Evaluation of hepatic blood perfusion parameters using spiral CT after transjugular intrahepatic portosystemic shunt in patients with hepatitis B cirrhosis and portal hypertension

Abstract

Abstract: Objective To evaluate the hepatic blood perfusion after transjugular intrahepatic portosystemic shunt (TIPS) in patients with hepatitis B cirrhosis and portal hypertension by using the hepatic blood perfusion parameters of spiral CT. Methods Between January 2020 and January 2024, 116 patients with hepatitis B cirrhosis complicated with portal hypertension were scanned with whole liver perfusion CT before and 1 week after TIPS. The image quality was evaluated and the changes of CT perfusion parameters was calculated by post-processing workstation. After a 6-month follow-up, the differences of CT perfusion parameters in patients with portal hypertension due to hepatitis B cirrhosis in different prognosis were compared. Results Hepatic artery perfusion (HAP), portal vein perfusion (PVP), total hepatic perfusion (THP) and hepatic artery perfusion index (HAPI) [1]in patients with hepatitis B cirrhosis complicated with portal hypertension were significantly different from those before TACE (P<0.05). The levels of alanine aminotransferase (ALT), albumin (Alb), total bilirubin (TBil) and prothrombin time (PT) in patients with hepatitis B cirrhosis complicated with portal hypertension were (32.1±7.4) U/L, (33.1±1.0) g/L, (17.3±2.9) μmol/L and (12.2±0.6) s at 1 week after TACE, compared with the patients in preoperative TACE group [(42.8±8.9) U/L, (32.0±1.1) g/L, (32.6±6.2) μmol/L and (13.4±1.0) s]. The difference was statistically significant (P<0.05). After following up for 6 months, 17 (14.6%) of the 116 patients died, including 6 (35.3%) from gastrointestinal bleeding and 11 (64.7%) from hepatic encephalopathy. HAP, PVP, THP and HAPI in death group were (23.1±11.6) mL/min × 100 mL, (38.0±14.3) mL/min × 100 mL and (54.7±19.3)%, their parameter were significantly lower than those in the survival group [(30.2±8.9) mL/min × 100 mL, (46.2±8.5) mL/min × 100 mL and (67.0±14.1)%, respectively, P<0.05]. Conclusion CT perfusion imaging was used to evaluate the changes of perfusion parameters before and after TIPS in patients with portal hypertension due to hepatitis B cirrhosis, and to understand the hemodynamic differences, so as to provide reference for preoperative and curative effect evaluation of patients.

Key words: Hepatitis B cirrhosis, Portal hypertension, Transjugular intrahepatic portosystemic shunt, CT perfusion imaging

DU Xin-yang, SHI Ke. Evaluation of hepatic blood perfusion parameters using spiral CT after transjugular intrahepatic portosystemic shunt in patients with hepatitis B cirrhosis and portal hypertension[J]. Chinese Hepatolgy, 2025, 30(2): 207-210.

