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Hu Q, Li G, Zhang D, Jiang Y, Nie L, Yang H, Yang H. Assessment of four-dimensional flow MRI for prediction of varices risk in cirrhotic patients. Eur Radiol 2025; 35:3568-3575. [PMID: 39601830 DOI: 10.1007/s00330-024-11222-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 10/02/2024] [Accepted: 10/22/2024] [Indexed: 11/29/2024]
Abstract
OBJECTIVE This study aims to validate the application of abdominal four-dimensional flow magnetic resonance imaging (MRI) for cirrhotic patients and quantify its effectiveness in assessing the hemodynamic impacts of cirrhosis to evaluate varices. METHODS All consecutive patients who underwent MRIs between September 2022 and June 2023 were enrolled. Groups were divided into varicose, non-varicose, and healthy groups. ANOVA and post hoc LSD-t tests were used for statistical analysis. The correlation between hemodynamic parameters and liver function grade was evaluated using Kendall's correlation coefficient. RESULTS A total of 80 patients were included (53 cirrhotic, 27 healthy). Significant disparities were found in main portal vein flow (MPV-FR), splenic vein flow (SV-FR), and vessel diameters (MPV-VD, SV-VD) among the groups (p < 0.05). MPV-FR was higher in the varicose group (24.81 ± 8.52) compared to non-varicose (19.52 ± 5.07) and healthy groups (17.26 ± 5.48). The most robust assessment of variceal risk was achieved by combining the flow rates (FRs) and VDs of MPV and SV (AUC 0.83, 95% CI 0.72-0.94). CONCLUSION The combined indices of FRs and VDs of MPV and SV effectively predict the occurrence of varicose veins in cirrhotic patients. KEY POINTS Question Non-invasive prediction of variceal risk is essential for the clinical management of advanced chronic cirrhosis, yet existing clinical examinations are inadequate. Findings The effective assessment of variceal risk was achieved by combining the flow rates and vessel diameters of the main portal vein and splenic vein. Clinical relevance Four-dimensional flow MRI can reveal hemodynamic changes in cirrhotic patients and assist in identifying gastroesophageal varices, serving as a marker for varices risk prediction.
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Affiliation(s)
- Qinqin Hu
- Department of Radiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, 400021, China
| | - Gangjing Li
- Department of Radiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, 400021, China
| | - Dechuan Zhang
- Department of Radiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, 400021, China
| | - Yang Jiang
- Department of Radiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, 400021, China
| | - Lisha Nie
- GE HealthCare MR Research, Beijing, China
| | - Huiping Yang
- Department of Radiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, 400021, China.
| | - Hua Yang
- Department of Radiology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, 400021, China.
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Karam R, Elged BA, Elmetwally O, El-Etreby S, Elmansy M, Elhawary M. Porto-mesenteric four-dimensional flow MRI: a novel non-invasive technique for assessment of gastro-oesophageal varices. Insights Imaging 2024; 15:231. [PMID: 39331303 PMCID: PMC11436693 DOI: 10.1186/s13244-024-01805-6] [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: 04/10/2024] [Accepted: 09/01/2024] [Indexed: 09/28/2024] Open
Abstract
OBJECTIVES To assess the role of 4D flow MRI in the assessment of gastro-oesophageal varices and in the prediction of high-risk varices in patients with chronic liver disease. METHODS Thirty-eight patients diagnosed with either oesophageal or gastric varices were included in this single-centre prospective study. 4D flow MRI was used to calculate peak flow, average flow and peak velocity at the portal vein confluence (PV1) and hilum (PV2), splenic vein hilum (SV1) and confluence (SV2), and superior mesenteric vein (SMV). PV and SV fractional flow changes were also measured. RESULTS ROC analysis revealed that both PV2 average flow and PV fractional average flow change had 100% sensitivity to predict high-risk patients with the PV fractional peak flow change having the widest area under the curve (AUC) and the highest specificity (92.3%). SV1 average flow, SV2 average flow, SV2 peak flow, and SV2 peak velocity increased significantly in patients with oesophageal compared to gastric varices included (p = 0.022, < 0.001, < 0.001 and 0.001, respectively). CONCLUSION Based on certain porto-mesenteric blood flow, velocity, and fractional flow change parameters, 4D flow MRI showed excellent performance in identifying high-risk patients and giving an idea about the grade and location of varices. CRITICAL RELEVANCE STATEMENT Variceal bleeding is a major consequence of unidentified risky upper GI varices. Thus, by identifying and locating high-risk varices early, either oesophageal or gastric, using a non-invasive method like MRI, adverse events might be avoided. KEY POINTS 4D flow MRI can be used as a potential alternative for endoscopy to predict patients with high-risk varices. Based on portal vein fractional flow change, splenic flow and velocity, 4D MRI can predict and locate high-risk varices. Earlier identification of high-risk varices can allow for interventions to prevent adverse events.
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Affiliation(s)
- Rasha Karam
- Department of Radiology, Mansoura University, Mansoura, Egypt.
| | - Basma A Elged
- Department of Radiology, Mansoura University, Mansoura, Egypt
| | - Omar Elmetwally
- Department of Internal Medicine, Hepatology and Gastroenterology Unit, Mansoura University, Mansoura, Egypt
| | - Shahira El-Etreby
- Department of Internal Medicine, Hepatology and Gastroenterology Unit, Mansoura University, Mansoura, Egypt
| | - Mostafa Elmansy
- Department of Radiology, Mansoura University, Mansoura, Egypt
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Du L, Deng H, Wu X, Liu F, Yin T, Zheng J. Relationship Between Spleen Pathologic Changes and Spleen Stiffness in Portal Hypertension Rat Model. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:216-223. [PMID: 37919143 DOI: 10.1016/j.ultrasmedbio.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/16/2023] [Accepted: 10/01/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The aim of the study described here was to explore the influence of splenic pathology and hemodynamic parameters on spleen stiffness in portal hypertension (PH). METHODS A Sprague‒Dawley rat model of PH (n = 34) induced by CCl4 was established, and 9 normal rats were used as controls. All animals underwent a routine ultrasound examination, spleen stiffness measurement (SSM), liver stiffness measurement (LSM), portal vein pressure (PVP) measurement and histopathologic assessment. The diagnostic performance of SSM and LSM in PH was evaluated. SSMs were compared among the groups at different pathologic and hemodynamic levels. Multiple linear regression was used to analyze the factors affecting SSM. RESULTS SSM had excellent diagnostic efficacy for PH (area under the receiver operating characteristic curve [AUC] = 0.900) and was superior to LSM (AUC = 0.794). In a rat model of PH, pathologic changes such as splenic sinus widening, thickening of the splenic capsule and an increase in collagen fibers were observed in the spleen. There were significant differences in SSM at different splenic capsule thicknesses and splenic sinus widths (all p values <0.05), but there were no significant differences in the SSM at different levels of the splenic collagen fiber area and red pulp area (all p values >0.05). In addition, there were significant differences in SSM at different levels of portal vein diameter, blood flow and congestion index (all p values <0.05). Multiple linear regression analysis revealed that PVP, portal vein congestion index and splenic capsule thickness were significantly associated with SSM. CONCLUSION SSM is a good non-invasive way to assess PH. PVP, splenic capsule thickness and portal vein congestion index are responsible for spleen stiffness but not the proliferation of splenic fibrous tissue.
