 score≥15 had 83% accuracy, 90% sensitivity, 81% specificity and 96% negative predictive value in predicting HVPG≥10 mmHg. CONCLUSION HVPG10 score is an easy-to-use noninvasive continuous scale tool to rule out clinically significant portal hypertension in >95% patients with chronic liver disease.
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Affiliation(s)
- Muthukumarassamy Rajakannu
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Audrey Coilly
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France
| | - Daniel Cherqui
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Antonio Sa Cunha
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Denis Castaing
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - René Adam
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France; Inserm, Unité UMR-S 776, Villejuif, France
| | - Didier Samuel
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Eric Vibert
- Centre Hépato-Biliaire, AH-HP Hôpital Paul Brousse, Villejuif, France; Inserm, Unité UMR-S 1193, Villejuif, France; Université Paris-Sud, Faculté de Médecine, Le Kremlin-Bicêtre, France.
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10
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Sun X, Ni HB, Xue J, Wang S, Aljbri A, Wang L, Ren TH, Li X, Niu M. Bibliometric-analysis visualization and review of non-invasive methods for monitoring and managing the portal hypertension. Front Med (Lausanne) 2022; 9:960316. [PMID: 36186776 PMCID: PMC9520322 DOI: 10.3389/fmed.2022.960316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPortal hypertension monitoring is important throughout the natural course of cirrhosis. Hepatic venous pressure gradient (HVPG), regarded as the golden standard, is limited by invasiveness and technical difficulties. Portal hypertension is increasingly being assessed non-invasively, and hematological indices, imaging data, and statistical or computational models are studied to surrogate HVPG. This paper discusses the existing non-invasive methods based on measurement principles and reviews the methodological developments in the last 20 years.MethodsFirst, we used VOSviewer to learn the architecture of this field. The publications about the non-invasive assessment of portal hypertension were retrieved from the Web of Science Core Collection (WoSCC). VOSviewer 1.6.17.0 was used to analyze and visualize these publications, including the annual trend, the study hotspots, the significant articles, authors, journals, and organizations in this field. Next, according to the cluster analysis result of the keywords, we further retrieved and classified the related studies to discuss.ResultsA total of 1,088 articles or review articles about our topic were retrieved from WoSCC. From 2000 to 2022, the number of publications is generally growing. “World Journal of Gastroenterology” published the most articles (n = 43), while “Journal of Hepatology” had the highest citations. “Liver fibrosis” published in 2005 was the most influential manuscript. Among the 20,558 cited references of 1,088 retrieved manuscripts, the most cited was a study on liver stiffness measurement from 2007. The highest-yielding country was the United States, followed by China and Italy. “Berzigotti, Annalisa” was the most prolific author and had the most cooperation partners. Four study directions emerged from the keyword clustering: (1) the evaluation based on fibrosis; (2) the evaluation based on hemodynamic factors; (3) the evaluation through elastography; and (4) the evaluation of variceal bleeding.ConclusionThe non-invasive assessment of portal hypertension is mainly based on two principles: fibrosis and hemodynamics. Liver fibrosis is the major initiator of cirrhotic PH, while hemodynamic factors reflect secondary alteration of splanchnic blood flow. Blood tests, US (including DUS and CEUS), CT, and magnetic resonance imaging (MRI) support the non-invasive assessment of PH by providing both hemodynamic and fibrotic information. Elastography, mainly USE, is the most important method of PH monitoring.
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Affiliation(s)
- XiaoHan Sun
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Hong Bo Ni
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Jian Xue
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Shuai Wang
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Afaf Aljbri
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Liuchun Wang
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Tian Hang Ren
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Xiao Li,
| | - Meng Niu
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
- Meng Niu,
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11
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Romero-Cristóbal M, Clemente-Sánchez A, Peligros MI, Ramón E, Matilla AM, Colón A, Alonso S, Catalina MV, Fernández-Yunquera A, Caballero A, García R, López-Baena JÁ, Salcedo MM, Bañares R, Rincón D. Liver and spleen volumes are associated with prognosis of compensated and decompensated cirrhosis and parallel its natural history. United European Gastroenterol J 2022; 10:805-816. [PMID: 36065767 PMCID: PMC9557954 DOI: 10.1002/ueg2.12301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/14/2022] [Indexed: 12/30/2022] Open
Abstract
Objective Cirrhosis is characterized by the complex interplay among biological, histological and haemodynamic events. Liver and spleen remodelling occur throughout its natural history, but the prognostic role of these volumetric changes is unclear. We evaluated the relationship between volumetric changes assessed by multidetector computerised tomography (MDCT) and landmark features of cirrhosis. Methods We included consecutive cirrhotic patients who underwent liver transplantation (LT) or hepatocellular carcinoma (HCC) resection in whom dynamic MDCT was available. Different volumetric indices were calculated. Fibrosis was evaluated by the collagen proportional area and Laennec sub‐stages. Correlation and logistic regression analysis were performed to explore associations of volumetric indexes and fibrosis with key prognostic features across the clinical stages of cirrhosis. Results 185 patients were included (146 LT; 39 HCC); the predominant aetiology was viral hepatitis (51.35%); 65.9% had decompensated disease and 85.08% clinically significant portal hypertension (CSPH). The standardised liver volume and liver‐spleen volume ratio negatively correlated with Model for End‐stage Liver Disease (MELD), albumin and hepatic venous pressure gradient (HVPG) and were significantly lower in decompensated patients. The liver segmental volume ratio (segments I–III/segments IV–VIII) best captured the characteristic features of the compensated phase, showing a positive correlation with HVPG and a good discrimination between patients with and without CSPH and varices. Volumetric changes and fibrosis severity were independently associated with key prognostic events, with no association between these two parameters. Conclusions Liver and spleen volumetric indices evolve differently along the natural history of cirrhosis and are associated with key prognostic factors in each phase, regardless of fibrosis severity and portal hypertension.
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Affiliation(s)
| | - Ana Clemente-Sánchez
- Liver Unit and Digestive Department H.G.U, Gregorio Marañón, Madrid, Spain.,CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Enrique Ramón
- Department of Radiology, H.G.U, Gregorio Marañón, Madrid, Spain
| | - Ana-María Matilla
- Liver Unit and Digestive Department H.G.U, Gregorio Marañón, Madrid, Spain.,CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain
| | - Arturo Colón
- Liver Transplant and Hepatobiliary Surgery Unit, H.G.U, Gregorio Marañón, Madrid, Spain
| | - Sonia Alonso
- Liver Unit and Digestive Department H.G.U, Gregorio Marañón, Madrid, Spain.,CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Aranzazu Caballero
- Liver Unit and Digestive Department H.G.U, Gregorio Marañón, Madrid, Spain
| | - Rita García
- CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain.,Department of Internal Medicine, H.G.U, Gregorio Marañón, Madrid, Spain
| | | | - María-Magdalena Salcedo
- Liver Unit and Digestive Department H.G.U, Gregorio Marañón, Madrid, Spain.,CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Complutense University, Madrid, Spain
| | - Rafael Bañares
- Liver Unit and Digestive Department H.G.U, Gregorio Marañón, Madrid, Spain.,CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Complutense University, Madrid, Spain
| | - Diego Rincón
- Liver Unit and Digestive Department H.G.U, Gregorio Marañón, Madrid, Spain.,CIBEREHD, Instituto de Salud Carlos III, Madrid, Spain.,School of Medicine, Complutense University, Madrid, Spain
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12
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Vranić L, Nadarevic T, Štimac D, Fraquelli M, Manzotti C, Casazza G, Colli A. Liver and spleen stiffness as assessed by vibration controlled transient elastography for diagnosing clinically significant portal hypertension in comparison with other elastography-based techniques in adults with chronic liver disease. Hippokratia 2022. [DOI: 10.1002/14651858.cd015415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Luka Vranić
- Department of Gastroenterology; Clinical Hospital Centre Rijeka; Rijeka Croatia
| | - Tin Nadarevic
- Department of Radiology; Clinical Hospital Centre Rijeka; Rijeka Croatia
| | - Davor Štimac
- Department of Gastroenterology; Clinical Hospital Centre Rijeka; Rijeka Croatia
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit; Fondazione IRCCS Ca´ Granda - Ospedale Maggiore Policlinico, Milano; Milan Italy
| | - Cristina Manzotti
- Department of Pathophysiology and Transplantation; Università degli Studi di Milano; Milan Italy
| | - Giovanni Casazza
- Department of Clinical Sciences and Community Health - Laboratory of Medical Statistics, Biometry and Epidemiology "G.A. Maccacaro"; Università degli Studi di Milano; Milan Italy
| | - Agostino Colli
- Department of Transfusion Medicine and Haematology; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
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13
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Choi SJ, Lee SS, Jung KH, Lee JB, Kang HJ, Park HJ, Choi SH, Kim DW, Jang JK. Noncirrhotic Portal Hypertension after Trastuzumab Emtansine in HER2-positive Breast Cancer as Determined by Deep Learning-measured Spleen Volume at CT. Radiology 2022; 305:606-613. [PMID: 35943338 DOI: 10.1148/radiol.220536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Trastuzumab emtansine (T-DM1) is an antibody-drug conjugate approved for use in human epidermal growth factor receptor 2 (HER2)-positive breast cancer. Case reports have suggested an association between T-DM1 and portal hypertension. Purpose To evaluate the association of T-DM1 therapy with spleen volume changes and portal hypertension on CT scans and clinical findings compared with lapatinib and capecitabine therapy. Materials and Methods Patients with HER2-positive breast cancer who were administered at least two cycles of T-DM1 or lapatinib and capecitabine (controls) in a tertiary institution from 2001 to 2020 and who underwent CT before initial treatment and at least once during treatment were retrospectively enrolled. Spleen volume changes and the signs of portal hypertension (gastroesophageal varix [GEV], spontaneous portosystemic shunt [SPSS], and ascites) were evaluated at contrast-enhanced CT. Patients were followed until treatment ended or for 2 years after the start of treatment. Spleen volume changes were measured with a deep learning algorithm and evaluated by using a linear mixed model. The incidences of splenomegaly and portal hypertension were compared between the T-DM1 and control groups by using a χ2 test or Fisher exact test. Results The T-DM1 group included 111 patients (mean age, 54 years ± 11 [SD]; 111 women) and the control group included 122 patients (mean age, 50 years ± 9; 121 women). Spleen volume progressively increased with T-DM1 therapy but was constant in the control group (104% ± 5 vs -1% ± 6 at the 33rd treatment cycle, respectively; P < .001). Incidences of splenomegaly (46% [51 of 111] vs 3% [four of 122] of patients; P < .001), GEV (11% [12 of 111] vs 1% [one of 122] of patients; P < .001), and SPSS (27% [30 of 111] vs 1% [one of 122] of patients; P < .001) were higher in the T-DM1 group than in the control group. Conclusion Trastuzumab emtansine therapy was associated with noncirrhotic portal hypertension at CT, with higher incidences of splenomegaly, gastroesophageal varix, and spontaneous portosystemic shunt than those with lapatinib and capecitabine therapy. © RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Se Jin Choi
- From the Departments of Radiology and Research Institute of Radiology (S.J.C., S.S.L., H.J.P., S.H.C., D.W.K., J.K.J.), Oncology (K.H.J.), Clinical Epidemiology and Biostatistics (J.B.L.), and Pathology (H.J.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Seung Soo Lee
- From the Departments of Radiology and Research Institute of Radiology (S.J.C., S.S.L., H.J.P., S.H.C., D.W.K., J.K.J.), Oncology (K.H.J.), Clinical Epidemiology and Biostatistics (J.B.L.), and Pathology (H.J.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Kyung Hae Jung
- From the Departments of Radiology and Research Institute of Radiology (S.J.C., S.S.L., H.J.P., S.H.C., D.W.K., J.K.J.), Oncology (K.H.J.), Clinical Epidemiology and Biostatistics (J.B.L.), and Pathology (H.J.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Jung Bok Lee
- From the Departments of Radiology and Research Institute of Radiology (S.J.C., S.S.L., H.J.P., S.H.C., D.W.K., J.K.J.), Oncology (K.H.J.), Clinical Epidemiology and Biostatistics (J.B.L.), and Pathology (H.J.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Hyo Jeong Kang
- From the Departments of Radiology and Research Institute of Radiology (S.J.C., S.S.L., H.J.P., S.H.C., D.W.K., J.K.J.), Oncology (K.H.J.), Clinical Epidemiology and Biostatistics (J.B.L.), and Pathology (H.J.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Hyo Jung Park
- From the Departments of Radiology and Research Institute of Radiology (S.J.C., S.S.L., H.J.P., S.H.C., D.W.K., J.K.J.), Oncology (K.H.J.), Clinical Epidemiology and Biostatistics (J.B.L.), and Pathology (H.J.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Sang Hyun Choi
- From the Departments of Radiology and Research Institute of Radiology (S.J.C., S.S.L., H.J.P., S.H.C., D.W.K., J.K.J.), Oncology (K.H.J.), Clinical Epidemiology and Biostatistics (J.B.L.), and Pathology (H.J.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Dong Wook Kim
- From the Departments of Radiology and Research Institute of Radiology (S.J.C., S.S.L., H.J.P., S.H.C., D.W.K., J.K.J.), Oncology (K.H.J.), Clinical Epidemiology and Biostatistics (J.B.L.), and Pathology (H.J.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
| | - Jong Keon Jang
- From the Departments of Radiology and Research Institute of Radiology (S.J.C., S.S.L., H.J.P., S.H.C., D.W.K., J.K.J.), Oncology (K.H.J.), Clinical Epidemiology and Biostatistics (J.B.L.), and Pathology (H.J.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea
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Müller L, Gairing SJ, Kloeckner R, Foerster F, Weinmann A, Mittler J, Stoehr F, Emrich T, Düber C, Galle PR, Hahn F. Baseline Splenic Volume Outweighs Immuno-Modulated Size Changes with Regard to Survival Outcome in Patients with Hepatocellular Carcinoma under Immunotherapy. Cancers (Basel) 2022; 14:cancers14153574. [PMID: 35892833 PMCID: PMC9332404 DOI: 10.3390/cancers14153574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Splenic volume (SV) has been identified as a highly predictive parameter for prognosis in patients with hepatocellular carcinoma (HCC). Moreover, an association between immunotherapy and an increase in SV has been described for various types of cancer. In our cohort of patients with HCC under immunotherapy, SV was a highly predictive factor for overall survival at baseline and initial follow-up. Although a large proportion of patients (76%) showed an SV increase after the initiation of immunotherapy, this additional immuno-modulated SV change was negligible compared to long-standing changes in the splanchnic circulation in our patient cohort. Abstract Background: An association between immunotherapy and an increase in splenic volume (SV) has been described for various types of cancer. SV is also highly predictive of overall survival (OS) in patients with hepatocellular carcinoma (HCC). We evaluated SV and its changes with regard to their prognostic influence in patients with HCC undergoing immunotherapy. Methods: All patients with HCC who received immunotherapy in first or subsequent lines at our tertiary care center between 2016 and 2021 were screened for eligibility. SV was assessed at baseline and follow-up using an AI-based tool for spleen segmentation. Patients were dichotomized into high and low SV based on the median value. Results: Fifty patients were included in the analysis. The median SV prior to treatment was 532 mL. The median OS of patients with high and low SV was 5.1 months and 18.1 months, respectively (p = 0.01). An increase in SV between treatment initiation and the first follow-up was observed in 28/37 (75.7%) patients with follow-up imaging available. This increase in itself was not prognostic for median OS (7.0 vs. 8.5 months, p = 0.73). However, patients with high absolute SV at the first follow-up continued to have impaired survival (4.0 months vs. 30.7 months, p = 0.004). Conclusion: High SV prior to and during treatment was a significant prognostic factor for impaired outcome. Although a large proportion of patients showed an SV increase after the initiation of immunotherapy, this additional immuno-modulated SV change was negligible compared to long-standing changes in the splanchnic circulation in patients with HCC.