References

[1] Chen R, Luo L, Zhang YZ, et al. Bayesian network-based survival prediction model for patients having undergone post-transjugular intrahepatic portosystemic shunt for portal hypertension[J]. World J Gastroenterol, 2024, 30(13):1859-1870.
[2] Pastrovic F, Novak R, Grgurevic I, et al. Serum proteomic profiling of patients with compensated advanced chronic liver disease with and without clinically significant portal hypertension[J]. PLoS One, 2024, 19(4):e0301416.
[3] Su Y, Chen Y, Zheng J, et al. Association between proton pump inhibitors and risk of hepatic encephalopathy in patients undergoing transjugular intrahepatic portosystemic shunt: a protocol for a systematic review and meta-analysis[J]. BMJ Open, 2024, 14(4):e078412.
[4] Gurtatta RS, Gaba RC, Herren JL. Combined spontaneous portosystemic shunt embolization and transjugular intrahepatic portosystemic shunt creation for treatment of hepatic encephalopathy[J]. J Vasc Interv Radiol, 2024, 35(5):659-663.
[5] Rössle M, Bettinger D, Sturm L, et al. Fibrosis progression in patients with Budd-Chiari syndrome and transjugular intrahepatic portosystemic shunt (TIPS): A long-term study using transient elastography[J]. Diagnostics (Basel), 2024, 14(3):344.
[6] Giri S, Anirvan P, Chaudhary M, et al. Impact of nutritional status on the outcome of transjugular intrahepatic portosystemic shunt in patients with cirrhosis: a systematic review[J]. Br J Radiol, 2024, 97(1154):331-340.
[7] Ganga KP, Gupta P, Kalra N, et al. Role of computed tomography perfusion in patients with liver cirrhosis and hepatocellular carcinoma[J]. J Clin Exp Hepatol, 2024, 14(1):101259.
[8] Song XJ, Liu JL, Jia SY, et al. Portal vein computed tomography imaging characteristics and their relationship with bleeding risk in patients with liver cirrhosis undergoing interventional therapy[J]. World J Clin Cases, 2023, 11(18):4277-4286.
[9] Dong J, Zhang Y, Wu YF, et al. Computed tomography perfusion in differentiating portal hypertension: A correlation study with hepatic venous pressure gradient[J]. World J Gastrointest Surg, 2023, 15(4):664-673.
[10] 中华医学会肝病学分会, 中华医学会感染病学分会. 慢性乙型肝炎防治指南(2022年版)[J]. 实用肝脏病杂志, 2023, 26(3):后插1-后插22.
[11] 翟亚楠, 李雷, 殷亮, 等. 双源CT全肝低剂量灌注成像对肝硬化门静脉高压患者经颈静脉肝内门体分流术后肝血流灌注的评估价值[J]. 临床肝胆病杂志, 2016, 32(10):1894-1899.
[12] Talakić E, Schaffellner S, Kniepeiss D, et al. CT perfusion imaging of the liver and the spleen in patients with cirrhosis: Is there a correlation between perfusion and portal venous hypertension?[J]. Eur Radiol, 2017, 27(10):4173-4180.
[13] Wang L, Zhang Y, Wu YF, et al. Computed tomography perfusion in liver and spleen for hepatitis B virus-related portal hypertension: A correlation study with hepatic venous pressure gradient[J]. World J Gastroenterol, 2022, 28(42):6068-6077.
[14] 吴晶晶, 李迎春, 孙勇, 等. TIPS术后肝脏灌注指标的变化及临床意义[J]. 中国临床医学影像杂志, 2015, 26(3):217-219.
[15] Weidekamm C, Cejna M, Kramer L, et al. Effects of TIPS on liver perfusion measured by dynamic CT[J]. AJR Am J Roentgenol, 2005, 184(2):505-510.
[16] Liao Y, Zhang L, Wang JT, et al. A novel nomogram predicting overt hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in portal hypertension patients[J]. Sci Rep, 2023, 13(1):15244.
[17] Giri S, Singh A, Angadi S, et al. Prevalence of hepatic encephalopathy in patients with non-cirrhotic portal hypertension: A systematic review and meta-analysis[J]. Indian J Gastroenterol, 2023, 42(5):642-650.
[18] Garcia-Tsao G, Abraldes JG, Berzigotti A, et al. Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases[J]. Hepatology, 2017, 65(1):310-335.
[19] Shneider BL, Bosch J, de Franchis R, et al. Portal hypertension in children: expert pediatric opinion on the report of the Baveno v Consensus Workshop on Methodology of Diagnosis and Therapy in Portal Hypertension[J]. Pediatr Transplant, 2012, 16(5):426-437.
[20] Téllez L, Guerrero A, Albillos A. Update on the diagnosis and management of portal hypertension in cirrhosis according to the Baveno VII Consensus Conference recommendations[J]. Rev Esp Enferm Dig, 2022, 114(9):534-542.
[21] Larrue H, D'Amico G, Olivas P, et al. TIPS prevents further decompensation and improves survival in patients with cirrhosis and portal hypertension in an individual patient data meta-analysis[J]. J Hepatol, 2023, 79(3):692-703.
[22] Yang M, Qin F, Zhou Y, et al Evaluation and clinical significance of contrast-enhanced ultrasound on changes in liver blood flow perfusion after TIPS surgery[J]. Medicine (Baltimore), 2024, 103(17):e37899.