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Affiliation(s)
- Lingyue Du
- Department of Second Affiliated Hospital, School of Medicine, Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, China; Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Huan Deng
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaoting Wu
- Department of Second Affiliated Hospital, School of Medicine, Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, China
| | - Fan Liu
- Department of Second Affiliated Hospital, School of Medicine, Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, China
| | - Tinghui Yin
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jian Zheng
- Department of Second Affiliated Hospital, School of Medicine, Chinese University of Hong Kong, Shenzhen & Longgang District People's Hospital of Shenzhen, Shenzhen, China; Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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Liver cirrhosis: relationship between fibrosis-associated hepatic morphological changes and portal hemodynamics using four-dimensional flow magnetic resonance imaging. Jpn J Radiol 2023; 41:625-636. [PMID: 36656540 DOI: 10.1007/s11604-023-01388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE The mechanisms underlying the morphological changes in liver cirrhosis remain unknown. This study aimed to clarify the relationship between fibrotic hepatic morphology and portal hemodynamic changes using four-dimensional flow magnetic resonance imaging (MRI). MATERIALS AND METHODS Overall, 100 patients with suspected liver disease who underwent 3-T MRI were evaluated in this retrospective study. Liver fibrosis was assessed using a combination of visual assessment of the hepatic morphology and quantitative measures, including the fibrosis-4 index and aspartate transaminase-to-platelet ratio. It was classified into three groups according to the severity of fibrosis as follows: A (normal), B (mild-to-moderate), and C (severe). Quantitative indices, including area (mm2), net flow (mL/s), and average velocity (cm/s), were measured in the right portal vein (RPV) and left portal vein (LPV), and were compared across the groups using the Kruskal-Wallis and Mann-Whitney U tests. RESULTS Among the 100 patients (69.1 ± 12.1 years; 59 men), 45, 35, and 20 were categorized into groups A, B, and C, respectively. The RPV area significantly differed among the groups (from p < 0.001 to p = 0.001), showing a gradual decrease with fibrosis progression. Moreover, the net flow significantly differed between groups A and B and between groups A and C (p < 0.001 and p < 0.001, respectively), showing a decrease during the early stage of fibrosis. In the LPV, the net flow significantly differed among the groups (from p = 0.001 to p = 0.030), revealing a gradual increase with fibrosis progression. CONCLUSION The atrophy-hypertrophy complex, which is a characteristic imaging finding in advanced cirrhosis, was closely associated with decreased RPV flow in the early stage of fibrosis and a gradual increase in LPV flow across all stages of fibrosis progression.
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Nouh MAEL, Abd-Elmageed MK, Amer AAM, ELhamouly MS. Role of portal color Doppler ultrasonography as noninvasive predictive tool for esophageal varices in cirrhotic patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-021-00681-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Esophageal varices (EV) is the most common apprehensive complication of portal hypertension in patients with cirrhotic liver. Guidelines recommend Upper gastro-intestinal endoscopic screening for EV in patients with newly diagnosed chronic cirrhosis (Imperiale et al. in Hepatology 45(4):870–878, 2007). Yet, it is invasive, time consuming and costly. To avoid unnecessary endoscopy, some studies have suggested Doppler ultrasound examination as simple, and noninvasive tool in prediction and assessment of severity of EV (Agha et al. in Dig Dis Sci 54(3):654–660, 2009). Our study was to assess the role of different Doppler indices of portal vein, hepatic and splenic arteries as a noninvasive tool for prediction of esophageal varices in cirrhotic patients.
Results
This prospective case control study was conducted on 100 cirrhotic liver patients and 100 of healthy volunteers as control group. Patients were subjected to clinical examination, upper gastrointestinal tract endoscopy, abdominal ultrasonography with duplex Doppler evaluation of different portal Doppler hemodynamic indices were done for each patient. The results revealed that portal vein diameter, hepatic artery pulsatility index, portal hypertensive index, portal vein flow velocity, portal congestion index have high sensitivity for prediction of EV. However, Splenic artery resistance index, hepatic artery resistance index HARI, liver vascular index and platelet count/spleen diameter have less sensitivity for prediction of EV.
Conclusion
Measuring the portal hemodynamic indices can help physicians as noninvasive predictors of EV in cirrhotic patients to restrict the need for unnecessary endoscopic screening especially when endoscopic facilities are limited.
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Hyodo R, Takehara Y, Naganawa S. 4D Flow MRI in the portal venous system: imaging and analysis methods, and clinical applications. Radiol Med 2022; 127:1181-1198. [PMID: 36123520 PMCID: PMC9587937 DOI: 10.1007/s11547-022-01553-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 08/29/2022] [Indexed: 02/07/2023]
Abstract
Thus far, ultrasound, CT, and 2D cine phase-contrast MRI has been adopted to evaluate blood flow and vascular morphology in the portal venous system; however, all these techniques have some shortcomings, such as limited field of view and difficulty in accurately evaluating blood flow. A new imaging technique, namely 3D cine phase-contrast (4D Flow) MRI, can acquire blood flow data of the entire abdomen at once and in a time-resolved manner, allowing visual, quantitative, and comprehensive assessment of blood flow in the portal venous system. In addition, a retrospective blood flow analysis, i.e., "retrospective flowmetry," is possible. Although the development of 4D Flow MRI for the portal system has been delayed compared to that for the arterial system owing to the lower flow velocity of the portal venous system and the presence of respiratory artifacts, several useful reports have recently been published as the technology has advanced. In the first part of this narrative review article, technical considerations of image acquisition and analysis methods of 4D Flow MRI for the portal venous system and the validations of their results are described. In the second part, the current clinical application of 4D Flow MRI for the portal venous system is reviewed.
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Affiliation(s)
- Ryota Hyodo
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
| | - Yasuo Takehara
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
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Bao J, Feng X, Ma Y, Wang Y, Qi J, Qin C, Tan X, Tian Y. The latest application progress of radiomics in prediction and diagnosis of liver diseases. Expert Rev Gastroenterol Hepatol 2022; 16:707-719. [PMID: 35880549 DOI: 10.1080/17474124.2022.2104711] [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: 11/04/2022]
Abstract
INTRODUCTION Early detection and individualized treatment of patients with liver disease is the key to survival. Radiomics can extract high-throughput quantitative features by multimode imaging, which has good application prospects for the diagnosis, staging and prognosis of benign and malignant liver diseases. Therefore, this paper summarizes the current research status in the field of liver disease, in order to help these patients achieve personalized and precision medical care. AREAS COVERED This paper uses several keywords on the PubMed database to search the references, and reviews the workflow of traditional radiomics, as well as the characteristics and influencing factors of different imaging modes. At the same time, the references on the application of imaging in different benign and malignant liver diseases were also summarized. EXPERT OPINION For patients with liver disease, the traditional imaging evaluation can only provide limited information. Radiomics exploits the characteristics of high-throughput and high-dimensional extraction, enabling liver imaging capabilities far beyond the scope of traditional visual image analysis. Recent studies have demonstrated the prospect of this technology in personalized diagnosis and treatment decision in various fields of the liver. However, further clinical validation is needed in its application and practice.
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Affiliation(s)
- Jiaying Bao
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, P.R. China
| | - Xiao Feng
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, P.R. China
| | - Yan Ma
- Department of Ultrasound, Zibo Central Hospital, Zibo, P.R. China
| | - Yanyan Wang
- Departments of Emergency Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
| | - Jianni Qi
- Central Laboratory, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
| | - Chengyong Qin
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, P.R. China
| | - Xu Tan
- Department of Gynecology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
| | - Yongmei Tian
- Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, P.R. China
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Duan T, Jiang HY, Ling WW, Song B. Noninvasive imaging of hepatic dysfunction: A state-of-the-art review. World J Gastroenterol 2022; 28:1625-1640. [PMID: 35581963 PMCID: PMC9048786 DOI: 10.3748/wjg.v28.i16.1625] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/17/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
Hepatic dysfunction represents a wide spectrum of pathological changes, which can be frequently found in hepatitis, cholestasis, metabolic diseases, and focal liver lesions. As hepatic dysfunction is often clinically silent until advanced stages, there remains an unmet need to identify affected patients at early stages to enable individualized intervention which can improve prognosis. Passive liver function tests include biochemical parameters and clinical grading systems (e.g., the Child-Pugh score and Model for End-Stage Liver Disease score). Despite widely used and readily available, these approaches provide indirect and limited information regarding hepatic function. Dynamic quantitative tests of liver function are based on clearance capacity tests such as the indocyanine green (ICG) clearance test. However, controversial results have been reported for the ICG clearance test in relation with clinical outcome and the accuracy is easily affected by various factors. Imaging techniques, including ultrasound, computed tomography, and magnetic resonance imaging, allow morphological and functional assessment of the entire hepatobiliary system, hence demonstrating great potential in evaluating hepatic dysfunction noninvasively. In this article, we provide a state-of-the-art summary of noninvasive imaging modalities for hepatic dysfunction assessment along the pathophysiological track, with special emphasis on the imaging modality comparison and selection for each clinical scenario.