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Affiliation(s)
- Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (F.S.); (T.E.); (C.D.)
| | - Simon Johannes Gairing
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.J.G.); (F.F.); (A.W.); (P.R.G.)
| | - Roman Kloeckner
- Department of Interventional Radiology, University Hospital Schleswig-Holstein–Campus Luebeck, 23562 Luebeck, Germany;
| | - Friedrich Foerster
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.J.G.); (F.F.); (A.W.); (P.R.G.)
| | - Arndt Weinmann
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.J.G.); (F.F.); (A.W.); (P.R.G.)
| | - Jens Mittler
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany;
| | - Fabian Stoehr
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (F.S.); (T.E.); (C.D.)
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (F.S.); (T.E.); (C.D.)
- German Center for Cardiovascular Research (DZHK), Partner-Site Rhine-Main, 55131 Mainz, Germany
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (F.S.); (T.E.); (C.D.)
| | - Peter Robert Galle
- Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (S.J.G.); (F.F.); (A.W.); (P.R.G.)
| | - Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany; (L.M.); (F.S.); (T.E.); (C.D.)
- Correspondence:
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15
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Reiberger T. The Value of Liver and Spleen Stiffness for Evaluation of Portal Hypertension in Compensated Cirrhosis. Hepatol Commun 2022; 6:950-964. [PMID: 34904404 PMCID: PMC9035575 DOI: 10.1002/hep4.1855] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 09/23/2021] [Accepted: 10/17/2021] [Indexed: 12/11/2022] Open
Abstract
Patients with compensated advanced chronic liver disease who develop clinically significant portal hypertension (CSPH) are at high risk for hepatic decompensation and mortality if left untreated. Liver biopsy and hepatic venous pressure gradient (HVPG) measurements are the current gold standard procedures for determining fibrosis severity and diagnosing CSPH, respectively; however, both are invasive, limiting their use in clinical practice and larger trials of novel agents. As such, there is an unmet clinical need for reliable, validated, noninvasive measures to detect CSPH and to further assess portal hypertension (PH) severity. Alterations in the biomechanical properties of the liver or spleen in patients with cirrhosis can be quantified by tissue elastography, which examines the elastic behavior of tissue after a force has been applied. A variety of methods are available, including magnetic resonance elastography, shear-wave elastography, and the most thoroughly investigated measure, vibration-controlled transient elastography. Liver stiffness (LS) and spleen stiffness (SS) measurements offer valuable alternatives to detect and monitor CSPH. Both LS and SS correlate well with HVPG, with thresholds of LS >20-25 kPa and SS >40-45 kPa indicating a high likelihood of CSPH. Because SS is a direct and dynamic surrogate of portal pressure, it has the potential to monitor PH severity and assess PH improvement as a surrogate marker for clinical outcomes. Importantly, SS seems to be superior to LS for monitoring treatment response in clinical trials focusing on reducing PH.
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Affiliation(s)
- Thomas Reiberger
- Division of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria.,Vienna Hepatic Hemodynamic LaboratoryDivision of Gastroenterology and HepatologyDepartment of Internal Medicine IIIMedical University of ViennaViennaAustria.,Christian-Doppler Laboratory for Portal Hypertension and Liver FibrosisMedical University of ViennaViennaAustria
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16
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Tonini V, Vigutto G, Donati R. Liver surgery for colorectal metastasis: New paths and new goals with the help of artificial intelligence. Artif Intell Gastroenterol 2022; 3:28-35. [DOI: 10.35712/aig.v3.i2.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/28/2022] [Accepted: 04/19/2022] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is one of the most common neoplasia with an high risk to metastatic spread. Improving medical and surgical treatment is moving along with improving the precision of diagnosis and patient's assessment, the latter two aided more and more with the use of artificial intelligence (AI). The management of colorectal liver metastasis is multidisciplinary, and surgery is the main option. After the diagnosis, a surgical assessment of the patient is fundamental. Reaching a R0 resection with a proper remnant liver volume can be done using new techniques involving also artificial intelligence. Considering the recent application of artificial intelligence as a valid substitute for liver biopsy in chronic liver diseases, several authors tried to apply similar techniques to pre-operative imaging of liver metastasis. Radiomics showed good results in identifying structural changes in a unhealthy liver and in evaluating the prognosis after a liver resection. Recently deep learning has been successfully applied in estimating the remnant liver volume before surgery. Moreover AI techniques can help surgeons to perform an early diagnosis of neoplastic relapse or a better differentiation between a colorectal metastasis and a benign lesion. AI could be applied also in the histopathological diagnostic tool. Although AI implementation is still partially automatized, it appears faster and more precise than the usual diagnostic tools and, in the short future, could become the new gold standard in liver surgery.
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Affiliation(s)
- Valeria Tonini
- Department of Medical and Surgical Sciences, Sant' Orsola Hospital University of Bologna, Bologna 40138, Italy
| | - Gabriele Vigutto
- Department of Medical and Surgical Sciences, St Orsola Hospital, University of Bologna, Bologna 40138, Italy
| | - Riccardo Donati
- Department of Electrical, Electronic and Information Engineering ”Guglielmo Marconi” (DEI), University of Bologna, Bologna 40138, Italy
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17
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Wan S, Wei Y, Zhang X, Yang C, Hu F, Song B. Computed Tomography-Based Texture Features for the Risk Stratification of Portal Hypertension and Prediction of Survival in Patients With Cirrhosis: A Preliminary Study. Front Med (Lausanne) 2022; 9:863596. [PMID: 35433759 PMCID: PMC9010529 DOI: 10.3389/fmed.2022.863596] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 02/22/2022] [Indexed: 12/21/2022] Open
Abstract
ObjectiveClinical evidence suggests that the risk stratification of portal hypertension (PH) plays a vital role in disease progression and patient outcomes. However, the gold standard for stratifying PH [portal vein pressure (PVP) measurement] is invasive and therefore not suitable for routine clinical practice. This study is aimed to stratify PH and predict patient outcomes using liver or spleen texture features based on computed tomography (CT) images non-invasively.MethodsA total of 114 patients with PH were included in this retrospective study and divided into high-risk PH (PVP ≥ 20 mm Hg, n = 57) or low-risk PH (PVP < 20 mm Hg, n = 57), a progression-free survival (PFS) group (n = 14), or a non-PFS group (n = 51) based on patients with rebleeding or death after the transjugular intrahepatic portosystemic shunt (TIPS) procedure. All patients underwent contrast-enhanced CT, and the laboratory data were recorded. Texture features of the liver or spleen were obtained by a manual drawing of the region of interest (ROI) and were performed in the portal venous phase. Logistic regression analysis was applied to select the significant features related to high-risk PH, and PFS-related features were determined by the Cox proportional hazards model and Kaplan-Meier analysis. Receiver operating characteristic (ROC) curves were used to test the diagnostic capacity of each feature.ResultsFive texture features (one first-order feature from the liver and four wavelet features from the spleen) and the international normalized ratio (INR) were identified as statistically significant for stratifying PH (p < 0.05). The best performance was achieved by the spleen-derived feature of wavelet.LLH_ngtdm_Busyness, with an AUC of 0.72. The only log.sigma.3.0.mm.3D_firstorder_RobustMeanAbsoluteDeviation feature from the liver was associated with PFS with a C-index of 0.72 (95% CI 0.566–0.885), which could stratify patients with PH into high- or low-risk groups. The 1-, 2-, and 3-year survival probabilities were 66.7, 50, and 33.3% for the high-risk group and 93.2, 91.5, and 84.4% for the low-risk group, respectively (p < 0.05).ConclusionCT-based texture features from the liver or spleen may have the potential to stratify PH and predict patient survival.
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Affiliation(s)
- Shang Wan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Wei
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Zhang
- Pharmaceutical Diagnostics, GE Healthcare, Beijing, China
| | - Caiwei Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fubi Hu
- Department of Radiology, First Affiliated Hospital of Chengdu Medical College, Chengdu, China
- *Correspondence: Fubi Hu,
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
- Department of Radiology, Sanya People’s Hospital, Sanya, China
- Bin Song,
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18
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Yu Q, Huang Y, Li X, Pavlides M, Liu D, Luo H, Ding H, An W, Liu F, Zuo C, Lu C, Tang T, Wang Y, Huang S, Liu C, Zheng T, Kang N, Liu C, Wang J, Akçalar S, Çelebioğlu E, Üstüner E, Bilgiç S, Fang Q, Fu CC, Zhang R, Wang C, Wei J, Tian J, Örmeci N, Ellik Z, Asiller ÖÖ, Ju S, Qi X. An imaging-based artificial intelligence model for non-invasive grading of hepatic venous pressure gradient in cirrhotic portal hypertension. Cell Rep Med 2022; 3:100563. [PMID: 35492878 PMCID: PMC9040173 DOI: 10.1016/j.xcrm.2022.100563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 12/19/2021] [Accepted: 02/17/2022] [Indexed: 12/15/2022]
Abstract
The hepatic venous pressure gradient (HVPG) is the gold standard for cirrhotic portal hypertension (PHT), but it is invasive and specialized. Alternative non-invasive techniques are needed to assess the hepatic venous pressure gradient (HVPG). Here, we develop an auto-machine-learning CT radiomics HVPG quantitative model (aHVPG), and then we validate the model in internal and external test datasets by the area under the receiver operating characteristic curves (AUCs) for HVPG stages (≥10, ≥12, ≥16, and ≥20 mm Hg) and compare the model with imaging- and serum-based tools. The final aHVPG model achieves AUCs over 0.80 and outperforms other non-invasive tools for assessing HVPG. The model shows performance improvement in identifying the severity of PHT, which may help non-invasive HVPG primary prophylaxis when transjugular HVPG measurements are not available. aHVPG is an automated HVPG quantitative estimation model based on CT aHVPG has the potential to assess HVPG and outperforms other non-invasive tools Non-invasive tools may help PHT monitoring when invasive HVPG is not available
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Affiliation(s)
- Qian Yu
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yifei Huang
- CHESS Center, Institute of Portal Hypertension, First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaoguo Li
- CHESS Center, Institute of Portal Hypertension, First Hospital of Lanzhou University, Lanzhou, China
| | - Michael Pavlides
- Radcliffe Department of Medicine, Oxford Centre for Magnetic Resonance Research, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Dengxiang Liu
- CHESS Working Party, Xingtai People's Hospital, Xingtai, China
| | - Hongwu Luo
- Department of General Surgery, Third Xiangya Hospital of Central South University, Changsha, China
| | - Huiguo Ding
- Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Weimin An
- Department of Radiology, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Fuquan Liu
- Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Changzeng Zuo
- CHESS Working Party, Xingtai People's Hospital, Xingtai, China
| | - Chunqiang Lu
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Tianyu Tang
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Yuancheng Wang
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Shan Huang
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Chuan Liu
- CHESS Center, Institute of Portal Hypertension, First Hospital of Lanzhou University, Lanzhou, China
| | - Tianlei Zheng
- CHESS Center, Institute of Portal Hypertension, First Hospital of Lanzhou University, Lanzhou, China
| | - Ning Kang
- CHESS Center, Institute of Portal Hypertension, First Hospital of Lanzhou University, Lanzhou, China
| | - Changchun Liu
- Department of Radiology, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Jitao Wang
- CHESS Working Party, Xingtai People's Hospital, Xingtai, China
| | - Seray Akçalar
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Emrecan Çelebioğlu
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Evren Üstüner
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Sadık Bilgiç
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Qu Fang
- Shanghai Aitrox Technology Corporation, Shanghai, China
| | - Chi-Cheng Fu
- Shanghai Aitrox Technology Corporation, Shanghai, China
| | - Ruiping Zhang
- Department of Radiology, Shanxi Bethune Hospital, Third Hospital of Shanxi Medical University, Shanxi, China
| | - Chengyan Wang
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Jingwei Wei
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,Beijing Key Laboratory of Molecular Imaging, Beijing, China
| | - Jie Tian
- Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China.,Beijing Key Laboratory of Molecular Imaging, Beijing, China
| | - Necati Örmeci
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Ellik
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Özgün Ömer Asiller
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Shenghong Ju
- Department of Radiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Xiaolong Qi
- CHESS Center, Institute of Portal Hypertension, First Hospital of Lanzhou University, Lanzhou, China
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19
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Meddeb A, Kossen T, Bressem KK, Hamm B, Nagel SN. Evaluation of a Deep Learning Algorithm for Automated Spleen Segmentation in Patients with Conditions Directly or Indirectly Affecting the Spleen. Tomography 2021; 7:950-960. [PMID: 34941650 PMCID: PMC8704906 DOI: 10.3390/tomography7040078] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/06/2021] [Accepted: 12/07/2021] [Indexed: 12/12/2022] Open
Abstract
The aim of this study was to develop a deep learning-based algorithm for fully automated spleen segmentation using CT images and to evaluate the performance in conditions directly or indirectly affecting the spleen (e.g., splenomegaly, ascites). For this, a 3D U-Net was trained on an in-house dataset (n = 61) including diseases with and without splenic involvement (in-house U-Net), and an open-source dataset from the Medical Segmentation Decathlon (open dataset, n = 61) without splenic abnormalities (open U-Net). Both datasets were split into a training (n = 32.52%), a validation (n = 9.15%) and a testing dataset (n = 20.33%). The segmentation performances of the two models were measured using four established metrics, including the Dice Similarity Coefficient (DSC). On the open test dataset, the in-house and open U-Net achieved a mean DSC of 0.906 and 0.897 respectively (p = 0.526). On the in-house test dataset, the in-house U-Net achieved a mean DSC of 0.941, whereas the open U-Net obtained a mean DSC of 0.648 (p < 0.001), showing very poor segmentation results in patients with abnormalities in or surrounding the spleen. Thus, for reliable, fully automated spleen segmentation in clinical routine, the training dataset of a deep learning-based algorithm should include conditions that directly or indirectly affect the spleen.
