Clinical Trials Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Apr 27, 2023; 15(4): 664-673
Published online Apr 27, 2023. doi: 10.4240/wjgs.v15.i4.664
Computed tomography perfusion in differentiating portal hypertension: A correlation study with hepatic venous pressure gradient
Jian Dong, Yu Zhang, Yi-Fan Wu, Zhen-Dong Yue, Zhen-Hua Fan, Chun-Yan Zhang, Fu-Quan Liu, Lei Wang
Jian Dong, Chun-Yan Zhang, Department of Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Yu Zhang, Yi-Fan Wu, Zhen-Dong Yue, Zhen-Hua Fan, Fu-Quan Liu, Lei Wang, Department of Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Author contributions: Dong J, Liu FQ and Wang L designed the report; Zhang Y, Wu YF, Yue ZD, and Fan ZH collected the clinical data; Wang L and Zhang CY analyzed the data and wrote the paper; Dong J and Liu FQ performed quality control; Liu FQ contributed to administrative and financial support.
Supported by the National Natural Science Foundation of China General Program, No. 81871461.
Institutional review board statement: This study was approved by the Ethics Committee of the Beijing Shijitan Hospital, Capital Medical University (No. 201801).
Clinical trial registration statement: This study is registered at ClinicalTrials.gov, registration number ChiCTR1800015268 (https://www.chictr.org.cn/showproj.aspx?proj=26048).
Informed consent statement: Written informed consent was obtained from each patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lei Wang, MD, Doctor, Department of Interventional Radiology, Beijing Shijitan Hospital, Capital Medical University, No. 10 Tieyi Street, Haidian District, Beijing 100038, China. wanglei800212@126.com
Received: December 20, 2022
Peer-review started: December 20, 2022
First decision: January 9, 2023
Revised: January 11, 2023
Accepted: March 23, 2023
Article in press: March 23, 2023
Published online: April 27, 2023
Abstract
BACKGROUND

Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosis of portal hypertension (PH), invasiveness and potential risks in the process of measurement limited its widespread use.

AIM

To investigate the correlation of computed tomography (CT) perfusion parameters with HVPG in PH, and quantitatively assess the blood supply changes in liver and spleen parenchyma before and after transjugular intrahepatic portosystemic shunt (TIPS).

METHODS

Twenty-four PH related gastrointestinal bleeding patients were recruited in this study, and all patients were performed perfusion CT before and after TIPS surgery within 2 wk. Quantitative parameters of CT perfusion, including liver blood volume (LBV), liver blood flow (LBF), hepatic arterial fraction (HAF), spleen blood volume (SBV) and spleen blood flow (SBF), were measured and compared before and after TIPS, and the quantitative parameters between clinically significant PH (CSPH) and non-CSPH (NCSPH) group were also compared. Then the correlation of CT perfusion parameters with HVPG were analyzed, with statistical significance as P < 0.05.

RESULTS

For all 24 PH patients after TIPS, CT perfusion parameters demonstrated decreased LBV, increased HAF, SBV and SBF, with no statistical difference in LBF. Compared with NCSPH, CSPH showed higher HAF, with no difference in other CT perfusion parameters. HAF before TIPS showed positive correlation with HVPG (r = 0.530, P = 0.008), while no correlation was found in other CT perfusion parameters with HVPG and Child-Pugh scores.

CONCLUSION

HAF, an index of CT perfusion, was positive correlation with HVPG, and higher in CSPH than NCSPH before TIPS. While increased HAF, SBF and SBV, and decreased LBV, were found after TIPS, which accommodates a potential non-invasive imaging tool for evaluation of PH.

Keywords: Portal hypertension, Transjugular intrahepatic portosystemic shunt, Hepatic vein pressure gradient, Perfusion, Computed tomography

Core Tip: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective therapy for portal hypertension (PH) related gastro-esophageal variceal bleeding (GEVB). However, the decrease of liver blood supply after TIPS led to a decline in the liver detoxification, which increased potential risk for the occurrence of various complications such as hepatic encephalopathy, liver dysfunction and even liver failure. This study explored the feasibility of computed tomography perfusion imaging in quantitatively evaluating the changes in liver and spleen blood supply in PH related GEVB before and after TIPS, and making correlation analysis between perfusion parameters, hepatic venous pressure gradient and Child-Pugh scores were evaluated.