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Affiliation(s)
- Ting Duan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Han-Yu Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wen-Wu Ling
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Chen Y, Li J, Zhou Q, Lyu G, Li S. Detection of liver and spleen stiffness in rats with portal hypertension by two-dimensional shear wave elastography. BMC Med Imaging 2022; 22:68. [PMID: 35418033 PMCID: PMC9006581 DOI: 10.1186/s12880-022-00786-6] [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: 11/22/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The measurement of liver stiffness (LS) and spleen stiffness (SS) based on ultrasound elastography can be used for non-invasive assessment of portal hypertension (PH). However, there are few studies on the corresponding mechanism of increased spleen stiffness. Our aim was to use two-dimensional shear wave elastrography (2D-SWE) to evaluate the relationship between LS and SS and the severity of PH in rats. And explore the mechanism of the increase of LS and SS in PH. METHODS Sixty male Sprague-Dawley rats were randomly divided into portal hypertension (PH group, n = 45) and normal control (NC group, n = 15). At 12 weeks, LS and SS was detected by 2D-SWE in vivo. Related hemodynamic parameters and portal vein pressure (PVP) was measured. Spleen and liver 2D-SWE detection was performed again after sacrifice. Pathological changes were observed. RESULTS The SS and LS were increased in PH group (P < 0.05). The SS decreased after sacrifice, and what's more the magnitude of SS decline significantly higher in PH group than in NC group (P < 0.05). The correlation between SS and PVP is stronger than LS (r = 0.624, P < 0.001). SS has positive correlation with indexes of hyperdynamic circulation, but LS was weakly. The correlation between SS and the pathological grade (r = 0.633, P < 0.001) was lower than that in LS (r = 0.905, P < 0.001). Multiple linear regression analysis revealed that SS, portal vein inner diameter (PVD) and splenic vein blood flow velocity (SVV) were significantly associated with PH. CONCLUSIONS Spleen and liver measurement by 2D-SWE may be helpful in evaluating PVP. The correlation between SS and PVP is stronger than LS in rats measured by 2D-SWE. Hemodynamic circulation are important in the elevation of SS with portal hypertension. Pathological changes also have a degree of influence, but have more significance for the elevation of LS. SS may be a more effective noninvasive predictor of PH than LS.
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Affiliation(s)
- YongJian Chen
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, , Quanzhou, 362000, Fujian, China
| | - JingYun Li
- Maternal and Child Health Service Application Technology Collaborative Innovation Center, Quanzhou Medical College, Quanzhou, Fujian, China
| | - Qin Zhou
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, , Quanzhou, 362000, Fujian, China
| | - GuoRong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, , Quanzhou, 362000, Fujian, China. .,Maternal and Child Health Service Application Technology Collaborative Innovation Center, Quanzhou Medical College, Quanzhou, Fujian, China.
| | - ShiLin Li
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, No. 34 North Zhongshan Road, Licheng District, , Quanzhou, 362000, Fujian, China
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Salman A, Salman MA, Ismaeel Saadawy AM, Tourky M, Shawkat M. Portal venous hemodynamics as predictors for the development and grades of esophageal varices in
Post‐HCV
cirrhotic patients: An Egyptian center study. ADVANCES IN DIGESTIVE MEDICINE 2021. [DOI: 10.1002/aid2.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ahmed Salman
- Internal Medicine Department, Faculty of Medicine Cairo University Cairo Egypt
| | - Mohamed A. Salman
- General Surgery Department, Faculty of Medicine Cairo University Cairo Egypt
| | | | - Mohamed Tourky
- General Surgery Department Omm Elmisrien General Hospital Cairo Egypt
| | - Mohamed Shawkat
- Internal Medicine Department, Faculty of Medicine Minia University Minia Egypt
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Elkenawy YN, Elarabawy RA, Ahmed LM, Elsawy AA. Portal vein flow velocity as a possible fast noninvasive screening tool for esophageal varices in cirrhotic patients. JGH OPEN 2020; 4:589-594. [PMID: 32782943 PMCID: PMC7411658 DOI: 10.1002/jgh3.12301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/21/2019] [Accepted: 12/30/2019] [Indexed: 01/08/2023]
Abstract
Background and Aim Esophagogastroduodenoscopy (EGD) is the gold standard tool in both screening/diagnosis and management of varices in cirrhotic patients; however, its invasive nature may be uncomfortable to some patients, and in addition, it may be unavailable in some centers that cannot afford it. Therefore, to decrease the economic and physical burden on patients, multiple noninvasive clinical, laboratory, and radiological parameters are evaluated as triage screening predictors of varices before patients' referral to endoscopy. In this respect, we tried to evaluate the validity of portal vein velocity (PVV) as a noninvasive screening tool of esophageal varices (EV). Methods One hundred thirty‐five cirrhotic patients were consecutively enrolled in this cross‐sectional study. All patients were evaluated independently and blindly by EGD as the gold standard and then by Doppler ultrasound on portal vein (PV). Results Univariate regression showed significant coefficients for PVV, platelet (PLT), albumin, bilirubin, international normalized ratio (INR), portal vein diameter, and ascites; however, multivariable regression showed significant coefficients only for PVV, PLT, and albumin; (P = 0.000, 0.000, and 0.006, respectively). Area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, LR+, and LR− values were then calculated and validated using bootstrap analysis. PVV was more accurate than other evaluated parameters (AUROC: 0.927 and P = 0.000). The most accurate rule out cutoff value for PVV was ≥19 cm/s with the sensitivity of 97% and LR− of 0.05. Conclusion PVV may be useful as a noninvasive triage test for selection of the high‐risk cirrhotic patients who should be referred to and could benefit from EGD. We could highlight using PVV to rule out EV at a cutoff value ≥19 cm/s, reserving EGD only for patients with the PVV value <19 cm/s.
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Affiliation(s)
- Yara N Elkenawy
- Department of Internal Medicine, Faculty of MedicineTanta UniversityTantaEgypt
| | - Reda A Elarabawy
- Department of Diagnostic Radiology, Faculty of MedicineTanta UniversityTantaEgypt
| | - Layla M Ahmed
- Department of Internal Medicine, Faculty of MedicineTanta UniversityTantaEgypt
| | - Abdallah A Elsawy
- Department of Internal Medicine, Faculty of MedicineTanta UniversityTantaEgypt
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Noninvasive evaluation of esophageal varices in cirrhotic patients based on spleen hemodynamics: a dual-energy CT study. Eur Radiol 2020; 30:3210-3216. [PMID: 32072256 DOI: 10.1007/s00330-020-06680-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/17/2019] [Accepted: 01/28/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate noninvasively the severity of esophageal varices (EV) in cirrhotic patients using splenic hemodynamics obtained with dual-energy CT. METHODS We retrospectively analyzed 72 cirrhotic patients with EV between December 2018 and June 2019. Patients were divided into three groups: mild (EV1), medium (EV2), or severe (EV3) EV groups based on severity of EV assessed by endoscopy. An additional control group included 20 patients with normal liver CT. All patients underwent contrast-enhanced dual-energy CT. The iodine weight in spleen (IW-S) was calculated as IW-S = IC-S (iodine concentration in spleen) × V-S (spleen volume). Differences between EV and control groups were analyzed using one-way analysis of variance with Welch's correction. Games-Howell test made further pairwise comparison. The diagnostic value of IW-S on high-risk EV (EV2, EV3, or EV1 with red color sign) was evaluated using the ROC curve. p < 0.05 indicated statistical significance. RESULTS The overall difference of IW-S between the control and EV groups was statistically significant (p < 0.001). Patients with more severe EV had higher IW-S values. Pairwise comparisons showed that except for control vs. EV1 groups, the IW-S between any other two groups was significantly different (p < 0.05). With a cutoff value at 1087 mg, the AUC for using IW-S for the detection of high-risk EV was 0.87 (95% CI 0.77~0.94). Sensitivity and specificity were 84.9% and 84.2%, respectively. CONCLUSION IW-S obtained with dual-energy CT can noninvasively predict EV severity. KEY POINTS • A higher iodine weight in spleen (IW-S) was observed in case of severe esophageal varices. • Cirrhotic patients have significantly higher IW-S than normal-liver patients. • IW-S in dual-energy CT maybe used to evaluate the severity of EV.