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Affiliation(s)
- Aymen Meddeb
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Radiologie, Hindenburgdamm 30, 12203 Berlin, Germany; (K.K.B.); (B.H.); (S.N.N.)
- Correspondence: ; Tel.: +49-30-450-527792
| | - Tabea Kossen
- CLAIM—Charité Lab for AI in Medicine, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany;
| | - Keno K. Bressem
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Radiologie, Hindenburgdamm 30, 12203 Berlin, Germany; (K.K.B.); (B.H.); (S.N.N.)
- Berlin Institute of Health, Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Bernd Hamm
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Radiologie, Hindenburgdamm 30, 12203 Berlin, Germany; (K.K.B.); (B.H.); (S.N.N.)
| | - Sebastian N. Nagel
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Klinik für Radiologie, Hindenburgdamm 30, 12203 Berlin, Germany; (K.K.B.); (B.H.); (S.N.N.)
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20
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Frangakis C, Sohn JH, Bas A, Chapiro J, Schernthaner RE, Lin M, Hamilton JP, Pawlik TM, Hong K, Duran R. Longitudinal Analysis of the Effect of Repeated Transarterial Chemoembolization for Liver Cancer on Portal Venous Pressure. Front Oncol 2021; 11:639235. [PMID: 34804911 PMCID: PMC8602787 DOI: 10.3389/fonc.2021.639235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 10/22/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives Investigate long-term effects of repeated transarterial chemoembolization (TACE) on portal venous pressure (PVP) using non-invasive surrogate markers of portal hypertension. Methods Retrospective, Institutional Review Board-approved study. 99 patients [hepatocellular carcinoma (HCC) group (n=57); liver metastasis group (n=42)] who underwent 279TACEs and had longitudinal pre-/post-therapy contrast-enhanced-MRI (n=388) and complete blood work were included. Outcomes of interest were platelet count (PC), spleen volume, ascites and portosystemic collaterals. Variables included TACE type/number, tumor type, microcatheter location, Child-Pugh, baseline tumor burden (tumor number/total/largest size), vessel invasion, alpha-fetoprotein, Eastern Cooperative Oncology Group (ECOG) performance status, and Model for End-Stage Liver Disease (MELD) score. Generalized Estimating Equations assessed the associations between TACE and outcomes. Power analysis determined the sample size was sufficient. Results No significant change in PC over time was observed in either groups, regardless of liver function (P>0.05). Baseline spleen volume was 226 cm3 for metastatic group, and was larger by 204 cm3 for HCC group (P<0.001). Spleen volume increased by 20 cm3 (95%CI: 8-32; P=0.001) for both groups after 1stTACE and by 16cm3/TACE (P=0.099) over the full follow-up (up to 9TACEs). Spleen volume also tended to increase by 23cm3 (95%CI: -1–48; P=0.064) with higher tumor burden. Odds of developing moderate/severe ascites for metastatic patients was decreased by 0.5 (95%CI: 0.3–0.9; P=0.014), regardless of the Child-Pugh, and increased by 1.5 (95%CI: 1.2–1.9; P<0.001) among HCC patients with unstable Child-Pugh, whereas no change was noted with stable Child-Pugh. HCC patients with unstable Child-Pugh demonstrated a significant increase in portosystemic collaterals number over time (P=0.008). PVP-related complications such as variceal bleeding post-TACE were low (0.4%). Conclusion Repeated TACEs did seem to have an impact on PVP. However, the increase in PVP had marginal effects with low portal hypertension-related complications.
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Affiliation(s)
- Constantine Frangakis
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jae Ho Sohn
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Ahmet Bas
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Julius Chapiro
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - Ruediger E Schernthaner
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - MingDe Lin
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, United States
| | - James P Hamilton
- Division of Gastroenterology and Hepatology, Department of Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH, United States
| | - Kelvin Hong
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States
| | - Rafael Duran
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins Hospital, Baltimore, MD, United States.,Department of Radiology and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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21
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Artificial intelligence in the diagnosis of cirrhosis and portal hypertension. J Med Ultrason (2001) 2021; 49:371-379. [PMID: 34787742 DOI: 10.1007/s10396-021-01153-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/03/2021] [Indexed: 12/17/2022]
Abstract
Clinically significant portal hypertension is associated with an increased risk of developing gastroesophageal varices and hepatic decompensation. Hepatic venous pressure gradient measurement and esophagogastroduodenoscopy are the gold-standard methods for assessing clinically significant portal hypertension and gastroesophageal varices, respectively. However, invasiveness, cost, and feasibility limit their widespread use, especially if repeated and serial evaluations are required to assess the efficacy of pharmacotherapy. Artificial intelligence describes a range of techniques that allow machines to perform tasks typically thought to require human reasoning and problem-solving skills. Artificial intelligence has made great strides in the field of medicine, and is also involved in portal hypertension diagnosis. Artificial intelligence tools will potentially transform our practice by leveraging massive amounts of data to personalize care to the right patient, in the right amount, at the right time. This review focuses on the recent advances in artificial intelligence for the noninvasive diagnosis of portal hypertension and gastroesophageal varices and monitoring of risk assessment of its complications in clinical practice.
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22
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Renzulli M, Dajti E, Ierardi AM, Brandi N, Berzigotti A, Milandri M, Rossini B, Clemente A, Ravaioli F, Marasco G, Azzaroli F, Carrafiello G, Festi D, Colecchia A, Golfieri R. Validation of a standardized CT protocol for the evaluation of varices and porto-systemic shunts in cirrhotic patients. Eur J Radiol 2021; 147:110010. [PMID: 34801322 DOI: 10.1016/j.ejrad.2021.110010] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE The aim of the present study was to propose and validate a standardized CT protocol for evaluating all the types of portosystemic collaterals (P-SC), including gastroesophageal varices and spontaneous portosystemic shunts (SPSS), and to evaluate the prognostic role of portal hypertension CT features for the prediction of the hepatic decompensation risk in cirrhotic patients. METHODS A retrospective cohort study of 184 advanced chronic liver disease who underwent CT scan between January 2014 and December 2017. Patients with an interval > 6 months between the imaging, elastometric, endoscopic and biochemical evaluation were excluded, as well as patients with previous transjugular intrahepatic portosystemic shunt (TIPS), liver transplantation (LT) or terminal medical conditions. Data on liver disease history, co-morbidities, endoscopic and radiologic findings were collected. The incidence of hepatic decompensation and other events, such as portal vein thrombosis, HCC, TIPS placement, LT, death, and its cause, were also recorded. The procedure was performed at baseline and after the administration of contrast agent using a multiphasic technique and bolus tracking. Two senior radiologists working in different centres and a non-expert radiologist reviewed all CT examinations, to evaluate both intra-observer and inter-observer variability of the CT protocol and to obtain an external validation. The radiological variables were evaluated using both univariate and adjusted multivariate competing risk regression models. RESULTS Both intra-observer and inter-observer agreement were excellent in detection and measurement of almost all types of P-SC. The presence of SPSS, a spleen diameter > 16 cm, a portal vein diameter > 17 mm and the presence of ascites resulted independent predictors of decompensation-free survival for cirrhotic patients and were incorporated in an easy-to-use score (AUROC = 0.799, p-value = 0.732) which can the risk of decompensation at 5 years, ranking it as low (11.3%), moderate (35.6%) or high (70.8%). CONCLUSIONS The CT protocol commonly performed during the HCC surveillance program for cirrhotic patients is valid for detecting all types of P-SC. The radiological score identified to predict the decompensation-free survival for cirrhotic patients could be an easy-to-use clinical tool.
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Affiliation(s)
- Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy.
| | - Elton Dajti
- Department of Medical and Surgical Sciences (DIMEC), IRCCS, University of Bologna, Via Massarenti 9, Bologna 40138, Italy
| | - Anna Maria Ierardi
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano Milan, Italy
| | - Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Annalisa Berzigotti
- Hepatology, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, Switzerland
| | - Matteo Milandri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
| | - Benedetta Rossini
- Department of Medical and Surgical Sciences (DIMEC), IRCCS, University of Bologna, Via Massarenti 9, Bologna 40138, Italy
| | - Alfredo Clemente
- Radiology and Radiotherapy Unit, Department of Precision Medicine, University of Campania "L. Vanvitelli", 80138 Naples, Italy
| | - Federico Ravaioli
- Department of Medical and Surgical Sciences (DIMEC), IRCCS, University of Bologna, Via Massarenti 9, Bologna 40138, Italy
| | - Giovanni Marasco
- Department of Medical and Surgical Sciences (DIMEC), IRCCS, University of Bologna, Via Massarenti 9, Bologna 40138, Italy
| | - Francesco Azzaroli
- Department of Medical and Surgical Sciences (DIMEC), IRCCS, University of Bologna, Via Massarenti 9, Bologna 40138, Italy
| | - Gianpaolo Carrafiello
- Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano Milan, Italy
| | - Davide Festi
- Department of Medical and Surgical Sciences (DIMEC), IRCCS, University of Bologna, Via Massarenti 9, Bologna 40138, Italy
| | - Antonio Colecchia
- Unit of Gastroenterology, Borgo Trento University Hospital of Verona, Verona, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna, Italy
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23
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Kwon JH, Lee SS, Yoon JS, Suk HI, Sung YS, Kim HS, Lee CM, Kim KM, Lee SJ, Kim SY. Liver-to-Spleen Volume Ratio Automatically Measured on CT Predicts Decompensation in Patients with B Viral Compensated Cirrhosis. Korean J Radiol 2021; 22:1985-1995. [PMID: 34564961 PMCID: PMC8628160 DOI: 10.3348/kjr.2021.0348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/03/2021] [Accepted: 06/30/2021] [Indexed: 01/05/2023] Open
Abstract
Objective Although the liver-to-spleen volume ratio (LSVR) based on CT reflects portal hypertension, its prognostic role in cirrhotic patients has not been proven. We evaluated the utility of LSVR, automatically measured from CT images using a deep learning algorithm, as a predictor of hepatic decompensation and transplantation-free survival in patients with hepatitis B viral (HBV)-compensated cirrhosis. Materials and Methods A deep learning algorithm was used to measure the LSVR in a cohort of 1027 consecutive patients (mean age, 50.5 years; 675 male and 352 female) with HBV-compensated cirrhosis who underwent liver CT (2007–2010). Associations of LSVR with hepatic decompensation and transplantation-free survival were evaluated using multivariable Cox proportional hazards and competing risk analyses, accounting for either the Child-Pugh score (CPS) or Model for End Stage Liver Disease (MELD) score and other variables. The risk of the liver-related events was estimated using Kaplan-Meier analysis and the Aalen-Johansen estimator. Results After adjustment for either CPS or MELD and other variables, LSVR was identified as a significant independent predictor of hepatic decompensation (hazard ratio for LSVR increase by 1, 0.71 and 0.68 for CPS and MELD models, respectively; p < 0.001) and transplantation-free survival (hazard ratio for LSVR increase by 1, 0.8 and 0.77, respectively; p < 0.001). Patients with an LSVR of < 2.9 (n = 381) had significantly higher 3-year risks of hepatic decompensation (16.7% vs. 2.5%, p < 0.001) and liver-related death or transplantation (10.0% vs. 1.1%, p < 0.001) than those with an LSVR ≥ 2.9 (n = 646). When patients were stratified according to CPS (Child-Pugh A vs. B–C) and MELD (< 10 vs. ≥ 10), an LSVR of < 2.9 was still associated with a higher risk of liver-related events than an LSVR of ≥ 2.9 for all Child-Pugh (p ≤ 0.045) and MELD (p ≤ 0.009) stratifications. Conclusion The LSVR measured on CT can predict hepatic decompensation and transplantation-free survival in patients with HBV-compensated cirrhosis.
