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Zheng T, Qu Y, Chen J, Yang J, Yan H, Jiang H, Song B. Noninvasive diagnosis of liver cirrhosis: qualitative and quantitative imaging biomarkers. Abdom Radiol (NY) 2024; 49:2098-2115. [PMID: 38372765 DOI: 10.1007/s00261-024-04225-8] [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: 10/30/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/20/2024]
Abstract
A diagnosis of cirrhosis initiates a shift in the management of chronic liver disease and affects the diagnostic workflow and treatment decision of primary liver cancer. Liver biopsy remains the gold standard for cirrhosis diagnosis, but it is invasive and susceptible to sampling bias and observer variability. Various qualitative and quantitative imaging biomarkers based on ultrasound, CT and MRI have been proposed for noninvasive diagnosis of cirrhosis. Qualitative imaging features are easy to apply but have moderate diagnostic sensitivity. Elastography techniques allow quantitative assessment of liver stiffness and are highly accurate for cirrhosis diagnosis. Ultrasound elastography are widely used in clinical practice, while MR elastography has narrower availability. Although not applicable in clinical practice yet, other quantitative imaging features, including liver surface nodularity, linear and volumetric measurement, extracellular volume fraction, liver enhancement on hepatobiliary phase, and parameters derived from diffusion-weighted imaging, can provide additional information of liver morphology, perfusion, and function, thus may increase diagnosis performance. The introduction of radiomics and deep learning has further improved diagnostic accuracy while reducing subjectivity. Several imaging features may also help to assess liver function and outcomes in patients with cirrhosis. In this review, we summarize the qualitative and quantitative imaging biomarkers for noninvasive cirrhosis diagnosis, and the assessment of liver function and outcomes, and discuss the challenges and future directions in this field.
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Affiliation(s)
- Tianying Zheng
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China
- Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China
| | - Yali Qu
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China
- Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China
| | - Jie Chen
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China
- Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China
| | - Jie Yang
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hualin Yan
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hanyu Jiang
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China
- Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China
| | - Bin Song
- Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China.
- Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China.
- Department of Radiology, Sanya People's Hospital, Sanya, Hainan, China.
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Sun X, Ni HB, Xue J, Wang S, Aljbri A, Wang L, Ren TH, Li X, Niu M. Bibliometric-analysis visualization and review of non-invasive methods for monitoring and managing the portal hypertension. Front Med (Lausanne) 2022; 9:960316. [PMID: 36186776 PMCID: PMC9520322 DOI: 10.3389/fmed.2022.960316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPortal hypertension monitoring is important throughout the natural course of cirrhosis. Hepatic venous pressure gradient (HVPG), regarded as the golden standard, is limited by invasiveness and technical difficulties. Portal hypertension is increasingly being assessed non-invasively, and hematological indices, imaging data, and statistical or computational models are studied to surrogate HVPG. This paper discusses the existing non-invasive methods based on measurement principles and reviews the methodological developments in the last 20 years.MethodsFirst, we used VOSviewer to learn the architecture of this field. The publications about the non-invasive assessment of portal hypertension were retrieved from the Web of Science Core Collection (WoSCC). VOSviewer 1.6.17.0 was used to analyze and visualize these publications, including the annual trend, the study hotspots, the significant articles, authors, journals, and organizations in this field. Next, according to the cluster analysis result of the keywords, we further retrieved and classified the related studies to discuss.ResultsA total of 1,088 articles or review articles about our topic were retrieved from WoSCC. From 2000 to 2022, the number of publications is generally growing. “World Journal of Gastroenterology” published the most articles (n = 43), while “Journal of Hepatology” had the highest citations. “Liver fibrosis” published in 2005 was the most influential manuscript. Among the 20,558 cited references of 1,088 retrieved manuscripts, the most cited was a study on liver stiffness measurement from 2007. The highest-yielding country was the United States, followed by China and Italy. “Berzigotti, Annalisa” was the most prolific author and had the most cooperation partners. Four study directions emerged from the keyword clustering: (1) the evaluation based on fibrosis; (2) the evaluation based on hemodynamic factors; (3) the evaluation through elastography; and (4) the evaluation of variceal bleeding.ConclusionThe non-invasive assessment of portal hypertension is mainly based on two principles: fibrosis and hemodynamics. Liver fibrosis is the major initiator of cirrhotic PH, while hemodynamic factors reflect secondary alteration of splanchnic blood flow. Blood tests, US (including DUS and CEUS), CT, and magnetic resonance imaging (MRI) support the non-invasive assessment of PH by providing both hemodynamic and fibrotic information. Elastography, mainly USE, is the most important method of PH monitoring.