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Acoustic radiation forced impulse-based splenic prediction model using data mining for the noninvasive prediction of esophageal varices in hepatitis C virus advanced fibrosis. Eur J Gastroenterol Hepatol 2019; 31:1533-1539. [PMID: 31689264 DOI: 10.1097/meg.0000000000001458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Esophageal varices (EV) are serious complications of hepatitis C virus (HCV) cirrhosis. Endoscopic screening is expensive, invasive, and uncomfortable. Accordingly, noninvasive methods are mandatory to avoid unnecessary endoscopy. Acoustic radiation forced impulse (ARFI) imaging using point shear wave elastography as demonstrated with virtual touch quantification is a possible noninvasive EV predictor. We aimed to validate the reliability of liver stiffness (LS) and spleen stiffness (SS) by an ARFI-based study together with other noninvasive parameters for EV prediction in HCV patients. Also, we aimed to evaluate the diagnostic performance of a new simple prediction model (incorporating SS) using data mining analysis. PATIENTS AND METHODS This cross-sectional study included 200 HCV patients with advanced fibrosis. Labs, endoscopic, ultrasonographic, LS, and SS data were collected. Their accuracy in diagnosing EV was assessed and a data mining analysis was carried out. RESULTS Ninety patients (22/46% of F3/F4 patients) had EV (39/30/18/3 patients had grade I/II/III/IV, respectively). LS and SS by ARFI showed high significance in differentiating not only patients with/without EV (P = 0.000 for both) but also correlated with the grading of varices (R = 0.31 and 0.45, respectively; P = 0.000 for both). Spleen longitudinal diameter (SD), splenic vein diameter (SVD), platelets to spleen diameter ratio, LOK index, and FIB-4 score were the best ultrasonographic and biochemical predictors for the prediction of EV [area under receiver operating characteristic (AUROC) 0.79, 0.76, 0.76, 0.74, and 0.71, respectively]. SS (using ARFI) had better diagnostic performance than LS for the prediction of EV (AUROC = 0.76 and 0.70, respectively). The diagnostic performance increased using data mining to construct a simple prediction model: high probability for EV if [(SD cm) × 0.17 + (SVD mm) × 0.06 + (SS) × 0.97] more than 6.35 with AUROC 0.85. CONCLUSION SS by ARFI represents a reliable noninvasive tool for the prediction of EV in HCV patients, especially when incorporated into a new data mining-based prediction model.
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Motosugi U, Roldán-Alzate A, Bannas P, Said A, Kelly S, Zea R, Wieben O, Reeder SB. Four-dimensional Flow MRI as a Marker for Risk Stratification of Gastroesophageal Varices in Patients with Liver Cirrhosis. Radiology 2018; 290:101-107. [PMID: 30325278 DOI: 10.1148/radiol.2018180230] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose To assess the feasibility of four-dimensional (4D) flow MRI as a noninvasive imaging marker for stratifying the risk of variceal bleeding in patients with liver cirrhosis. Materials and Methods This study recruited participants scheduled for both liver MRI and gastroesophageal endoscopy. Risk of variceal bleeding was assessed at endoscopy by using a three-point scale: no varices, low risk, and high risk requiring treatment. Four-dimensional flow MRI was used to create angiograms for evaluating visibility of varices and to measure flow volumes in main portal vein (PV), superior mesenteric vein, splenic vein (SV), and azygos vein. Fractional flow changes in PV and SV were calculated to quantify shunting (outflow) from PV and SV into varices. Logistic analysis was used to identify the independent indicator of high-risk varices. Results There were 23 participants (mean age, 52.3 years; age range, 25-75 years), including 14 men (mean age, 51.7 years; age range, 25-75 years) and nine women (mean age, 53.2 years; age range, 31-72 years) with no varices (n = 8), low-risk varices (n = 8), and high-risk varices (n = 7) determined at endoscopy. Four-dimensional flow MRI-based angiography helped radiologists to view varices in four of 15 participants with varices. Independent indicators of high-risk varices were flow volume in the azygos vein greater than 0.1 L/min (P = .034; 100% sensitivity [seven of seven] and 62% specificity [10 of 16]) and fractional flow change in PV of less than 0 (P < .001; 100% sensitivity [seven of seven] and 94% specificity [15 of 16]). Conclusion Azygos flow greater than 0.1 L/min and portal venous flow less than the sum of splenic and superior mesenteric vein flow are useful markers to stratify the risk of gastroesophageal varices bleeding in patients with liver cirrhosis. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Utaroh Motosugi
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
| | - Alejandro Roldán-Alzate
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
| | - Peter Bannas
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
| | - Adnan Said
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
| | - Sean Kelly
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
| | - Ryan Zea
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
| | - Oliver Wieben
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
| | - Scott B Reeder
- From the Department of Radiology (U.M., A.R.A., P.B., O.W., S.B.R.), Department of Mechanical Engineering (A.R.A.), Division of Gastroenterology and Hepatology, Department of Medicine (A.S.), Department of Biostatistics & Medical Informatics (R.Z.), Department of Medical Physics (O.W., S.B.R.), Department of Medicine (S.B.R.), Department of Biomedical Engineering (S.B.R.), and Department of Emergency Medicine (S.B.R.), University of Wisconsin, Madison, Wis; Department of Radiology, University of Yamanashi, 1110 Shimokato, Chuo-shi, Yamanashi 409-3898, Japan (U.M.); Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany (P.B.); and Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio (S.K.)
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Kim T, Hong SI, Park SY, Jung J, Chong YP, Kim SH, Lee SO, Kim YS, Woo JH, Lim YS, Sung H, Kim MN, Choi SH. Clinical Features and Outcomes of Spontaneous Bacterial Peritonitis Caused by Streptococcus pneumoniae: A Matched Case-Control Study. Medicine (Baltimore) 2016; 95:e3796. [PMID: 27258513 PMCID: PMC4900721 DOI: 10.1097/md.0000000000003796] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Streptococcus pneumoniae is a well-known cause of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. However, little information is available regarding clinical characteristics and outcomes of SBP caused by S. pneumoniae. It has been suggested that spontaneous pneumococcal peritonitis (SPP) often spreads hematogenously from concomitant pneumococcal pneumonia, and is associated with a higher rate of mortality.During the period between January 1997 and December 2013, 50 SPP cases were identified. These cases were then age/sex-matched with 100 patients with SBP due to causes other than S. pneumoniae (controls).SPP accounted for 4.3% (50/1172) of all culture-proven SBPs. The baseline Child-Pugh class, etiology of cirrhosis, and model for end-stage liver disease scores were comparable for the 2 groups. SPP patients were more likely than control patients to have a community-acquired infection (90.0% vs. 76.0%; P = 0.04), concurrent bacteremia (84.0% vs. 59.0%; P = 0.002), and to present with variceal bleeding (10.0% vs. 1.0%; P = 0.02). None of the study patients had pneumococcal pneumonia. The most common initial empirical therapy for both groups was third-generation cephalosporins (96.0% vs. 91.0%; P = 0.34) which was active against a significantly higher proportion of the cases than of the controls (97.8% vs. 78.7%; P = 0.003). Thirty-day mortality was significantly lower in the case group than in the control group (10.0% vs. 24.0%; P = 0.04).SPP was not associated with pneumococcal pneumonia and showed lower mortality than SBP caused by other organisms. However, the present study was constrained by the natural limitations characteristic of a small, retrospective study. Therefore, large-scale, well-controlled studies are required to demonstrate the influence of SPP on mortality, which was marginal in the present study.