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Affiliation(s)
- Ji Hye Kwon
- Department of Radiology, Good-Jang Hospital, Seoul, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Jee Seok Yoon
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
| | - Heung-Il Suk
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea.,Department of Artificial Intelligence, Korea University, Seoul, Korea
| | - Yu Sub Sung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chul-Min Lee
- Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Korea
| | - Kang Mo Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - So Jung Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - So Yeon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Kim DW, Ha J, Lee SS, Kwon JH, Kim NY, Sung YS, Yoon JS, Suk HI, Lee Y, Kang BK. Population-based and Personalized Reference Intervals for Liver and Spleen Volumes in Healthy Individuals and Those with Viral Hepatitis. Radiology 2021; 301:339-347. [PMID: 34402668 DOI: 10.1148/radiol.2021204183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Reference intervals guiding volumetric assessment of the liver and spleen have yet to be established. Purpose To establish population-based and personalized reference intervals for liver volume, spleen volume, and liver-to-spleen volume ratio (LSVR). Materials and Methods This retrospective study consecutively included healthy adult liver donors from 2001 to 2013 (reference group) and from 2014 to 2016 (healthy validation group) and patients with viral hepatitis from 2007 to 2017. Liver volume, spleen volume, and LSVR were measured with CT by using a deep learning algorithm. In the reference group, the reference intervals for the volume indexes were determined by using the population-based (ranges encompassing the central 95% of donors) and personalized (quantile regression modeling of the 2.5th and 97.5th percentiles as a function of age, sex, height, and weight) approaches. The validity of the reference intervals was evaluated in the healthy validation group and the viral hepatitis group. Results The reference and healthy validation groups had 2989 donors (mean age ± standard deviation, 30 years ± 9; 1828 men) and 472 donors (mean age, 30 years ± 9; 334 men), respectively. The viral hepatitis group had 158 patients (mean age, 48 years ± 12; 95 men). The population-based reference intervals were 824.5-1700.0 cm3 for liver volume, 81.1-322.0 cm3 for spleen volume, and 3.96-13.78 for LSVR. Formulae and a web calculator (https://i-pacs.com/calculators) were presented to calculate the personalized reference intervals. In the healthy validation group, both the population-based and personalized reference intervals were used to classify the volume indexes of 94%-96% of the donors as falling within the reference interval. In the viral hepatitis group, when compared with the population-based reference intervals, the personalized reference intervals helped identify more patients with volume indexes outside the reference interval (liver volume, 21.5% [34 of 158] vs 13.3% [21 of 158], P = .01; spleen volume, 29.1% [46 of 158] vs 22.2% [35 of 158], P = .01; LSVR, 35.4% [56 of 158] vs 26.6% [42 of 158], P < .001). Conclusion Reference intervals derived from a deep learning approach in healthy adults may enable evidence-based assessments of liver and spleen volume in clinical practice. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Ringl in this issue.
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Affiliation(s)
- Dong Wook Kim
- From the Department of Radiology and Research Institute of Radiology (D.W.K., J.H., S.S.L., J.H.K., Y.S.S.) and Department of Clinical Epidemiology and Biostatistics (N.Y.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea; Department of Brain and Cognitive Engineering (J.S.Y., H.I.S.) and Department of Artificial Intelligence (H.I.S.), Korea University, Seoul, Republic of Korea; Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Republic of Korea (B.K.K.)
| | - Jiyeon Ha
- From the Department of Radiology and Research Institute of Radiology (D.W.K., J.H., S.S.L., J.H.K., Y.S.S.) and Department of Clinical Epidemiology and Biostatistics (N.Y.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea; Department of Brain and Cognitive Engineering (J.S.Y., H.I.S.) and Department of Artificial Intelligence (H.I.S.), Korea University, Seoul, Republic of Korea; Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Republic of Korea (B.K.K.)
| | - Seung Soo Lee
- From the Department of Radiology and Research Institute of Radiology (D.W.K., J.H., S.S.L., J.H.K., Y.S.S.) and Department of Clinical Epidemiology and Biostatistics (N.Y.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea; Department of Brain and Cognitive Engineering (J.S.Y., H.I.S.) and Department of Artificial Intelligence (H.I.S.), Korea University, Seoul, Republic of Korea; Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Republic of Korea (B.K.K.)
| | - Ji Hye Kwon
- From the Department of Radiology and Research Institute of Radiology (D.W.K., J.H., S.S.L., J.H.K., Y.S.S.) and Department of Clinical Epidemiology and Biostatistics (N.Y.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea; Department of Brain and Cognitive Engineering (J.S.Y., H.I.S.) and Department of Artificial Intelligence (H.I.S.), Korea University, Seoul, Republic of Korea; Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Republic of Korea (B.K.K.)
| | - Na Young Kim
- From the Department of Radiology and Research Institute of Radiology (D.W.K., J.H., S.S.L., J.H.K., Y.S.S.) and Department of Clinical Epidemiology and Biostatistics (N.Y.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea; Department of Brain and Cognitive Engineering (J.S.Y., H.I.S.) and Department of Artificial Intelligence (H.I.S.), Korea University, Seoul, Republic of Korea; Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Republic of Korea (B.K.K.)
| | - Yu Sub Sung
- From the Department of Radiology and Research Institute of Radiology (D.W.K., J.H., S.S.L., J.H.K., Y.S.S.) and Department of Clinical Epidemiology and Biostatistics (N.Y.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea; Department of Brain and Cognitive Engineering (J.S.Y., H.I.S.) and Department of Artificial Intelligence (H.I.S.), Korea University, Seoul, Republic of Korea; Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Republic of Korea (B.K.K.)
| | - Jee Seok Yoon
- From the Department of Radiology and Research Institute of Radiology (D.W.K., J.H., S.S.L., J.H.K., Y.S.S.) and Department of Clinical Epidemiology and Biostatistics (N.Y.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea; Department of Brain and Cognitive Engineering (J.S.Y., H.I.S.) and Department of Artificial Intelligence (H.I.S.), Korea University, Seoul, Republic of Korea; Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Republic of Korea (B.K.K.)
| | - Heung-Il Suk
- From the Department of Radiology and Research Institute of Radiology (D.W.K., J.H., S.S.L., J.H.K., Y.S.S.) and Department of Clinical Epidemiology and Biostatistics (N.Y.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea; Department of Brain and Cognitive Engineering (J.S.Y., H.I.S.) and Department of Artificial Intelligence (H.I.S.), Korea University, Seoul, Republic of Korea; Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Republic of Korea (B.K.K.)
| | - Yedaun Lee
- From the Department of Radiology and Research Institute of Radiology (D.W.K., J.H., S.S.L., J.H.K., Y.S.S.) and Department of Clinical Epidemiology and Biostatistics (N.Y.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea; Department of Brain and Cognitive Engineering (J.S.Y., H.I.S.) and Department of Artificial Intelligence (H.I.S.), Korea University, Seoul, Republic of Korea; Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Republic of Korea (B.K.K.)
| | - Bo-Kyeong Kang
- From the Department of Radiology and Research Institute of Radiology (D.W.K., J.H., S.S.L., J.H.K., Y.S.S.) and Department of Clinical Epidemiology and Biostatistics (N.Y.K.), University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea; Department of Brain and Cognitive Engineering (J.S.Y., H.I.S.) and Department of Artificial Intelligence (H.I.S.), Korea University, Seoul, Republic of Korea; Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea (Y.L.); and Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Republic of Korea (B.K.K.)
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25
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Zhou LL, Wang GC, Zhang MY, Huang GJ, Li W, Wang LY, Wang AH, Zhang CQ. Nomogram for hepatic venous pressure gradient in patients with cirrhosis. J Dig Dis 2021; 22:488-495. [PMID: 34272920 DOI: 10.1111/1751-2980.13033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The hepatic venous pressure gradient (HVPG) plays an important role in the treatment and prognosis of patients with cirrhosis. Our study aimed to develop and validate a nomogram for an HVPG >12 mmHg. METHODS A retrospective study was performed to create a nomogram for an HVPG >12 mmHg in a training cohort that was validated in another cohort. The discriminatory ability and calibration of the nomogram were tested using the C-statistic, area under the receiver operating characteristic curve (AUROC) and calibration plots. RESULTS The nomogram was based on portosystemic shunts identified on computed tomography images, the etiology of cirrhosis and the Child-Pugh grade. These parameters were significantly associated with an HVPG >12 mmHg (P < 0.05 for both the training and validation cohorts). In the training cohort, the model showed good discrimination (C-statistic, AUROC, and R2 of 0.71, 0.71 and 0.13, respectively) and good calibration. The total cutoff value was 112 and the sensitivity and specificity were 57.1% and 77.6%, respectively. The application of the nomogram in the validation cohort still yielded good discrimination (C-statistic 0.75 [95% confidence interval 0.61-0.89], AUROC 0.75, and R2 0.16) and good calibration. CONCLUSIONS This nomogram is a convenient tool for predicting an HVPG >12 mmHg in patients with cirrhosis and can help clinicians quickly identify patients with decompensated cirrhosis.
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Affiliation(s)
- Li Li Zhou
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China.,Department of Gastroenterology, Jining No. 1 People's Hospital, Jining, Shandong Province, China
| | - Guang Chuan Wang
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Ming Yan Zhang
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Guang Jun Huang
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
| | - Wen Li
- Digestive Diseases Hospital of Shandong First Medical Uniersity, Jining, Shandong Province, China
| | - Ling Yun Wang
- Department of Gastroenterology, Jining No. 1 People's Hospital, Jining, Shandong Province, China
| | - Ai Hua Wang
- Department of Gastroenterology, Linyi People's Hospital, Linyi, Shandong Province, China
| | - Chun Qing Zhang
- Department of Gastroenterology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, China
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Golse N, Joly F, Combari P, Lewin M, Nicolas Q, Audebert C, Samuel D, Allard MA, Sa Cunha A, Castaing D, Cherqui D, Adam R, Vibert E, Vignon-Clementel IE. Predicting the risk of post-hepatectomy portal hypertension using a digital twin: A clinical proof of concept. J Hepatol 2021; 74:661-669. [PMID: 33212089 DOI: 10.1016/j.jhep.2020.10.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS Despite improvements in medical and surgical techniques, post-hepatectomy liver failure (PHLF) remains the leading cause of postoperative death. High postoperative portal vein pressure (PPV) and portocaval gradient (PCG), which cannot be predicted by current tools, are the most important determinants of PHLF. Therefore, we aimed to evaluate a digital twin to predict the risk of postoperative portal hypertension (PHT). METHODS We prospectively included 47 patients undergoing major hepatectomy. A mathematical (0D) model of the entire blood circulation was assessed and automatically calibrated from patient characteristics. Hepatic flows were obtained from preoperative flow MRI (n = 9), intraoperative flowmetry (n = 16), or estimated from cardiac output (n = 47). Resection was then simulated in these 3 groups and the computed PPV and PCG were compared to intraoperative data. RESULTS Simulated post-hepatectomy pressures did not differ between the 3 groups, comparing well with collected data (no significant differences). In the entire cohort, the correlation between measured and simulated PPV values was good (r = 0.66, no adjustment to intraoperative events) or excellent (r = 0.75) after adjustment, as well as for PCG (respectively r = 0.59 and r = 0.80). The difference between simulated and measured post-hepatectomy PCG was ≤3 mmHg in 96% of cases. Four patients suffered from lethal PHLF for whom the model satisfactorily predicted their postoperative pressures. CONCLUSIONS We demonstrated that a 0D model could correctly anticipate postoperative PHT, even using estimated hepatic flow rates as input data. If this major conceptual step is confirmed, this algorithm could change our practice toward more tailor-made procedures, while ensuring satisfactory outcomes. LAY SUMMARY Post-hepatectomy portal hypertension is a major cause of liver failure and death, but no tool is available to accurately anticipate this potentially lethal complication for a given patient. Herein, we propose using a mathematical model to predict the portocaval gradient at the end of liver resection. We tested this model on a cohort of 47 patients undergoing major hepatectomy and demonstrated that it could modify current surgical decision-making algorithms.
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Affiliation(s)
- Nicolas Golse
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193; INRIA, Centre de Recherche de Paris, 2 rue Simone Iff, Paris 75012, France.
| | - Florian Joly
- INRIA, Centre de Recherche de Paris, 2 rue Simone Iff, Paris 75012, France; Université de la Sorbonne, CNRS, Université de Paris, Laboratoire Jacques-Louis Lions (LJLL), F-75005 Paris, France
| | - Prisca Combari
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France
| | - Maïté Lewin
- Department of Radiology, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France
| | - Quentin Nicolas
- INRIA, Centre de Recherche de Paris, 2 rue Simone Iff, Paris 75012, France
| | - Chloe Audebert
- INRIA, Centre de Recherche de Paris, 2 rue Simone Iff, Paris 75012, France; Université de la Sorbonne, CNRS, Université de Paris, Laboratoire Jacques-Louis Lions (LJLL), F-75005 Paris, France; Université de la Sorbonne, CNRS, Institut de Biologie Paris-Seine (IBPS), Laboratoire de Biologie Computationnelle et Quantitative UMR 7238, F-75005 Paris, France
| | - Didier Samuel
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193
| | - Marc-Antoine Allard
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193
| | - Antonio Sa Cunha
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193
| | - Denis Castaing
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193
| | - Daniel Cherqui
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193
| | - René Adam
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; INSERM, Unit 985, Villejuif, 94800, France
| | - Eric Vibert
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris, Centre Hépato-Biliaire, Villejuif, 94800, France; Université Paris-Saclay, INSERM, Physiopathogénèse et Traitement des Maladies du Foie, UMR-S 1193
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Sung YS, Park B, Park HJ, Lee SS. Radiomics and deep learning in liver diseases. J Gastroenterol Hepatol 2021; 36:561-568. [PMID: 33709608 DOI: 10.1111/jgh.15414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 12/14/2022]
Abstract
Recently, radiomics and deep learning have gained attention as methods for computerized image analysis. Radiomics and deep learning can perform diagnostic or predictive tasks using high-dimensional image-derived features and have the potential to expand the capabilities of liver imaging beyond the scope of traditional visual image analysis. Recent research has demonstrated the potential of these techniques in various fields of liver imaging, including staging of liver fibrosis, prognostication of malignant liver tumors, automated detection and characterization of liver tumors, automated abdominal organ segmentation, and body composition analysis. However, because most of the previous studies were preliminary and focused mainly on technical feasibility, further clinical validation is required for the application of radiomics and deep learning in clinical practice. In this review, we introduce the technical aspects of radiomics and deep learning and summarize the recent studies on the application of these techniques in liver radiology.
