背景:肝静脉压力梯度(HVPG)是诊断门静脉高压症(PH)的金标准。然而,它的使用可能是有限的,因为它是一个侵入性的过程。因此,有必要探索一种非侵入性的方法来评估PH。
目的:探讨乙型肝炎病毒(HBV)相关PH的肝脏计算机断层扫描(CT)灌注与HVPG和Child-Pugh评分的相关性。
方法:28名患者(4名女性,在我们的研究中招募了24名男性)与HBV相关的PH引起的胃食管静脉曲张破裂出血。所有患者在经颈静脉肝内门体支架分流术(TIPS)治疗之前均接受了肝脏CT灌注。肝脏CT灌注的定量参数,包括肝血流量(LBF),肝血容量(LBV),肝动脉分数,测量脾血流量和脾血容量。在TIPS治疗期间记录HVPG。分析肝脏灌注与Child-Pugh评分及HVPG的相关性,并对接收机工作特性曲线进行了分析。基于HVPG(>12mmHg与≤12mmHg),患者分为中度和重度组,并对所有参数进行了比较。
结果:基于HVPG,18例患者分为中度组,10例患者分为重度组。Child-Pugh评分,HVPG,中度组LBF和LBV明显高于重度组(均P<0.05)。LBF和LBV与HVPG呈负相关(r=-0.473,P<0.05,r=-0.503,P<0.01),脾血流量与肝动脉分数呈正相关(r=0.434,P<0.05)。LBV与Child-Pugh评分呈负相关。Child-Pugh评分与HVPG无关。LBV的截断值为17.85mL/min/100g,HVPG≥12mmHg诊断的敏感性和特异性分别为80%和89%,分别。
结论:LBV和LBF与HVPG和Child-Pugh评分呈负相关。CT灌注成像是HBV相关肝硬化PH的潜在非侵入性定量预测指标。
BACKGROUND: Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosis of portal hypertension (PH). However, its use can be limited because it is an invasive procedure. Therefore, it is necessary to explore a non-invasive method to assess PH.
OBJECTIVE: To investigate the correlation of computed tomography (CT) perfusion of the liver with HVPG and Child-Pugh score in hepatitis B virus (HBV)-related PH.
METHODS: Twenty-eight patients (4 female, 24 male) with gastroesophageal variceal bleeding induced by HBV-related PH were recruited in our
study. All patients received CT perfusion of the liver before transjugular intrahepatic portosystemic stent-shunt (TIPS) therapy. Quantitative parameters of CT perfusion of the liver, including liver blood flow (LBF), liver blood volume (LBV), hepatic artery fraction, splenic blood flow and splenic blood volume were measured. HVPG was recorded during TIPS therapy. Correlation of liver perfusion with Child-Pugh score and HVPG were analyzed, and the receiver operating characteristic curve was analyzed. Based on HVPG (> 12 mmHg vs ≤ 12 mmHg), patients were divided into moderate and severe groups, and all parameters were compared.
RESULTS: Based on HVPG, 18 patients were classified into the moderate group and 10 patients were classified into the severe group. The Child-Pugh score, HVPG, LBF and LBV were significantly higher in the moderate group compared to the severe group (all P < 0.05). LBF and LBV were negatively associated with HVPG (r = -0.473, P < 0.05 and r = -0.503, P < 0.01, respectively), whereas splenic blood flow was positively associated with hepatic artery fraction (r = 0.434, P < 0.05). LBV was negatively correlated with Child-Pugh score. Child-Pugh score was not related to HVPG. Using a cutoff value of 17.85 mL/min/100 g for LBV, the sensitivity and specificity of HVPG ≥ 12 mmHg for diagnosis were 80% and 89%, respectively.
CONCLUSIONS: LBV and LBF were negatively correlated with HVPG and Child-Pugh scores. CT perfusion imaging is a potential non-invasive quantitative predictor for PH in HBV-related liver cirrhosis.