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Affiliation(s)
- Taeeun Kim
- From the Department of Infectious Diseases (TK, SIH, SYP, JJ, YPC, S-HK, S-OL, YSK, JHW, S-HC); Department of Gastroenterology (Y-SL); and Department of Laboratory Medicine (HS, M-NK), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Ohira H. Spleen and Liver. THE LIVER IN SYSTEMIC DISEASES 2016. [PMCID: PMC7122130 DOI: 10.1007/978-4-431-55790-6_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In liver cirrhosis, the spleen is a source of nitric oxide which affects a hyperdynamic state typical of portal hypertension. It is generally accepted that pancytopenia results predominantly from the increased phagocytosis and destruction of hemocytes in splenic macrophages. In addition, liver fibrosis is amplified by migrated Th2 lymphocytes and transforming growth factor beta from the spleen. There is a possibility that increase of the spleen stiffness is the primary factor of idiopathic portal hypertension. Spleen stiffness is caused by bleeding, fibrosis, and calcareous deposits after increase in red pulp pressure due to venous congestion. In nonalcoholic steatohepatitis, macrophage activity in the spleen is upregulated. In addition, high levels of inflammatory cytokines are produced and T cell shows increased proliferation in the spleen. In autoimmune hepatitis model, CD4+ T cells are differentiated into follicular helper T cells (TFH) in the spleen. TFH cells promoted hypergammaglobulinemia and antinuclear antibodies production. TFH cells migrate from the spleen to the liver, triggering induction of autoimmune hepatitis in this model. IgM-positive B cells localize in the CD21-positive lymph follicle in the spleen of primary biliary cholangitis. These findings prove that the spleen influences on the pathogenesis and severity of several kinds of liver disease.
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Affiliation(s)
- Hiromasa Ohira
- Dept. Gastroenterology & Rheumatogy, Fukushima Med. Univ. School of Med., Fukushima, Fukushima Japan
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A new model combining the liver/spleen volume ratio and classification of varices predicts HVPG in hepatitis B patients with cirrhosis. Eur J Gastroenterol Hepatol 2015; 27:335-43. [PMID: 25563138 DOI: 10.1097/meg.0000000000000269] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although the therapy of varices in liver cirrhosis has improved, the mortality during a variceal hemorrhage episode remains high. Patients with hepatic venous pressure gradient (HVPG) greater than 12 mmHg have been identified as being at a higher risk for the first hemorrhage episode. AIMS The aim of this study was to find an accurate method to predict HVPG greater than 12 mmHg. METHODS A total of 150 hepatitis B patients with liver cirrhosis were enrolled and analyzed retrospectively. The patients were randomly divided into the experiment group and the validation group. The experiment group was used to construct a model to predict HVPG greater than 12 mmHg. The validation group was used to verify the predictive equation. RESULTS The predictive model combined with the liver/spleen volume ratio and classification of varices was constructed to predict HVPG greater than 12 mmHg. The area under the curve of this predictive equation was 0.919. The values of sensitivity, specificity, positive predictive value, and negative predictive value were 92.9, 87.0, 89.7, and 90.9%, respectively. The following equation was used to calculate the HVPG score: HVPG score = 13.651 - 6.187×ln (liver/spleen volume)+2.755×[classification of varices score (classification of varices : small, 1; large; 2]. CONCLUSION The new model combining the liver/spleen volume ratio and classification of varices can accurately predict HVPG in hepatitis B patients with cirrhosis.
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18
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Kim G, Cho YZ, Baik SK, Kim MY, Hong WK, Kwon SO. The accuracy of ultrasonography for the evaluation of portal hypertension in patients with cirrhosis: a systematic review. Korean J Radiol 2015; 16:314-24. [PMID: 25741193 PMCID: PMC4347267 DOI: 10.3348/kjr.2015.16.2.314] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/15/2014] [Indexed: 02/06/2023] Open
Abstract
Objective Studies have presented conflicting results regarding the accuracy of ultrasonography (US) for diagnosing portal hypertension (PH). We sought to identify evidence in the literature regarding the accuracy of US for assessing PH in patients with liver cirrhosis. Materials and Methods We conducted a systematic review by searching databases, including MEDLINE, EMBASE, and the Cochrane Library, for relevant studies. Results A total of 14 studies met our inclusion criteria. The US indices were obtained in the portal vein (n = 9), hepatic artery (n = 6), hepatic vein (HV) (n = 4) and other vessels. Using hepatic venous pressure gradient (HVPG) as the reference, the sensitivity (Se) and specificity (Sp) of the portal venous indices were 69-88% and 67-75%, respectively. The correlation coefficients between HVPG and the portal venous indices were approximately 0.296-0.8. No studies assess the Se and Sp of the hepatic arterial indices. The correlation between HVPG and the hepatic arterial indices ranged from 0.01 to 0.83. The Se and Sp of the hepatic venous indices were 75.9-77.8% and 81.8-100%, respectively. In particular, the Se and Sp of HV arrival time for clinically significant PH were 92.7% and 86.7%, respectively. A statistically significant correlation between HVPG and the hepatic venous indices was observed (0.545-0.649). Conclusion Some US indices, such as HV, exhibited an increased accuracy for diagnosing PH. These indices may be useful in clinical practice for the detection of significant PH.
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Affiliation(s)
- Gaeun Kim
- College of Nursing, Research Institute for Nursing Science, Keimyung Univercity, Daegu 704-701, Korea
| | - Youn Zoo Cho
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 220-701, Korea
| | - Soon Koo Baik
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 220-701, Korea
| | - Moon Young Kim
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 220-701, Korea
| | - Won Ki Hong
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 220-701, Korea
| | - Sang Ok Kwon
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 220-701, Korea
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George SM, Eckert LM, Martin DR, Giddens DP. Hemodynamics in Normal and Diseased Livers: Application of Image-Based Computational Models. Cardiovasc Eng Technol 2014; 6:80-91. [DOI: 10.1007/s13239-014-0195-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 09/10/2014] [Indexed: 01/14/2023]
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WANG XINKAI, LI GUOJIE, CHEN BIN, PU YANSONG, NIE PENG, LI XIAO, LI ZONGFANG, SU KAI. NUMERICAL SIMULATION OF HEMODYNAMICS IN PORTAL VEIN WITH THROMBOSIS BY COMPUTATIONAL FLUID DYNAMICS. J MECH MED BIOL 2014. [DOI: 10.1142/s0219519414400065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Portal vein thrombosis (PVT) is an important complication that is associated with cirrhotic portal hypertension. The etiology is as yet unclear but could be closely related to the hemodynamics of the portal vein system. This paper investigated the hemodynamics in the portal vein model, both with and without thrombosis, as well as the effect of obstructions on the hemodynamics of the portal vein system using the computational fluid dynamics (CFD) method. PVT can probably develop in the inlets of the portal vein as well as the left/right branches of the portal vein because the distribution of wall shear stress satisfies the conditions for PVT formation based upon the simulation of the hemodynamics in the normal portal vein model. According to the above results, geometric models for a portal vein with a thrombus were constructed and the influence of different degrees (26%, 39%, 53% and 64%) of obstructions was studied. In the model with the maximum obstruction (64% blocked), the maximum velocity of portal vein (PV) increased up to twice than in the model without thrombosis, and the maximum wall shear stress of PV in the model with thrombosis (64% blocked) increased up to 9.4 Pa, whereas it was only 1.9 Pa in the model without thrombosis (nearly one fifth of the maximum wall shear stress). Excessive wall shear stress may cause mechanical damage to the blood vessels and induce physiological changes.