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Affiliation(s)
- Yu Sub Sung
- Department of Convergence Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Bumwoo Park
- Big Data Research Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Republic of Korea
| | - Hyo Jung Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Liu Y, Ning Z, Örmeci N, An W, Yu Q, Han K, Huang Y, Liu D, Liu F, Li Z, Ding H, Luo H, Zuo C, Liu C, Wang J, Zhang C, Ji J, Wang W, Wang Z, Wang W, Yuan M, Li L, Zhao Z, Wang G, Li M, Liu Q, Lei J, Liu C, Tang T, Akçalar S, Çelebioğlu E, Üstüner E, Bilgiç S, Ellik Z, Asiller ÖÖ, Liu Z, Teng G, Chen Y, Hou J, Li X, He X, Dong J, Tian J, Liang P, Ju S, Zhang Y, Qi X. Deep Convolutional Neural Network-Aided Detection of Portal Hypertension in Patients With Cirrhosis. Clin Gastroenterol Hepatol 2020; 18:2998-3007.e5. [PMID: 32205218 DOI: 10.1016/j.cgh.2020.03.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/11/2020] [Accepted: 03/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Noninvasive and accurate methods are needed to identify patients with clinically significant portal hypertension (CSPH). We investigated the ability of deep convolutional neural network (CNN) analysis of computed tomography (CT) or magnetic resonance (MR) to identify patients with CSPH. METHODS We collected liver and spleen images from patients who underwent contrast-enhanced CT or MR analysis within 14 days of transjugular catheterization for hepatic venous pressure gradient measurement. The CT cohort comprised participants with cirrhosis in the CHESS1701 study, performed at 4 university hospitals in China from August 2016 through September 2017. The MR cohort comprised participants with cirrhosis in the CHESS1802 study, performed at 8 university hospitals in China and 1 in Turkey from December 2018 through April 2019. Patients with CSPH were identified as those with a hepatic venous pressure gradient of 10 mm Hg or higher. In total, we analyzed 10,014 liver images and 899 spleen images collected from 679 participants who underwent CT analysis, and 45,554 liver and spleen images from 271 participants who underwent MR analysis. For each cohort, participants were shuffled and then sampled randomly and equiprobably for 6 times into training, validation, and test data sets (ratio, 3:1:1). Therefore, a total of 6 deep CNN models for each cohort were developed for identification of CSPH. RESULTS The CT-based CNN analysis identified patients with CSPH with an area under the receiver operating characteristic curve (AUC) value of 0.998 in the training set (95% CI, 0.996-1.000), an AUC of 0.912 in the validation set (95% CI, 0.854-0.971), and an AUC of 0.933 (95% CI, 0.883-0.984) in the test data sets. The MR-based CNN analysis identified patients with CSPH with an AUC of 1.000 in the training set (95% CI, 0.999-1.000), an AUC of 0.924 in the validation set (95% CI, 0.833-1.000), and an AUC of 0.940 in the test data set (95% CI, 0.880-0.999). When the model development procedures were repeated 6 times, AUC values for all CNN analyses were 0.888 or greater, with no significant differences between rounds (P > .05). CONCLUSIONS We developed a deep CNN to analyze CT or MR images of liver and spleen from patients with cirrhosis that identifies patients with CSPH with an AUC value of 0.9. This provides a noninvasive and rapid method for detection of CSPH (ClincialTrials.gov numbers: NCT03138915 and NCT03766880).
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Affiliation(s)
- Yanna Liu
- Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS) Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China; Department of Hepatology Unit and Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhenyuan Ning
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | | | - Weimin An
- Department of Radiology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | | | - Kangfu Han
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Yifei Huang
- Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS) Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Dengxiang Liu
- Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS) Working Party, Xingtai People's Hospital, Xingtai, China
| | - Fuquan Liu
- Department of Interventional Therapy, Beijing Shijitan Hospital
| | - Zhiwei Li
- Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Huiguo Ding
- Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Hongwu Luo
- Department of General Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Changzeng Zuo
- Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS) Working Party, Xingtai People's Hospital, Xingtai, China
| | - Changchun Liu
- Department of Radiology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jitao Wang
- Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS) Working Party, Xingtai People's Hospital, Xingtai, China
| | - Chunqing Zhang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Jiansong Ji
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, Lishui, China
| | - Wenhui Wang
- Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS) Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Zhiwei Wang
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weidong Wang
- Department of Hepatobiliary Surgery, Shunde Hospital, Southern Medical University, Foshan, China
| | - Min Yuan
- Department of Interventional Radiology, Shanghai Public Health Clinical Center, Shanghai, China
| | - Lei Li
- Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS) Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Zhongwei Zhao
- Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research, Lishui Hospital of Zhejiang University, Lishui, China
| | - Guangchuan Wang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Mingxing Li
- Department of Vascular and Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingbo Liu
- Department of Hepatobiliary Surgery, Shunde Hospital, Southern Medical University, Foshan, China
| | - Junqiang Lei
- Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS) Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Chuan Liu
- Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS) Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | | | - Seray Akçalar
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Emrecan Çelebioğlu
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Evren Üstüner
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Sadık Bilgiç
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | | | | | - Zaiyi Liu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Gaojun Teng
- Department of Interventional Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Jinlin Hou
- Department of Hepatology Unit and Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xun Li
- Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS) Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaoshun He
- Organ Transplant Center, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiahong Dong
- Department of Hepatopancreatobiliary Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jie Tian
- Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, Chinese People's Liberation Army General Hospital, Beijing, China
| | | | - Yu Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.
| | - Xiaolong Qi
- Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS) Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China.
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Ahn Y, Yoon JS, Lee SS, Suk HI, Son JH, Sung YS, Lee Y, Kang BK, Kim HS. Deep Learning Algorithm for Automated Segmentation and Volume Measurement of the Liver and Spleen Using Portal Venous Phase Computed Tomography Images. Korean J Radiol 2020; 21:987-997. [PMID: 32677383 PMCID: PMC7369202 DOI: 10.3348/kjr.2020.0237] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/06/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023] Open
Abstract
Objective Measurement of the liver and spleen volumes has clinical implications. Although computed tomography (CT) volumetry is considered to be the most reliable noninvasive method for liver and spleen volume measurement, it has limited application in clinical practice due to its time-consuming segmentation process. We aimed to develop and validate a deep learning algorithm (DLA) for fully automated liver and spleen segmentation using portal venous phase CT images in various liver conditions. Materials and Methods A DLA for liver and spleen segmentation was trained using a development dataset of portal venous CT images from 813 patients. Performance of the DLA was evaluated in two separate test datasets: dataset-1 which included 150 CT examinations in patients with various liver conditions (i.e., healthy liver, fatty liver, chronic liver disease, cirrhosis, and post-hepatectomy) and dataset-2 which included 50 pairs of CT examinations performed at ours and other institutions. The performance of the DLA was evaluated using the dice similarity score (DSS) for segmentation and Bland-Altman 95% limits of agreement (LOA) for measurement of the volumetric indices, which was compared with that of ground truth manual segmentation. Results In test dataset-1, the DLA achieved a mean DSS of 0.973 and 0.974 for liver and spleen segmentation, respectively, with no significant difference in DSS across different liver conditions (p = 0.60 and 0.26 for the liver and spleen, respectively). For the measurement of volumetric indices, the Bland-Altman 95% LOA was −0.17 ± 3.07% for liver volume and −0.56 ± 3.78% for spleen volume. In test dataset-2, DLA performance using CT images obtained at outside institutions and our institution was comparable for liver (DSS, 0.982 vs. 0.983; p = 0.28) and spleen (DSS, 0.969 vs. 0.968; p = 0.41) segmentation. Conclusion The DLA enabled highly accurate segmentation and volume measurement of the liver and spleen using portal venous phase CT images of patients with various liver conditions.
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Affiliation(s)
- Yura Ahn
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jee Seok Yoon
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Heung Il Suk
- Department of Brain and Cognitive Engineering, Korea University, Seoul, Korea.,Department of Artificial Intelligence, Korea University, Seoul, Korea.
| | - Jung Hee Son
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yu Sub Sung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yedaun Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Bo Kyeong Kang
- Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Seoul, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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30
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Kennedy P, Bane O, Hectors SJ, Fischman A, Schiano T, Lewis S, Taouli B. Noninvasive imaging assessment of portal hypertension. Abdom Radiol (NY) 2020; 45:3473-3495. [PMID: 32926209 PMCID: PMC10124623 DOI: 10.1007/s00261-020-02729-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/16/2020] [Accepted: 08/30/2020] [Indexed: 02/07/2023]
Abstract
Portal hypertension (PH) is a spectrum of complications of chronic liver disease (CLD) and cirrhosis, with manifestations including ascites, gastroesophageal varices, splenomegaly, hypersplenism, hepatic hydrothorax, hepatorenal syndrome, hepatopulmonary syndrome and portopulmonary hypertension. PH can vary in severity and is diagnosed via invasive hepatic venous pressure gradient measurement (HVPG), which is considered the reference standard. Accurate diagnosis of PH and assessment of severity are highly relevant as patients with clinically significant portal hypertension (CSPH) are at higher risk for developing acute variceal bleeding and mortality. In this review, we discuss current and upcoming noninvasive imaging methods for diagnosis and assessment of severity of PH.
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31
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Garbuzenko DV, Arefyev NO. Primary prevention of bleeding from esophageal varices in patients with liver cirrhosis: An update and review of the literature. J Evid Based Med 2020; 13:313-324. [PMID: 33037792 DOI: 10.1111/jebm.12407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/19/2020] [Indexed: 12/12/2022]
Abstract
All patients with liver cirrhosis and portal hypertension should be stratified by risk groups to individualize different therapeutic strategies to increase the effectiveness of treatment. In this regard, the development of primary prophylaxis of variceal bleeding and its management according to the severity of portal hypertension may be promising. This paper is to describe the modern principles of primary prophylaxis of esophageal variceal bleeding in patients with liver cirrhosis. The PubMed and EMbase databases, Web of Science, Google Scholar, and the Cochrane Database of Systematic Reviews were used to search for relevant publications from 1999 to 2019. The results suggested that depending on the severity of portal hypertension, patients with cirrhosis should be divided into those who need preprimary prophylaxis, which aims to prevent the formation of esophageal varices, and those who require measures that aim to prevent esophageal variceal bleeding. In subclinical portal hypertension, therapy should be etiological and pathogenetic. Cirrhosis with clinically significant portal hypertension should receive nonselective β-blockers if they have small esophageal varices and risk factors for variceal bleeding. Nonselective β-blockers are the first-line drugs for the primary prevention of bleeding from medium to large-sized esophageal varices. Endoscopic band ligation is indicated for the patients who are intolerant to nonselective β-blockers or in the case of contraindications to pharmacological therapy. In summary, the stratification of cirrhotic patients by the severity of portal hypertension and an individual approach to the choice of treatment may increase the effectiveness of therapy as well as improve survival rate of these patients.
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Affiliation(s)
| | - Nikolay Olegovich Arefyev
- Department of Pathological Anatomy and Forensic Medicine, South Ural State Medical University, Chelyabinsk, Russia
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32
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Lee CM, Lee SS, Choi WM, Kim KM, Sung YS, Lee S, Lee SJ, Yoon JS, Suk HI. An index based on deep learning-measured spleen volume on CT for the assessment of high-risk varix in B-viral compensated cirrhosis. Eur Radiol 2020; 31:3355-3365. [PMID: 33128186 DOI: 10.1007/s00330-020-07430-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/05/2020] [Accepted: 10/14/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Deep learning enables an automated liver and spleen volume measurements on CT. The purpose of this study was to develop an index combining liver and spleen volumes and clinical factors for detecting high-risk varices in B-viral compensated cirrhosis. METHODS This retrospective study included 419 patients with B-viral compensated cirrhosis who underwent endoscopy and CT from 2007 to 2008 (derivation cohort, n = 239) and from 2009 to 2010 (validation cohort, n = 180). The liver and spleen volumes were measured on CT images using a deep learning algorithm. Multivariable logistic regression analysis of the derivation cohort developed an index to detect endoscopically confirmed high-risk varix. The cumulative 5-year risk of varix bleeding was evaluated with patients stratified by their index values. RESULTS The index of spleen volume-to-platelet ratio was devised from the derivation cohort. In the validation cohort, the cutoff index value for balanced sensitivity and specificity (> 3.78) resulted in the sensitivity of 69.4% and the specificity of 78.5% for detecting high-risk varix, and the cutoff index value for high sensitivity (> 1.63) detected all high-risk varices. The index stratified all patients into the low (index value ≤ 1.63; n = 118), intermediate (n = 162), and high (index value > 3.78; n = 139) risk groups with cumulative 5-year incidences of varix bleeding of 0%, 1.0%, and 12.0%, respectively (p < .001). CONCLUSION The spleen volume-to-platelet ratio obtained using deep learning-based CT analysis is useful to detect high-risk varices and to assess the risk of varix bleeding. KEY POINTS • The criterion of spleen volume to platelet > 1.63 detected all high-risk varices in the validation cohort, while the absence of visible varix did not exclude all high-risk varices. • Visual varix grade ≥ 2 detected high-risk varix with a high specificity (96.5-100%). • Combining spleen volume-to-platelet ratio ≤ 1.63 and visual varix grade of 0 identified low-risk patients who had no high-risk varix and varix bleeding on 5-year follow-up.
