A non-invasive multi-slice spiral CT-based diagnostic model predicts portal hypertension in liver cirrhotic patients

Abstract

Abstract: Objective To study on the value of noninvasive evaluation of portal hypertension in patients with liver cirrhosis by morphological characteristics of liver and spleen measured by multi-slice spiral CT. Methods Eighty-eight hospitalized cirrhotic patients in Shanghai Changzheng Hospital from September 2016 to December 2020 were enrolled in this study based on the inclusion and exclusion criteria. Patients with liver cirrhosis were divided into non-portal hypertension group, mild portal hypertension group (with esophagogastric varices or hypersplenism alone) and severe portal hypertension group (with both esophagogastric varices and hypersplenism). Add/Remove Structure software was used to measure the total liver volume and spleen volume. Hepatic venous pressure gradient (HVPG) was measured by vascular intervention method. Results There were no significant differences in the distribution of portal hypertension among Child-Pugh A, B and C patients with liver cirrhosis. There was a descendent trend but no significant differences in the associated CT parameters of liver volume within high portal pressure group [(1075.97±399.90) cm³], and the mild portal pressure group [(1053.14±281.21) cm³], and the severe portal hypertension group[(949.87±229.77) cm³]. However, the spleen volume was a good parameter to distinguish patients with portal hypertension. The spleen volume in the non-portal hypertension group was [(397.32±309.49) cm³], in mild portal hypertension group was[(676.55±274.69) cm³], and in severe portal hypertension group was[(903.80±362.33) cm³]. For the distinction of patients with mild and severe portal hypertension by spleen volume, the underlying area of the ROC curve was more than 0.700, reaching 0.894. By multi-regression analysis, the linear evaluation model of portal vein pressure was constructed, and portal vein pressure (mmHg)=-0.08×age-1.06×platelet + 1.89×CRP-1.71×LN total biliarylin + 2.06×spleen volume. This diagnostic model had a very good diagnostic value for portal hypertension, with the ROC curve as high as 0.859 (95%CI 0.759, 0.950), and a diagnostic sensitivity of 80.65%, and specificity of 55.56%. Conclusion The noninvasive evaluation model established by combining serological indexes and imaging parameters is simple and easy. It has preferable value for predicting portal pressure.

Key words: Portal hypertension, multi-layer spiral CT, full liver volume, spleen volume, diagnosis

WANG Jian, SHI Pei-mei, SHEN Jie, WEI Yu. A non-invasive multi-slice spiral CT-based diagnostic model predicts portal hypertension in liver cirrhotic patients[J]. Chinese Hepatolgy, 2021, 26(11): 1240-1245.

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