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Affiliation(s)
- XINKAI WANG
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an 710049, P. R. China
| | - GUOJIE LI
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an 710049, P. R. China
| | - BIN CHEN
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an 710049, P. R. China
| | - YANSONG PU
- Scientific Research Center, Department of General Surgery, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, P. R. China
| | - PENG NIE
- Huaihe Hospital of Henan University, Kaifeng 475000, P. R. China
| | - XIAO LI
- State Key Laboratory of Multiphase Flow in Power Engineering, Xi'an Jiaotong University, Xi'an 710049, P. R. China
| | - ZONGFANG LI
- Scientific Research Center, Department of General Surgery, The Second Affiliated Hospital, School of Medicine, Xi'an Jiaotong University, Xi'an 710004, P. R. China
| | - KAI SU
- Huaihe Hospital of Henan University, Kaifeng 475000, P. R. China
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Mahmoud HS, Mostafa EF, Mohammed MAW. Role of portal haemodynamic parameters in prediction of oesophageal varices in cirrhotic patients. Arab J Gastroenterol 2014; 15:130-4. [PMID: 25499211 DOI: 10.1016/j.ajg.2014.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 05/17/2014] [Accepted: 09/15/2014] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND STUDY AIMS Screening all cirrhotic patients by endoscopy for detection of varices is not cost-effective as the number of patients increases by time and half of them still would not have developed varices 10years after being diagnosed with cirrhosis. Therefore, this study aimed to evaluate hepatic haemodynamic Doppler parameters in predicting the presence of oesophageal varices (OVs) in cirrhotic patients for better selection of those actually needed for screening endoscopy. PATIENTS AND METHODS Eighty-one patients with liver cirrhosis, 32 females and 49 males, with a mean age of 50.7±11.7years were recruited for the study. They included 61 patients with OVs and 20 patients without varices. The diagnosis of liver cirrhosis was based on clinical history, examination, and investigations. Liver function and kidney function tests and complete blood count (CBC) were performed for all patients. All patients underwent abdominal ultrasound (US), upper endoscopy, and hepatic Doppler US examination. RESULTS The portal vein velocity (PVV) and liver vascular index (LVI) showed statistically significantly lower values in patients with OVs than those without OVs (p value=0.02 and 0.000, respectively). The congestion index (CI) of the portal vein, the portal hypertension index (PHI), and the splenoportal index (SPI) showed statistically significantly higher values in patients with OVs than those without OVs (p value=0.006, 0.001, and 0.001, respectively). CI and SPI were the best parameters that could predict the presence of OVs with high sensitivity, specificity, and diagnostic accuracy when cutoff values were set at >0.069 and 3.57, respectively (area under the curve=0.864 and 0.894, respectively). CONCLUSIONS The CI of the portal vein and SPI are good predictors for the presence of OVs in cirrhotic patients, and could be used noninvasively to decrease the burden on the upper endoscopy unit by proper selection of those who are candidates for screening endoscopy.
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Affiliation(s)
- Hasan S Mahmoud
- Department of Tropical Medicine and Gastroenterology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ehab F Mostafa
- Department of Tropical Medicine and Gastroenterology, Assiut Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohammed A W Mohammed
- Department of Tropical medicine and Gastroenterology, Sohag Faculty of Medicine, Sohag University, Egypt
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Clinical application of partial splenic embolization. ScientificWorldJournal 2014; 2014:961345. [PMID: 25538966 PMCID: PMC4235844 DOI: 10.1155/2014/961345] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 09/20/2014] [Accepted: 09/29/2014] [Indexed: 02/05/2023] Open
Abstract
Partial splenic embolization (PSE) is one of the intra-arterial therapeutic approaches of diseases. With the development of interventional radiology, the applications of PSE in clinical practice are greatly extended, while various materials are developed for embolization use. Common indications of PSE include hypersplenism with portal hypertension, hereditary spherocytosis, thalassemia, autoimmune hemolytic anemia, splenic trauma, idiopathic thrombocytopenic purpura, splenic hemangioma, and liver cancer. It is also performed to exclude splenic artery aneurysms from the parent vessel lumen and prevent aneurysm rupture, to treat splenic artery steal syndrome and improve liver perfusion in liver transplant recipients, and to administer targeted treatment to areas of neoplastic disease in the splenic parenchyma. Indicators of the therapeutic effect evaluation of PSE comprise blood routine test, changes in hemodynamics and in splenic volume. Major complications of PSE include the pulmonary complications, severe infection, damages of renal and liver function, and portal vein thrombosis. The limitations of PSE exist mainly in the difficulties in selecting the arteries to embolize and in evaluating the embolized volume.
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Shastri M, Kulkarni S, Patell R, Jasdanwala S. Portal vein Doppler: a tool for non-invasive prediction of esophageal varices in cirrhosis. J Clin Diagn Res 2014; 8:MC12-5. [PMID: 25177589 DOI: 10.7860/jcdr/2014/8571.4589] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 05/15/2014] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Esophageal varices (EV), a major complication of liver cirrhosis, can lead to life threatening gastrointestinal (GI) bleeding. Esophagogastroduodenoscopy (EGD) is the gold standard for diagnosis and management of esophageal varices. However, it is not always available in resource-constrained settings.This study was aimed at evaluating portal vein indices (PVI) using Doppler on ultrasound abdomen, which is more widely available, as tools to predict the presence of EV. METHODS A total of 50 adult patients with cirrhosis were included in the study. All subjects underwent a percutaneous liver biopsy, abdominal ultrasound and EGD along with other tests as part of the work up for cirrhosis. The portal vein indices that were studied included hepatic congestion index (HCI), portal vein diameter (PVD) and portal vein velocity (PVV). Their sensitivity, specificity and predictive values were calculated using EGD as a gold standard. RESULTS Association of PVD, PVV and HCI with presence of EV was statistically significant (p-value <0.01). PVV had the highest sensitivity 84% (95% CI 66.45%- 94.10%) for detecting the presence of EV. PVD and HCI had the highest specificity of 55% (95% CI 0.31-0.77) and the highest negative predictive value of 38%(95% CI 0.24-0.52). Positive predictive value was highest PVV at 76%. (95% CI 0.61-0.86). CONCLUSION In resources- constricted settings where EGD is not available, PVI (PVV, PVD and HCI) on ultrasound abdomen can be used as non-invasive parameters to predict the presence of EV. Although EGD remains the gold standard for the diagnosis and management of EV, when this is not possible due to scarcity of resources, PVV may be used a tool to triage patients for referral for an EGD as it has the highest sensitivity of 84% (95% CI 66.45%-94.10%) and positive predictive value of 76% (95% CI 61.51%-86.47%) amongst the PVI studied for detecting the presence of EV.