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Affiliation(s)
- Chul-Min Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea.,Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea.
| | - Won-Mook Choi
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Kang Mo Kim
- Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Yu Sub Sung
- Clinical Research Center, Asan Medical Center, Seoul, South Korea
| | - Sunho Lee
- SmartCareworks Inc., 1201, 6, Changgyeonggung-ro, Jung-gu, Seoul, 04559, South Korea
| | - So Jung Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-Gu, Seoul, 05505, South Korea
| | - Jee Seok Yoon
- Department of Brain and Cognitive Engineering, Korea University, 145 Anam-ro, Anam-dong, Seongbuk-gu, Seoul, 02841, South Korea
| | - Heung-Il Suk
- Department of Brain and Cognitive Engineering, Korea University, 145 Anam-ro, Anam-dong, Seongbuk-gu, Seoul, 02841, South Korea.,Department of Artificial Intelligence, Korea University, 145 Anam-ro, Anam-dong, Seongbuk-gu, Seoul, South Korea
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33
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Bae JS, Lee DH, Yoo J, Yi NJ, Lee KW, Suh KS, Kim H, Lee KB. Association between spleen volume and the post-hepatectomy liver failure and overall survival of patients with hepatocellular carcinoma after resection. Eur Radiol 2020; 31:2461-2471. [PMID: 33026503 DOI: 10.1007/s00330-020-07313-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/05/2020] [Accepted: 09/17/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Post-hepatectomy liver failure (PHLF) can occur as a major complication after hepatic resection (HR) in patients with hepatocellular carcinoma (HCC) and negatively affects the prognosis. We aimed to retrospectively assess whether the spleen volume (SV) measured from preoperative CT images would be associated with the development of PHLF and overall survival (OS) after HR in patients with HCC. METHODS We enrolled 317 consecutive patients with very early/early stage HCC who underwent a preoperative CT and HR between January 2010 and December 2016. The SV was obtained from preoperative CT images using semi-automated volumetric software and was divided by body surface area to yield SVBSA. Receiver operating characteristic (ROC) curves and logistic regression analyses were performed to identify factors affecting the development of PHLF. The Cox proportional hazard model was used to identify prognostic factors for OS. RESULTS PHLF was observed in 72 patients (22.7% [72/317]). SVBSA was associated with the development of PHLF (odds ratio, 2.321; 95% CI, 1.347-4.001; p = 0.002) with the area under the ROC curve of 0.663 using the cutoff value of 107.5 cm3 (p < 0.001). SVBSA was also an influencing factor for OS (hazard ratio, 3.935; 95% CI 1.520-10.184; p = 0.005), with the optimal cutoff of 146 cm3. The 5-year OS rate was higher in 245 patients with a SVBSA ≤ 146 cm3 than in 72 patients with a SVBSA > 146 cm3 (95.0% vs. 78.7%, p < 0.001). CONCLUSIONS In patients with HCC, a larger SVBSA was associated with a higher rate of PHLF and worse OS after HR. The SVBSA may be useful in selecting good surgical candidates. KEY POINTS • A significantly higher spleen volume divided by body surface area was observed in patients who experienced post-hepatectomy liver failure than in patients who did not (148 cm3 vs. 112 cm3, p < 0.001). • The area under the receiver operating characteristic curve of spleen volume divided by body surface area to predict the development of post-hepatectomy liver failure was 0.663 (p < 0.001). • Spleen volume divided by body surface area was a significant influencing factor for overall survival (hazard ratio, 3.935; 95% CI, 1.520-10.184; p < 0.001), with the optimal cutoff of 146 cm3.
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Affiliation(s)
- Jae Seok Bae
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Jeongin Yoo
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Nam-Joon Yi
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Kwang-Woong Lee
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Kyung-Suk Suh
- Department of Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Kyung Bun Lee
- Department of Pathology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
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Lin JY, Zhang CH, Zheng L, Song CL, Deng WS, Zhu YM, Zheng L, Wu LZ, Sun LC, Luo M. Assessment of a biofluid mechanics-based model for calculating portal pressure in canines. BMC Vet Res 2020; 16:308. [PMID: 32843036 PMCID: PMC7507948 DOI: 10.1186/s12917-020-02478-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Portal hypertension is a severe complication caused by various chronic liver diseases. The standard methods for detecting portal hypertension (hepatic venous pressure gradient and free portal pressure) are available in only a few hospitals due to their technical difficulty and invasiveness; thus, non-invasive measuring methods are needed. This study aimed to establish and assess a novel model to calculate free portal pressure based on biofluid mechanics. RESULT Comparison of each dog's virtual and actual free portal pressure showed that a biofluid mechanics-based model could accurately predict free portal pressure (mean difference: -0.220, 95% CI: - 0.738 to 0.298; upper limit of agreement: 2.24, 95% CI: 1.34 to 3.14; lower limit of agreement: -2.68, 95% CI: - 3.58 to - 1.78; intraclass correlation coefficient: 0.98, 95% CI: 0.96 to 0.99; concordance correlation coefficient: 0.97, 95% CI: 0.93 to 0.99) and had a high AUC (0.984, 95% CI: 0.834 to 1.000), sensitivity (92.3, 95% CI: 64.0 to 99.8), specificity (91.7, 95% CI: 61.5 to 99.8), positive likelihood ratio (11.1, 95% CI: 1.7 to 72.8), and low negative likelihood ratio (0.08, 95% CI: 0.01 to 0.6) for detecting portal hypertension. CONCLUSIONS Our study suggests that the biofluid mechanics-based model was able to accurately predict free portal pressure and detect portal hypertension in canines. With further research and validation, this model might be applicable for calculating human portal pressure, detecting portal hypertensive patients, and evaluating disease progression and treatment efficacy.
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Affiliation(s)
- Jia-Yun Lin
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Chi-Hao Zhang
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Lei Zheng
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Chen-Lu Song
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Wen-Sheng Deng
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Yi-Ming Zhu
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Li Zheng
- Department of Ultrasound, Shanghai Baoshan Integrated Traditional Chinese and Western Medicine Hospital, No. 181 Youyi Road, Shanghai, 201900, China
| | - Li-Zhong Wu
- Department of Radiation, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639 Zhizaoju Road, Shanghai, 200011, China
| | - Long-Ci Sun
- Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No.160 Pujian Road, Shanghai, 200127, China.
| | - Meng Luo
- Department of General Surgery, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, No. 639 Zhizaoju Road, Shanghai, 200011, China.
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Zhang Y, Wang Z, Yue ZD, Zhao HW, Wang L, Fan ZH, Wu YF, He FL, Liu FQ. Accurate ultrasonography-based portal pressure assessment in patients with hepatocellular carcinoma. World J Gastrointest Oncol 2020; 12:931-941. [PMID: 32879669 PMCID: PMC7443839 DOI: 10.4251/wjgo.v12.i8.931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/08/2020] [Accepted: 07/01/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Portal pressure is of great significance in the treatment of hepatocellular carcinoma (HCC), but direct measurement is complicated and costly; thus, non-invasive measurement methods are urgently needed.
AIM To investigate whether ultrasonography (US)-based portal pressure assessment could replace invasive transjugular measurement.
METHODS A cohort of 102 patients with HCC was selected (mean age: 54 ± 13 years, male/female: 65/37). Pre-operative US parameters were assessed by two independent investigators, and multivariate logistic analysis and linear regression analysis were conducted to develop a predictive formula for the portal pressure gradient (PPG). The estimated PPG predictors were compared with the transjugular PPG measurements. Validation was conducted on another cohort of 20 non-surgical patients.
RESULTS The mean PPG was 17.32 ± 1.97 mmHg. Univariate analysis identified the association of the following four parameters with PPG: Spleen volume, portal vein diameter, portal vein velocity (PVV), and portal blood flow (PBF). Multiple linear regression analysis was performed, and the predictive formula using the PVV and PBF was as follows: PPG score = 19.336 - 0.312 × PVV (cm/s) + 0.001 × PBF (mL/min). The PPG score was confirmed to have good accuracy with an area under the curve (AUC) of 0.75 (0.68-0.81) in training patients. The formula was also accurate in the validation patients with an AUC of 0.820 (0.53-0.83).
CONCLUSION The formula based on ultrasonographic Doppler flow parameters shows a significant correlation with invasive PPG and, if further confirmed by prospective validation, may replace the invasive transjugular assessment.
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Affiliation(s)
- Yu Zhang
- Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
| | - Zhong Wang
- Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
| | - Zhen-Dong Yue
- Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
| | - Hong-Wei Zhao
- Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
| | - Lei Wang
- Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
| | - Zhen-Hua Fan
- Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
| | - Yi-Fan Wu
- Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
| | - Fu-Liang He
- Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
| | - Fu-Quan Liu
- Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital and Capital Medical University, Beijing 100038, China
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Hobeika C, Cauchy F, Sartoris R, Beaufrère A, Yoh T, Vilgrain V, Rautou PE, Paradis V, Bouattour M, Ronot M, Soubrane O. Relevance of liver surface nodularity for preoperative risk assessment in patients with resectable hepatocellular carcinoma. Br J Surg 2020; 107:878-888. [PMID: 32118298 DOI: 10.1002/bjs.11511] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/08/2019] [Accepted: 12/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Quantification of liver surface nodularity (LSN) on routine preoperative CT images allows detection of cirrhosis and clinically significant portal hypertension. This study aimed to assess the relevance of LSN in preoperative assessment of operative risks for patients with resectable hepatocellular carcinoma (HCC). METHODS All patients undergoing hepatectomy for HCC between 2012 and 2017 were analysed retrospectively. LSN was assessed at the liver-fat interface on the left liver lobe on preoperative CT images. The feasibility of LSN quantification was assessed. The association between LSN and outcomes (severe complications and posthepatectomy liver failure (PHLF)) was evaluated by multivariable analysis and after propensity score matching. RESULTS Among 210 patients, LSN measurement was successful in 187 (89·0 per cent). Among these, the median LSN score was 2·42 (i.q.r. 2·21-2·66) and 52·9 per cent had severe fibrosis, including 33·7 per cent with cirrhosis. LSN score increased with hepatic venous pressure gradient (P = 0·048), severity of steatosis (P = 0·011) and fibrosis grade (P = 0·001). LSN score was independently associated with severe complications (odds ratio (OR) 5·25; P = 0·006) and PHLF (OR 6·78; P = 0·003). After matching with respect to model for end-stage liver disease, aspartate aminotransferase-to-platelet ratio index and fibrosis-4 score, patients with a LSN score of 2·63 or higher retained an increased risk of PHLF (OR 5·81; P = 0·018). In the subgroup of patients without severe fibrosis, LSN was accurate in predicting severe complications (P = 0·005). Patients with (P = 0·039) or without (P = 0·018) severe fibrosis with increased LSN score had a higher comprehensive complication index score. Among patients with cirrhosis who had clinically significant portal hypertension, a LSN value below 2·63 ruled out the risk of PHLF. CONCLUSION LSN measurement represents a practical tool that may allow improvement in the preoperative evaluation and management of patients with HCC.
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Affiliation(s)
- C Hobeika
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - F Cauchy
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - R Sartoris
- Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - A Beaufrère
- Department of Pathology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - T Yoh
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - V Vilgrain
- Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - P E Rautou
- Department of Hepatology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - V Paradis
- Department of Pathology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - M Bouattour
- Department of Hepatology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - M Ronot
- Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - O Soubrane
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
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Park HJ, Park B, Lee SS. Radiomics and Deep Learning: Hepatic Applications. Korean J Radiol 2020; 21:387-401. [PMID: 32193887 PMCID: PMC7082656 DOI: 10.3348/kjr.2019.0752] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/05/2020] [Indexed: 12/12/2022] Open
Abstract
Radiomics and deep learning have recently gained attention in the imaging assessment of various liver diseases. Recent research has demonstrated the potential utility of radiomics and deep learning in staging liver fibroses, detecting portal hypertension, characterizing focal hepatic lesions, prognosticating malignant hepatic tumors, and segmenting the liver and liver tumors. In this review, we outline the basic technical aspects of radiomics and deep learning and summarize recent investigations of the application of these techniques in liver disease.
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Affiliation(s)
- Hyo Jung Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Bumwoo Park
- Health Innovation Big Data Center, Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Fernández-Placencia R, Golse N, Cano L, Allard MA, Pittau G, Ciacio O, Cunha AS, Castaing D, Salloum C, Azoulay D, Cherqui D, Samuel D, Adam R, Vibert E. Spleen volumetry and liver transient elastography: Predictors of persistent posthepatectomy decompensation in patients with hepatocellular carcinoma. Surgery 2020; 168:17-24. [PMID: 32204923 DOI: 10.1016/j.surg.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/27/2020] [Accepted: 02/05/2020] [Indexed: 01/27/2023]
Abstract
BACKGROUND Posthepatectomy decompensation remains a frequent and poor outcome after hepatectomy, but its prediction is still inaccurate. Liver stiffness measurement can predict posthepatectomy decompensation, but there is a so-called "gray zone" that requires another predictor. Because splenomegaly is an objective sign of portal hypertension, we hypothesized that spleen volumetry could improve the identification of patients at risk. METHODS Patients with hepatocellular carcinoma who underwent hepatectomy in our tertiary center between August 2014 and December 2017 were reviewed. The primary endpoint was to determine if the spleen volumetry and liver stiffness measurement were independent predictors of posthepatectomy decompensation, and secondarily, to determine if they were synergistic through a theoretic predictive model. RESULTS One hundred and seven patients were included. The median follow-up time was 3 months (3-5). Postoperative 90-day mortality was 4.7%. By multivariate analysis, liver stiffness measurement and spleen volumetry predicted posthepatectomy decompensation. The liver stiffness measurement had a cutoff point of 11.6 kPa (area under receiver operating curve = 0.71 confidence interval 95% 0.71-0.88, sensitivity: 89%, specificity: 47%). The spleen volumetry cutoff point was 381.1 cm3 (area under receiver operating curve = 0.78, 95% confidence interval 0.77-0.93, sensitivity: 55%, specificity: 91%). The spleen volumetry improved prediction of posthepatectomy decompensation, because use of the spleen volumetry increased sensitivity (from 62% to 97%) and the negative predictive value (from 96% to 100%) along with a negligible decrease in specificity (from 96.7 to 93.4) and positive predictive value (from 64% to 59%) (P = .003). CONCLUSION Spleen volumetry (>380 cm3) and liver stiffness measurement (>12 kPa) are non-invasive, independent, and synergistic tools that appear to be able to predict posthepatectomy decompensation. The importance of this finding is that these measurements may help to anticipate posthepatectomy decompensation and may possibly be used to direct alternative treatments to resection.
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Affiliation(s)
- Ramiro Fernández-Placencia
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Department of Abdominal Surgery, Hepato-Pancreato-Biliary Section, Instituto Nacional de Enfermedades Neoplásicas (INEN) Lima, Peru
| | - Nicolas Golse
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 1193, Villejuif, France; Univ Paris-Sud, UMR-S 1193, Villejuif, France
| | - Luis Cano
- INSERM, Unit 991, Univ Rennes, Centre Hospitalier Universitaire Rennes, INRA, Univ Bretagne Loire, Nutrition Metabolism and Cancer, Rennes, France
| | - Marc-Antoine Allard
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 1193, Villejuif, France
| | - Gabriella Pittau
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France
| | - Oriana Ciacio
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France
| | - Antonio Sa Cunha
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 1193, Villejuif, France
| | - Denis Castaing
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 1193, Villejuif, France
| | - Chady Salloum
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France
| | - Daniel Azoulay
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Department of Hepatobiliary and Pancreatic Surgery and Transplantation, Sheba Medical Center, Faculty of Medicine Tel Aviv University, Israel
| | - Daniel Cherqui
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 1193, Villejuif, France
| | - Didier Samuel
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 1193, Villejuif, France; Univ Paris-Sud, UMR-S 1193, Villejuif, France
| | - René Adam
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 985, Villejuif, France; Univ Paris-Sud, UMR-S 985, Villejuif, France
| | - Eric Vibert
- Department of Surgery, Paul-Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), Centre Hépato-Biliaire, Villejuif, France; Département Hospitalo-Universitaire Hepatinov, Villejuif, France; INSERM, Unit 1193, Villejuif, France; Univ Paris-Sud, UMR-S 1193, Villejuif, France.
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Tseng Y, Ma L, Li S, Luo T, Luo J, Zhang W, Wang J, Chen S. Application of CT-based radiomics in predicting portal pressure and patient outcome in portal hypertension. Eur J Radiol 2020; 126:108927. [PMID: 32146345 DOI: 10.1016/j.ejrad.2020.108927] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE Portal venous pressure (PVP) measurement is of clinical significance, especially in patients with portal hypertension. However, the invasive nature and associated complications limits its application. The aim of the study is to propose a noninvasive predictive model of PVP values based on CT-extracted radiomic features. METHODS Radiomics PVP (rPVP) models based on liver, spleen and combined features were established on an experimental cohort of 169 subjects. Radiomics features were extracted from each ROI and reduced via the LASSO regression to achieve an optimal predictive formula. A validation cohort of 62 patients treated for gastroesophageal varices (GOV) was used to confirm the utility of rPVP in predicting variceal recurrence. The association between rPVP and response to treatment was observed. RESULTS Three separate predictive formula for PVP were derived from radiomics features. rPVP was significantly correlated to patient response to endoscopic treatment for GOV. Among which, the model containing both liver and spleen features has the highest predictability of variceal recurrence, with an optimal cut-off value at 29.102 mmHg (AUC 0.866). A Kaplan Meier analysis further confirmed the difference between patients with varying rPVP values. CONCLUSION PVP values can be accurately predicted by a non-invasive, CT derived radiomics model. rPVP serves as a non-invasive and precise reference for predicting treatment outcome for GOV secondary to portal hypertension.
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Affiliation(s)
- Yujen Tseng
- Department of Gastroenterology,Zhongshan Hosptial, Fudan University, China; Department of Digestive Diseases, Huashan Hospital, Fudan University, China
| | - Lili Ma
- Department of Endoscopy Center, Zhongshan Hospital, Fudan University, China
| | - Shaobo Li
- Shanghai Medical College, Fudan University, China
| | - Tiancheng Luo
- Department of Gastroenterology,Zhongshan Hosptial, Fudan University, China
| | - Jianjun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, China
| | - Jian Wang
- Department of Gastroenterology,Zhongshan Hosptial, Fudan University, China
| | - Shiyao Chen
- Department of Gastroenterology,Zhongshan Hosptial, Fudan University, China; Department of Endoscopy Center, Zhongshan Hospital, Fudan University, China; Evidence-Based Medicine Center, Fudan University, China.
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Son JH, Lee SS, Lee Y, Kang BK, Sung YS, Jo S, Yu E. Assessment of liver fibrosis severity using computed tomography-based liver and spleen volumetric indices in patients with chronic liver disease. Eur Radiol 2020; 30:3486-3496. [PMID: 32055946 DOI: 10.1007/s00330-020-06665-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/18/2019] [Accepted: 01/20/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate whether the liver and spleen volumetric indices, measured on portal venous phase CT images, could be used to assess liver fibrosis severity in chronic liver disease. METHODS From 2007 to 2017, 558 patients (mean age 48.7 ± 13.1 years; 284 men and 274 women) with chronic liver disease (n = 513) or healthy liver (n = 45) were retrospectively enrolled. The liver volume (sVolL) and spleen volume (sVolS), normalized to body surface area and liver-to-spleen volume ratio (VolL/VolS), were measured on CT images using a deep learning algorithm. The correlation between the volumetric indices and the pathologic liver fibrosis stages combined with the presence of decompensation (F0, F1, F2, F3, F4C [compensated cirrhosis], and F4D [decompensated cirrhosis]) were assessed using Spearman's correlation coefficient. The performance of the volumetric indices in the diagnosis of advanced fibrosis, cirrhosis, and decompensated cirrhosis were evaluated using the area under the receiver operating characteristic curve (AUC). RESULTS The sVolS (ρ = 0.47-0.73; p < .001) and VolL/VolS (ρ = -0.77-- 0.48; p < .001) showed significant correlation with liver fibrosis stage in all etiological subgroups (i.e., viral hepatitis, alcoholic and non-alcoholic fatty liver, and autoimmune diseases), while the significant correlation of sVolL was noted only in the viral hepatitis subgroup (ρ = - 0.55; p < .001). To diagnose advanced fibrosis, cirrhosis, and decompensated cirrhosis, the VolL/VolS (AUC 0.82-0.88) and sVolS (AUC 0.82-0.87) significantly outperformed the sVolL (AUC 0.63-0.72; p < .001). CONCLUSION The VolL/VolS and sVolS may be used for assessing liver fibrosis severity in chronic liver disease. KEY POINTS • Volumetric indices of liver and spleen measured on computed tomography images may allow liver fibrosis severity to be assessed in patients with chronic liver disease.
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Affiliation(s)
- Jung Hee Son
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Seung Soo Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| | - Yedaun Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Haeundae-ro 875, Haeundae-gu, Busan, 48108, South Korea
| | - Bo-Kyeong Kang
- Department of Radiology, Hanyang University Medical Center, Hanyang University School of Medicine, Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Yu Sub Sung
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - SoRa Jo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Eunsil Yu
- Department of Diagnostic Pathology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
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Kim R, Jeong WK, Kang TW, Song KD, Lee MW, Ahn SH, Rhim H. Intrahepatic distant recurrence after radiofrequency ablation of hepatocellular carcinoma: relationship with portal hypertension. Acta Radiol 2019; 60:1609-1618. [PMID: 31042068 DOI: 10.1177/0284185119842830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Ran Kim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Hyun Ahn
- Department of Mathematics, Ajou University, Suwon, Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Sciences, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Rana R, Wang S, Li J, Basnet S, Zheng L, Yang C. Diagnostic accuracy of non-invasive methods detecting clinically significant portal hypertension in liver cirrhosis: a systematic review and meta-analysis. Minerva Med 2019; 111:266-280. [PMID: 31638361 DOI: 10.23736/s0026-4806.19.06143-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION We attempted to investigate non-invasive techniques and their diagnostic performances for evaluating clinically significant portal hypertension. EVIDENCE ACQUISITION The systematic search was performed on PubMed, Embase, Scopus, and Web of Science TM core index databases before 13 December 2018 restricted to English language and human studies. EVIDENCE SYNTHESIS Thirty-two studies were included, with total populations of 3,987. The overall pooled analysis was performed by bivariate random effect model, which revealed significantly higher sensitivity and specificity of 77.1% (95% confidence interval, 76.8-78.5%) and 80.1% (95% confidence interval, 78.2-81.9%), respectively; positive likelihood ratio (3.67), negative likelihood ratio (0.26); and diagnostic odd ratio (16.24). Additionally, the area under curve exhibited significant diagnostic accuracy of 0.871. However, notable heterogeneity existed in between studies (I2=87.1%), therefore, further subgroup analysis was performed. It demonstrated ultrasonography, elastography, biomarker, and computed tomography scan had a significant overall summary sensitivity (specificity) of 89.6% (78.9%), 81.7% (83.2%), 72.2% (76.8%), and 77.2% (81.2%), respectively. Moreover, the areas under curve values were significantly higher in elastography (0.906), followed by computed tomography scan (0.847), biomarker (0.825), and ultrasonography (0.803). CONCLUSIONS In future, non-invasive techniques could be the future choice of investigations for screening and diagnosis of clinically significant portal hypertension in cirrhosis. However, standardization of diagnostic indices and their cut-off values in each non-invasive method needs to be addressed.
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Affiliation(s)
- Ramesh Rana
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Internal Medicine, Gautam Buddha Community Heart Hospital, Butwal, Nepal
| | - Shenglan Wang
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jing Li
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shiva Basnet
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liang Zheng
- Research Center for Translational Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Changqing Yang
- Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China -
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Qi X, An W, Liu F, Qi R, Wang L, Liu Y, Liu C, Xiang Y, Hui J, Liu Z, Qi X, Liu C, Peng B, Ding H, Yang Y, He X, Hou J, Tian J, Li Z. Virtual Hepatic Venous Pressure Gradient with CT Angiography (CHESS 1601): A Prospective Multicenter Study for the Noninvasive Diagnosis of Portal Hypertension. Radiology 2019; 290:370-377. [PMID: 30457484 DOI: 10.1148/radiol.2018180425] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose To develop and validate a computational model for estimating hepatic venous pressure gradient (HVPG) based on CT angiographic images, termed virtual HVPG, to enable the noninvasive diagnosis of portal hypertension in patients with cirrhosis. Materials and Methods In this prospective multicenter diagnostic trial (ClinicalTrials.gov identifier: NCT02842697), 102 consecutive eligible participants (mean age, 47 years [range, 21-75 years]; 68 men with a mean age of 44 years [range, 21-73 years] and 34 women with a mean age of 52 years [range, 24-75 years]) were recruited from three high-volume liver centers between August 2016 and April 2017. All participants with cirrhosis of various causes underwent transjugular HVPG measurement, Doppler US, and CT angiography. Virtual HVPG was developed with a three-dimensional reconstructed model and computational fluid dynamics. Results In the training cohort (n = 29), the area under the receiver operating characteristic curve (AUC) of virtual HVPG in the prediction of clinically significant portal hypertension (CSPH) was 0.83 (95% confidence interval [CI]: 0.58, 1.00). The diagnostic performance was prospectively confirmed in the validation cohort (n = 73), with an AUC of 0.89 (95% CI: 0.81, 0.96). Inter- and intraobserver agreement was 0.88 and 0.96, respectively, suggesting the good reproducibility of virtual HVPG measurements. There was good correlation between virtual HVPG and invasive HVPG (R = 0.61, P < .001), with a satisfactory performance to rule out (7.3 mm Hg) and rule in (13.0 mm Hg) CSPH. Conclusion The accuracy of a computational model of virtual hepatic venous pressure gradient (HVPG) shows significant correlation with invasive HVPG. The virtual HVPG also showed a good performance in the noninvasive diagnosis of clinically significant portal hypertension in cirrhosis. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Malayeri in this issue.
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Affiliation(s)
- Xiaolong Qi
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Weimin An
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Fuquan Liu
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Ruizhao Qi
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Lei Wang
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Yanna Liu
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Chuan Liu
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Yi Xiang
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Jialiang Hui
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Zhao Liu
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Xingshun Qi
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Changchun Liu
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Baogang Peng
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Huiguo Ding
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Yongping Yang
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Xiaoshun He
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Jinlin Hou
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Jie Tian
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
| | - Zhiwei Li
- From the Chinese Portal Hypertension Diagnosis and Monitoring Study Group (CHESS), CHESS Frontier Center, Lanzhou University, Lanzhou, China (Xiaolong Qi); Hepatic Hemodynamic Laboratory, Institute of Hepatology, Nanfang Hospital, Southern Medical University, Guangzhou, China (Xiaolong Qi, Y.L., Chuan Liu, Y.X., J. Hui, Z. Liu, J. Hou); Department of Radiology (W.A., Changchun Liu), Department of General Surgery (R.Q., Z. Li), and Center for Therapeutic Research of Hepatocarcinoma (Y.Y.), 302 Hospital of PLA, Beijing, China; Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China (F.L., L.W.); Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China (Xingshun Qi); Department of Hepatobiliary Surgery (B.P.) and Organ Transplant Center (X.H.), The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China (H.D.); Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China (J.T.); and Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China (Z. Li)
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Chen JJ, Li LJ. Comments on: Perioperative von Willebrand factor dynamics are associated with liver regeneration and predict outcome after liver resection. Hepatobiliary Pancreat Dis Int 2018; 17:485-486. [PMID: 30314769 DOI: 10.1016/j.hbpd.2018.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/17/2018] [Indexed: 02/05/2023]
Affiliation(s)
- Jia-Jia Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
| | - Lan-Juan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China.