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Affiliation(s)
- Minal Shastri
- Associate Professor, Department of Medicine, Medical College Baroda, Gujarat, India
| | - Sujay Kulkarni
- Senior Resident, Department of Medicine, Medical College Baroda, Gujarat, India
| | - Rushad Patell
- Senior Resident, Department of Medicine, Medical College Baroda, Gujarat, India
| | - Sarfaraz Jasdanwala
- Resident, Department of Internal Medicine, Monmouth Medical Center , New Jersey, USA
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Noiret L, Baigent S, Jalan R. Arterial ammonia levels in cirrhosis are determined by systemic and hepatic hemodynamics, and by organ function: a quantitative modelling study. Liver Int 2014; 34:e45-55. [PMID: 24134128 DOI: 10.1111/liv.12361] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 10/13/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Hyperammonaemia is a common complication of chronic liver failure. Two main factors are thought to underlie this complication: a loss of hepatic detoxification function and the development of portosystemic shunting. However, few studies have tried to quantify the importance of portosystemic shunting. Here, we used a theoretical approach to test the hypothesis that the development of portosystemic shunting is sufficient to cause hyperammonaemia in cirrhosis. METHODS Two mathematical models are developed. The first one describes the main vascular resistances of the circulation and is used to provide scenarios for the distributions of organ blood flow in cirrhosis, which are necessary to run the second model. The second model predicts arterial ammonia levels resulting from ammonia metabolism in gut, liver, kidney, muscle and brain, and the distribution of organ blood flow. RESULTS The fraction of gastrointestinal blood flow shunted through collaterals was estimated to be 41% in mild cirrhosis, 69% in moderate and 85% in severe cases. In the second model, the redistribution of organ blood flow associated with severe cirrhosis was sufficient to cause hyperammonaemia, even when the hepatic detoxification function and the ammonia production were set to normal. CONCLUSIONS The model indicates that the development of portosystemic shunting in cirrhosis is sufficient to cause hyperammonaemia. Interventions that reduce the fraction of shunting may be future targets of therapy to control severity of hyperammonaemia.
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Hadduck TA, McWilliams JP. Partial splenic artery embolization in cirrhotic patients. World J Radiol 2014; 6:160-168. [PMID: 24876920 PMCID: PMC4037542 DOI: 10.4329/wjr.v6.i5.160] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/09/2014] [Accepted: 05/08/2014] [Indexed: 02/06/2023] Open
Abstract
Splenomegaly is a common sequela of cirrhosis, and is frequently associated with decreased hematologic indices including thrombocytopenia and leukopenia. Partial splenic artery embolization (PSE) has been demonstrated to effectively increase hematologic indices in cirrhotic patients with splenomegaly. This is particularly valuable amongst those cirrhotic patients who are not viable candidates for splenectomy. Although PSE was originally developed decades ago, it has recently received increased attention. Presently, PSE is being utilized to address a number of clinical concerns in the setting of cirrhosis, including: decreased hematologic indices, portal hypertension and its associated sequela, and splenic artery steal syndrome. Following PSE patients demonstrate significant increases in platelets and leukocytes. Though progressive decline of hematologic indices occur following PSE, they remain improved as compared to pre-procedural values over long-term follow-up. PSE, however, is not without risk and complications of the procedure may occur. The most common complication of PSE is post-embolization syndrome, which involves a constellation of symptoms including fever, pain, and nausea/vomiting. The rate of complications has been shown to increase as the percent of total splenic volume embolized increases. The purpose of this review is to explore the current literature in regards to PSE in cirrhotic patients and to highlight their techniques, and statistically summarize their results and associated complications.
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Zardi EM, Di Matteo FM, Pacella CM, Sanyal AJ. Invasive and non-invasive techniques for detecting portal hypertension and predicting variceal bleeding in cirrhosis: a review. Ann Med 2014; 46:8-17. [PMID: 24328372 PMCID: PMC4904298 DOI: 10.3109/07853890.2013.857831] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Portal hypertension is a severe syndrome that may derive from pre-sinusoidal, sinusoidal, and post-sinusoidal causes. As a consequence, several complications (i.e. ascites, oesophageal varices) may develop. In sinusoidal portal hypertension, hepatic venous pressure gradient (HVPG) is a reliable method for defining the grade of portal pressure, establishing the effectiveness of the treatment, and predicting the occurrence of complications; however, some questions exist regarding its ability to discriminate bleeding from non-bleeding varices in cirrhotic patients. Other imaging techniques (transient elastography, endoscopy, endosonography, and duplex Doppler sonography) for assessing causes and complications of portal hypertensive syndrome are available and may be valuable for the management of these patients. In this review, we evaluate invasive and non-invasive techniques currently employed to obtain a clinical prediction of deadly complications, such as variceal bleeding in patients affected by sinusoidal portal hypertension, in order to create a diagnostic algorithm to manage them. Again, HVPG appears to be the reference standard to evaluate portal hypertension and monitor the response to treatment, but its ability to predict several complications and support management decisions might be further improved through the diagnostic combination with other imaging techniques.
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Affiliation(s)
- Enrico Maria Zardi
- Department of Clinical Medicine, 'Campus Bio-Medico' University , Rome , Italy
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Fathi MS, EL-Folly RF, Hassan RA, El-Arab ME. Genotypic and phenotypic patterns of antimicrobial susceptibility of Helicobacter pylori strains among Egyptian patients. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2013. [DOI: 10.1016/j.ejmhg.2013.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Ran HT, Ye XP, Zheng YY, Zhang DZ, Wang ZG, Chen J, Madoff D, Gao J. Spleen stiffness and splenoportal venous flow: assessment before and after transjugular intrahepatic portosystemic shunt placement. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:221-228. [PMID: 23341376 DOI: 10.7863/jum.2013.32.2.221] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To prospectively assess changes in spleen stiffness and splenoportal venous flow before and after transjugular intrahepatic portosystemic shunt (TIPS) placement. METHODS We prospectively evaluated spleen stiffness measured by the mean shear wave velocity with acoustic radiation force impulse imaging and the splenoportal venous velocity with color Doppler sonography in 12 patients (mean age ± SD, 42.6 ± 11.0 years; range, 29-65 years) who underwent TIPS placement for portal hypertension and gastroesophageal bleeding. The mean shear wave velocity and angle-corrected splenoportal venous velocity at the main portal and splenic veins were measured 1 day before and 3 to 9 days after TIPS placement (mean interval, 6.0 ± 1.95 days; range, 4-10 days) and were compared with portal vein pressure measured during the procedure. RESULTS There was a significant difference in portal vein pressure before and after TIPS (25.34 ± 6.21 versus 15.66 ± 6.07 mm Hg; P = .0005). After TIPS, the mean shear wave velocity decreased significantly in all 12 cases (3.50 ± 0.46 versus 3.15 ± 0.39 m/s before and after TIPS; P = .00015). The flow velocity at the main portal vein increased significantly after TIPS (22.21 ± 4.13 versus 47.25 ± 12.37 cm/s; P = .0000051). The splenic vein velocity and spleen index measured 25.57 ± 6.98 cm/s and 55.99 ± 21.27 cm(2), respectively, before TIPS and 35.72 ± 11.10 cm/s and 50.11 ± 21.12 cm(2) after TIPS (P = .0004 and .003). CONCLUSIONS A significant decrease in the mean shear wave velocity and increase in the splenoportal venous velocity occurred with reduced portal vein pressure after TIPS placement. Hence, both parameters can be used as noninvasive quantitative markers for monitoring TIPS function after placement.
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Affiliation(s)
- Hai-Tao Ran
- Institute of Ultrasound Imaging, Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Xu L, Ji F, Xu QW, Zhang MQ. Risk factors for predicting early variceal rebleeding after endoscopic variceal ligation. World J Gastroenterol 2011; 17:3347-52. [PMID: 21876624 PMCID: PMC3160540 DOI: 10.3748/wjg.v17.i28.3347] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 02/26/2011] [Accepted: 03/05/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To analyze the clinical risk factors for early variceal rebleeding after endoscopic variceal ligation (EVL).
METHODS: 342 cirrhotic patients with esophageal varices who received elective EVL to prevent bleeding or rebleeding at our endoscopy center between January 2005 and July 2010. were included in this study. The early rebleeding cases after EVL were confirmed by clinical signs or endoscopy. A case-control study was performed comparing the patients presenting with early rebleeding with those without this complication.
RESULTS: The incidence of early rebleeding after EVL was 7.60%, and the morbidity of rebleeding was 26.9%. Stepwise multivariate logistic regression analysis showed that four variables were independent risk factors for early rebleeding: moderate to excessive ascites [odds ratio (OR) 62.83, 95% CI: 9.39-420.56, P < 0.001], the number of bands placed (OR 17.36, 95% CI: 4.00-75.34, P < 0.001), the extent of varices (OR 15.41, 95% CI: 2.84-83.52, P = 0.002) and prothrombin time (PT) > 18 s (OR 11.35, 95% CI: 1.93-66.70, P = 0.007).
CONCLUSION: The early rebleeding rate after EVL is mainly affected by the volume of ascites, number of rubber bands used to ligate, severity of varices and prolonged PT. Effective measures for prevention and treatment should be adopted before and after EVL.
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Coriat R, Gouya H, Mir O, Ropert S, Vignaux O, Chaussade S, Sogni P, Pol S, Blanchet B, Legmann P, Goldwasser F. Reversible decrease of portal venous flow in cirrhotic patients: a positive side effect of sorafenib. PLoS One 2011; 6:e16978. [PMID: 21340026 PMCID: PMC3038868 DOI: 10.1371/journal.pone.0016978] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 01/15/2011] [Indexed: 12/12/2022] Open
Abstract
Portal hypertension, the most important complication with cirrhosis of the liver, is a serious disease. Sorafenib, a tyrosine kinase inhibitor is validated in advanced hepatocellular carcinoma. Because angiogenesis is a pathological hallmark of portal hypertension, the goal of our study was to determine the effect of sorafenib on portal venous flow and portosystemic collateral circulation in patients receiving sorafenib therapy for advanced hepatocellular carcinoma. Porto-collateral circulations were evaluated using a magnetic resonance technique prior sorafenib therapy, and at day 30. All patients under sorafenib therapy had a decrease in portal venous flow of at least 36%. In contrast, no specific change was observed in the azygos vein or the abdominal aorta. No portal venous flow modification was observed in the control group. Sorafenib is the first anti-angiogenic therapy to demonstrate a beneficial and reversible decrease of portal venous flow among cirrhotic patients.
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Affiliation(s)
- Romain Coriat
- Center for Research on Angiogenesis Inhibitors (CERIA), Hôpital Cochin, AP-HP, Paris, France.
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Johnson TN, Boussery K, Rowland-Yeo K, Tucker GT, Rostami-Hodjegan A. A semi-mechanistic model to predict the effects of liver cirrhosis on drug clearance. Clin Pharmacokinet 2010; 49:189-206. [PMID: 20170207 DOI: 10.2165/11318160-000000000-00000] [Citation(s) in RCA: 168] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Liver cirrhosis is characterized by a decrease in functional hepatocytes, lowered circulating levels of plasma proteins and alterations in blood flow due to the development of portacaval shunts. Depending on the interplay between these parameters and the characteristics of an administered drug, varying degrees of impaired systemic clearance and first-pass metabolism are anticipated. The Simcyp Population-based ADME Simulator has already been used successfully to incorporate genetic, physiological and demographic attributes of certain subgroups within healthy populations into in vitro-in vivo extrapolation (IVIVE) of xenobiotic clearance. The objective of this study was to extend population models to predict systemic and oral drug clearance in relation to the severity of liver cirrhosis. METHODS Information on demographics, changes in hepatic blood flow, cytochrome P450 enzymes, liver size, plasma protein binding and renal function was incorporated into three separate population libraries. The latter corresponded to Child-Pugh scores A (mild), B (moderate) and C (severe) liver cirrhosis. These libraries, together with mechanistic IVIVE within the Simcyp Simulator, were used to predict the clearance of intravenous and oral midazolam, oral caffeine, intravenous and oral theophylline, intravenous and oral metoprolol, oral nifedipine, oral quinidine, oral diclofenac, oral sildenafil, and intravenous and oral omeprazole. The simulated patients matched the clinical studies as closely as possible with regard to demographics and Child-Pugh scores. Predicted clearance values in both healthy control and liver cirrhosis populations were compared with observed values, as were the fold increases in clearance values between these populations. RESULTS There was good agreement (lack of statistically significant difference, two-tailed paired t-test) between observed and predicted clearance ratios, with the exception of those for two studies of intravenous omeprazole. Predicted clearance ratios were within 0.8- to 1.25-fold of observed ratios in 65% of cases (range 0.34- to 2.5-fold). CONCLUSION The various drugs that were studied showed different changes in clearance in relation to disease severity, and a 'one size fits all' solution does not exist without considering the multiple sources of the changes. Predictions of the effects of liver cirrhosis on drug clearance are of potential value in the design of clinical studies during drug development and, clinically, in the assessment of likely dosage adjustment.
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Yang Y, George S, Martin DR, Tannenbaum AR, Giddens DP. 3D modeling of patient-specific geometries of portal veins using MR images. CONFERENCE PROCEEDINGS : ... ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL CONFERENCE 2008; 2006:5290-3. [PMID: 17946691 DOI: 10.1109/iembs.2006.260291] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this note, we present an approach for developing patient-specific 3D models of portal veins to provide geometric boundary conditions for computational fluid dynamics (CFD) simulations of the blood flow inside portal veins. The study is based on MRI liver images of individual patients to which we apply image registration and segmentation techniques and inlet and outlet velocity profiles acquired using PC-MRI in the same imaging session. The portal vein and its connected veins are then extracted and visualized in 3D as surfaces. Image registration is performed to align shifted images between each breath-hold when the MRI images are acquired. The image segmentation method first labels each voxel in the 3D volume of interest by using a Bayesian probability approach, and then isolates the portal veins via active surfaces initialized inside the vessel. The method was tested with two healthy volunteers. In both cases, the main portal vein and its connected veins were successfully modeled and visualized.
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Affiliation(s)
- Yan Yang
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA.
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Yoshimoto T, Kotoh K, Horikawa Y, Kohjima M, Morizono S, Yamashita S, Enjoji M, Nakamuta M. Decreased portal flow volume increases the area of necrosis caused by radio frequency ablation in pigs. Liver Int 2007; 27:368-72. [PMID: 17355459 DOI: 10.1111/j.1478-3231.2007.01454.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
BACKGROUND/AIMS Although radio frequency ablation (RFA) has been widely accepted as an effective treatment for hepatocellular carcinoma (HCC), severe complications are not uncommon. Major complications seem to occur as a result of over-ablation beyond the intended area. As most patients with HCC have underlying cirrhosis, we speculated that decreased portal flow might cause the necrosis associated with RFA. To confirm this hypothesis, we examined the area of necrosis resulting from RFA under varying conditions of portal flow in a porcine model. METHODS RFA was performed using ultrasonographic guidance in anesthetized pigs. During the RFA procedure, portal flow was regulated by a balloon catheter, which was set in a portal trunk. The necrosis area was measured after sacrifice and was compared with the hyperechoic area that appeared during ablation. In another session, RFA was performed close to the hepatic vein and endothelial damage was examined. RESULTS The necrosis area caused by RFA was significantly larger when the portal flow volume was decreased by 50% or more. The hyperechoic lesion was always larger than the area of pathological necrosis regardless of portal flow volume. Under conditions of decreased portal flow, the vessel endothelium near the ablated area was more readily damaged. CONCLUSION Decreased portal flow volume resulted in enlargement of the area of necrosis caused by RFA. Our results indicate that over-ablation could easily occur in patients with advanced cirrhosis, and that this could lead to major complications. Ultrasonographic guidance may be helpful for avoiding over-ablation.
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Affiliation(s)
- Tsuyoshi Yoshimoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Science, Kyushu University, Fukuoka, Japan
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