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Spleno-hepatic index to predict portal hypertension by equilibrium radionuclide ventriculography. Nucl Med Commun 2018; 39:1138-1142. [PMID: 30371604 DOI: 10.1097/mnm.0000000000000927] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Structural and morphological changes accompanying liver cirrhosis lead to portal hypertension (PHT), which is the first step of most of the complications in patients with liver cirrhosis. Therefore, the development of noninvasive techniques to detect PHT is crucial for prognosis and treatment. AIM The aim of our study was to assess the diagnostic performance of a new spleno-hepatic index (SHI) measured from equilibrium radionuclide ventriculography (ERV) images in detecting patients with cirrhotic PHT. METHODS AND RESULTS A total of 38 patients with PHT were compared with 30 controls without liver disease. The SHI was measured on the sum of the tomographic images from the ERV and calculated according to the following formula: SHI=(mean splenic count×longest hepatic length)/mean hepatic count. Mean SHI was 54±14 and 36±8 (P<0.001) among patients with PHT and controls, respectively. A cutoff value of 40 for the SHI allowed a sensitivity of 90% and specificity of 77% to detect PHT. SHI greater than 51 was 100% specific. In a subset of 25 patients, SHI was not correlated with hepatic venous pressure gradient measured invasively in the right hepatic vein (R=-0.08, P=0.70). CONCLUSION Quantification of SHI derived from ERV could be used to detect liver cirrhosis with PHT although it is not linearly correlated with the hepatic venous pressure gradient. SHI should be considered as a useful index for the identification of PHT in patients referred for the detection/exploration of cirrhotic cardiomyopathy by ERV.
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Liu F, Ning Z, Liu Y, Liu D, Tian J, Luo H, An W, Huang Y, Zou J, Liu C, Liu C, Wang L, Liu Z, Qi R, Zuo C, Zhang Q, Wang J, Zhao D, Duan Y, Peng B, Qi X, Zhang Y, Yang Y, Hou J, Dong J, Li Z, Ding H, Zhang Y, Qi X. Development and validation of a radiomics signature for clinically significant portal hypertension in cirrhosis (CHESS1701): a prospective multicenter study. EBioMedicine 2018; 36:151-158. [PMID: 30268833 PMCID: PMC6197722 DOI: 10.1016/j.ebiom.2018.09.023] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/31/2018] [Accepted: 09/13/2018] [Indexed: 02/07/2023] Open
Abstract
Clinically significant portal hypertension (CSPH) is associated with an incremental risk of esophageal varices and overt clinical decompensations. However, hepatic venous pressure gradient (HVPG) measurement, the gold standard for defining CSPH (HVPG≥10 mm Hg) is invasive and therefore not suitable for routine clinical practice. This study aims to develop and validate a radiomics-based model as a noninvasive method for accurate detection of CSPH in cirrhosis. The prospective multicenter diagnostic trial (CHESS1701, ClinicalTrials.gov identifier: NCT03138915) involved 385 patients with cirrhosis from five liver centers in China between August 2016 and September 2017. Patients who had both HVPG measurement and contrast-enhanced CT within 14 days prior to the catheterization were collected. The noninvasive radiomics model, termed rHVPG for CSPH was developed based on CT images in a training cohort consisted of 222 consecutive patients and the diagnostic performance was prospectively assessed in 163 consecutive patients in four external validation cohorts. rHVPG showed a good performance in detection of CSPH with a C-index of 0·849 (95%CI: 0·786-0·911). Application of rHVPG in four external prospective validation cohorts still gave excellent performance with the C-index of 0·889 (95%CI: 0·752-1·000, 0·800 (95%CI: 0·614-0·986), 0·917 (95%CI: 0·772-1·000), and 0·827 (95%CI: 0·618-1·000), respectively. Intraclass correlation coefficients for inter- and intra-observer agreement were 0·92-0·99 and 0·97-0·99, respectively. A radiomics signature was developed and prospectively validated as an accurate method for noninvasive detection of CSPH in cirrhosis. The tool of rHVPG assessment can facilitate the identification of CSPH rapidly when invasive transjugular procedure is not available.
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Affiliation(s)
- Fuquan Liu
- CHESS Group, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhenyuan Ning
- CHESS Group, Hepatic Hemodynamic Lab, Institute of Hepatology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China; School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Yanna Liu
- CHESS Group, Hepatic Hemodynamic Lab, Institute of Hepatology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dengxiang Liu
- Xingtai People's Hospital, Xingtai Institute of Cancer Control, Xingtai, China
| | - Jie Tian
- Key Laboratory of Molecular Imaging of Chinese Academy of Sciences, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Hongwu Luo
- Department of General Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Weimin An
- Department of Radiology, 302 Hospital of PLA, Beijing, China
| | - Yifei Huang
- CHESS Group, Hepatic Hemodynamic Lab, Institute of Hepatology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jialiang Zou
- CHESS Group, Hepatic Hemodynamic Lab, Institute of Hepatology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Chuan Liu
- CHESS Group, Hepatic Hemodynamic Lab, Institute of Hepatology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Changchun Liu
- Department of Radiology, 302 Hospital of PLA, Beijing, China
| | - Lei Wang
- CHESS Group, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zaiyi Liu
- Department of Radiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruizhao Qi
- Department of General Surgery, 302 Hospital of PLA, Beijing, China
| | - Changzeng Zuo
- Xingtai People's Hospital, Xingtai Institute of Cancer Control, Xingtai, China
| | - Qingge Zhang
- Xingtai People's Hospital, Xingtai Institute of Cancer Control, Xingtai, China
| | - Jitao Wang
- Xingtai People's Hospital, Xingtai Institute of Cancer Control, Xingtai, China
| | - Dawei Zhao
- Department of Radiology, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Yongli Duan
- Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Baogang Peng
- Department of Hepatobiliary Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xingshun Qi
- Department of Gastroenterology, General Hospital of Shenyang Military Area, Shenyang, China
| | - Yuening Zhang
- Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Yongping Yang
- Center for Therapeutic Research of Hepatocarcinoma, 302 Hospital of PLA, Beijing, China
| | - Jinlin Hou
- CHESS Group, Hepatic Hemodynamic Lab, Institute of Hepatology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiahong Dong
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhiwei Li
- Department of General Surgery, 302 Hospital of PLA, Beijing, China; Department of Hepatobiliary Surgery, The Third People's Hospital of Shenzhen, Shenzhen, China
| | - Huiguo Ding
- Department of Gastroenterology and Hepatology, Beijing You'an Hospital, Capital Medical University, Beijing, China.
| | - Yu Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China.
| | - Xiaolong Qi
- CHESS Group, Hepatic Hemodynamic Lab, Institute of Hepatology, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China; Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China; CHESS Frontier Center, Lanzhou University, Lanzhou, China.
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Takeishi K, Kawanaka H, Itoh S, Harimoto N, Ikegami T, Yoshizumi T, Shirabe K, Maehara Y. Impact of Splenic Volume and Splenectomy on Prognosis of Hepatocellular Carcinoma Within Milan Criteria After Curative Hepatectomy. World J Surg 2018; 42:1120-1128. [PMID: 28920178 DOI: 10.1007/s00268-017-4232-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prognosis of hepatocellular carcinoma (HCC) with portal hypertension (PH) is very poor. Splenomegaly is considered important evidence of PH. Our aim was to clarify the prognostic value of splenic volume (SV) and the effect of splenectomy on the prognosis of HCC within the Milan criteria after curative hepatectomy. METHODS In this single-center retrospective study, we reviewed 160 patients with HCC that met the Milan criteria, including 138 who had undergone hepatectomy and 22 who had undergone hepatectomy and splenectomy between July 2004 and December 2010. SV was measured by three-dimensional computed tomography and patients allocated to three groups (high SV ≥300 mL; low <300 mL; and splenectomy) to compare post-hepatectomy survival rates. RESULTS Multivariate analyses showed that SV is an independent prognostic factor for overall and disease-free survival. The overall survival rates at 5 years in the high SV, low SV, and splenectomy groups were 39, 75, and 88%, respectively. The overall survival rate in the high SV group was significantly worse than in the low SV and splenectomy groups (P < 0.001). There was no significant difference between the low SV and splenectomy groups (P = 0.831). CONCLUSIONS High SV is an independent predictor of post-hepatectomy HCC recurrence and overall survival. There is no significant difference in prognosis between low SV and splenectomy groups, even though the latter had high SV. Combined splenectomy with hepatectomy for HCC and PH may improve prognosis and be an appropriate alternative when liver transplantation cannot be performed.
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Affiliation(s)
- Kazuki Takeishi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Hirofumi Kawanaka
- Clinical Research Institute and Department of Surgery, National Beppu Medical Center, Beppu, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Norifumi Harimoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Toru Ikegami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Ken Shirabe
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Sartoris R, Rautou PE, Elkrief L, Pollorsi G, Durand F, Valla D, Spahr L, Terraz S, Soubrane O, Cauchy F, Vilgrain V, Ronot M. Quantification of Liver Surface Nodularity at CT: Utility for Detection of Portal Hypertension. Radiology 2018; 289:698-707. [PMID: 30179109 DOI: 10.1148/radiol.2018181131] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose To determine whether quantification of liver surface nodularity (LSN) provides an estimate of the presence of clinically significant portal hypertension (CSPH) in patients with cirrhosis. Materials and Methods This retrospective study included a training cohort (n = 189) and separate external validation cohort (n = 78), both composed of patients with cirrhosis who underwent abdominal CT and hepatic venous pressure gradient (HVPG) measurement between 2010 and 2016. The LSN score, liver and spleen volumes, liver-to-spleen volume ratio, platelet count to spleen diameter ratio, Iranmanesh score, aspartate amino transferase-to-platelet ratio index, and Fibrosis-4 index were derived from CT images and serum laboratories. The accuracy of the various tests for predicting CSPH was evaluated with area under the receiver operating characteristic curve (AUROC) and compared by using the DeLong test. Student t test and Pearson correlation coefficient were used. Results One hundred eighty-nine patients were analyzed (119 men [mean age ± standard deviation, 57 years ± 11; range, 29-81 years] and 70 women [mean age, 61 years ± 10; range, 34-83 years]; overall mean age, 58 years ± 10; range, 29-83 years). A total of 102 patients (54%) had CSPH. LSN score correlated with HVPG (r = 0.75; P < .001). Patients with CSPH had a higher LSN score than did those without CSPH (3.2 ± 0.6 vs 2.4 ± 0.3; P < .001). A cutoff value of 2.8 had a positive predictive value of 88% for CSPH; the AUROC of LSN was 0.88 ± 0.03. This was higher than that of other available noninvasive tests (DeLong, all P < .001). In the validation cohort, LSN score of 2.8 had a positive predictive value of 86% for CSPH; the AUROC was 0.87 ± 0.04. Conclusion The CT-based liver surface nodularity score demonstrated high diagnostic performance for detecting clinically significant portal hypertension and outperformed multiple other noninvasive tests. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Riccardo Sartoris
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Pierre-Emmanuel Rautou
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Laure Elkrief
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Gaia Pollorsi
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - François Durand
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Dominique Valla
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Laurent Spahr
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Sylvain Terraz
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Olivier Soubrane
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - François Cauchy
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Valérie Vilgrain
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
| | - Maxime Ronot
- From the Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (R.S., V.V., M.R.); DHU Unity, Pôle des Maladies de l'Appareil Digestif, Service d'Hépatologie, Centre de Référence des Maladies Vasculaires du Foie, Hôpital Beaujon, AP-HP, Clichy, France (P.E.R., F.D., D.V.); University Paris Diderot, Sorbonne Paris Cité, Paris (P.E.R., F.D., D.V., V.V., M.R.); Inserm, U970, Paris Cardiovascular Research Center-PARCC, Université Paris Descartes, Sorbonne Paris Cité, Paris, France (P.E.R.); Department of Gastroenterology, University Hospitals of Geneva, Geneva, Switzerland (L.E., G.P., L.S.); Department of Radiology, University Hospitals of Geneva, Geneva, Switzerland (S.T., M.R.); Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France (O.S., F.C.); INSERM U1149, CRI, Paris, France (V.V.)
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Wang WD. Diagnosis and treatment of hepatocellular carcinoma with portal hypertension. Shijie Huaren Xiaohua Zazhi 2018; 26:1429-1433. [DOI: 10.11569/wcjd.v26.i24.1429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a common malignant tumor in China. HCC complicated with portal hypertension is a common problem in clinical practice. Bleeding from esophagogastric varices is a major cause of death in patients with HCC complicated with portal hypertension. How to treat HCC and portal hypertension simultaneously remains one of the challenges for liver surgeons. This article briefly reviews the current status of treatment of HCC with portal hypertension.
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Affiliation(s)
- Wei-Dong Wang
- Department of Hepatobiliary Surgery, Shunde Hospital, Southern Medical University (Shunde First People's Hospital of Foshan), Foshan 528300, Guangdong Province, China
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50
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Noninvasive Monitoring of Liver Disease Regression after Hepatitis C Eradication Using Gadoxetic Acid-Enhanced MRI. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:8489709. [PMID: 30116164 PMCID: PMC6079600 DOI: 10.1155/2018/8489709] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 06/02/2018] [Indexed: 12/30/2022]
Abstract
We evaluated changes in relative liver enhancement (RLE) obtained by gadoxetic acid-enhanced MRI (GA-MRI) in the hepatobiliary phase and changes in splenic volume (SV) after hepatitis C virus (HCV) eradication as well as their predictive value for the development of (further) hepatic decompensation during follow-up. This retrospective study comprised 31 consecutive patients with HCV-induced advanced chronic liver disease who underwent GA-MRI before and after successful interferon-free treatment, as well as a cohort of 14 untreated chronic HCV-patients with paired GA-MRI. RLE increased by 66% (20%-94%; P < 0.001) from pre- to posttreatment, while SV decreased by -16% (-28% to -8%; P < 0.001). However, SV increased in 16% (5/31) of patients, the identical subjects who showed a decrease in RLE (GA-MRI-nonresponse). We observed an inverse correlation between the changes in RLE and SV (ρ=-0.608; P < 0.001). In the untreated patients, there was a decrease in RLE by -11% (-25% to -3%; P=0.019) and an increase in SV by 23% (7%-43%; P=0.004) (both P < 0.001 versus treated patients). Interestingly, GA-MRI-nonresponse was associated with a substantially increased risk of (further) hepatic decompensation 2 years after the end of treatment: 80% versus 8%; P < 0.001. GA-MRI might distinguish between individuals at low and high risk of (further) hepatic decompensation (GA-MRI-nonresponse) after HCV eradication. This could allow for individualized surveillance strategies.
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