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Affiliation(s)
- XiaoHan Sun
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Hong Bo Ni
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Jian Xue
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Shuai Wang
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Afaf Aljbri
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Liuchun Wang
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Tian Hang Ren
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Xiao Li,
| | - Meng Niu
- Department of Interventional Radiology, The First Hospital of China Medical University, Shenyang, China
- Meng Niu,
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Xu W, Li B, Yang Z, Li J, Liu F, Liu Y. Rethinking Liver Fibrosis Staging in Patients with Hepatocellular Carcinoma: New Insights from a Large Two-Center Cohort Study. J Hepatocell Carcinoma 2022; 9:751-781. [PMID: 35983561 PMCID: PMC9380840 DOI: 10.2147/jhc.s372577] [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: 04/27/2022] [Accepted: 07/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) is a prevalent and aggressive malignancy closely related to background chronic liver disease. This study aimed to explore predictive factors associated with background liver fibrosis burden in patients with HCC and sought to construct a practical predictive model for clinical use. Methods This large two-center retrospective cohort study evaluated data from Chinese medical centers. Uni- and multivariate ordinal logistic regression analyses were performed to identify variables associated with liver fibrosis stages. Predictive models based on variables identified by multivariate analysis were established in the Derivation Cohort and subjected to internal and external validation. Model performance was evaluated for discriminative and calibration abilities. Results Multivariate ordinal logistic regression analysis identified liver fibrosis severity score (LFSS), portal hypertension (PH) severity, plateletcrit (PCT) and model for end-stage liver disease-sodium (MELD-Na) as independent predictors of liver fibrosis stage in HCC patients. Nomograms that integrated these factors disclosed that the area under receiver operating characteristic curves (AUROCs) to predict S1 in the Derivation and External Validation cohorts were 0.850 and 0.919, respectively. Internal validation disclosed C-indexes of 0.823 and 0.833 in the Derivation and External Validation cohorts, respectively, indicating that the nomogram had good and excellent performance for distinguishing between S1 and non-S1 patients. Nomogram performance in the Derivation and External Validation cohorts, respectively, was fair and good to predict stage S2 (AUROCs 0.726, 0.806; C-indexes 0.713, 0.791); poor for S3 (AUROCs 0.648, 0.698; C-indexes 0.616, 0.666); good for S4 (AUROCs 0.812, 0.824; C-indexes 0.804, 0.792); and good for S3+S4 (AUROCs 0.806, 0.840; C-indexes 0.795, 0.811). Conclusion We propose new predictive models for the staging of background liver fibrosis in patients with HCC that can be implemented into clinical practice as important complements to hepatic imaging to inform HCC management strategy.
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Affiliation(s)
- Wei Xu
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People's Republic of China
| | - Bolun Li
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People's Republic of China
| | - Zhanwei Yang
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People's Republic of China
| | - Jingdong Li
- Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, People's Republic of China
| | - Fei Liu
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People's Republic of China
| | - Yu Liu
- Department of Pathology, Hunan Provincial People's Hospital, The First Hospital Affiliated with Hunan Normal University, Changsha, People's Republic of China
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Jang W, Song JS, Kim TH, Yoon KH. Intraindividual comparison of MRI-derived liver surface nodularity score at 1.5 T and 3 T. Abdom Radiol (NY) 2022; 47:1053-1060. [PMID: 35064351 DOI: 10.1007/s00261-022-03415-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/07/2022] [Accepted: 01/07/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE To compare the MRI-derived liver surface nodularity (LSN) scores acquired on both 1.5 T and 3 T. MATERIALS AND METHODS Forty chronic liver disease patients who underwent gadoxetic acid-enhanced MRI at both 1.5 and 3 T were included. Axial hepatobiliary phase images with the same voxel size were used to calculate the LSN score in both liver lobes with a quantitative software. Rank correlation, Wilcoxon test, and Bland-Altman limits of agreement were used for statistical analysis. RESULTS There was a weak correlation between the right and left liver lobe on 1.5 T (rs = 0.331, p = 0.037) and 3 T (rs = 0.381, p = 0.015). The correlation between 1.5 T and 3 T on both liver lobes showed a very strong correlation (right, rs = 0.927, p < 0.001; left, rs = 0.845, p < 0.001). LSN scores differed significantly between both lobes on 1.5 T (median, 1.201 vs. 0.674, right vs. left) and 3 T (1.076 vs. 0.592) (all p < 0.001). LSN scores differed significantly between 1.5 T and 3 T on both lobes (all p < 0.001). The Bland-Altman plot comparing 1.5 T and 3 T on right and left liver lobes showed a systemic bias of 0.08 and 0.07, respectively. CONCLUSIONS LSN scores differed significantly on 1.5 T vs. 3 T and right vs. left liver lobe. Caution should be made when comparing LSN scores derived from different field strengths or the hepatic lobe. Interplatform, interlobar reproducibility should be resolved to use LSN scores, which is relatively easy to perform without additional hardware or images.
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Affiliation(s)
- Weon Jang
- Department of Radiology, Jeonbuk National University Medical School and Hospital, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea
- Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonbuk, Korea
| | - Ji Soo Song
- Department of Radiology, Jeonbuk National University Medical School and Hospital, Jeonju, Korea.
- Research Institute of Clinical Medicine of Jeonbuk National University, Jeonju, Korea.
- Biomedical Research Institute of Jeonbuk National University Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, 54907, Jeonbuk, Korea.
| | - Tae-Hoon Kim
- Medical Convergence Research Center, Wonkwang University, Iksan, South Korea
| | - Kwon-Ha Yoon
- Medical Convergence Research Center, Wonkwang University, Iksan, South Korea
- Department of Radiology, Wonkwang University School of Medicine, Iksan, South Korea
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De Broucker C, Plessier A, Ollivier-Hourmand I, Dharancy S, Bureau C, Cervoni JP, Sogni P, Goria O, Corcos O, Sartoris R, Ronot M, Vilgrain V, de Raucourt E, Zekrini K, Davy H, Durand F, Payancé A, Fidouh-Houhou N, Yazdanpanah Y, Valla D, Rautou PE. Multicenter study on recent portal venous system thrombosis associated with cytomegalovirus disease. J Hepatol 2022; 76:115-122. [PMID: 34563580 DOI: 10.1016/j.jhep.2021.09.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/23/2021] [Accepted: 09/09/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Recent non-malignant non-cirrhotic portal venous system thrombosis (PVT) is a rare condition. Among risk factors for PVT, cytomegalovirus (CMV) disease is usually listed based on a small number of reported cases. The aim of this study was to determine the characteristics and outcomes of PVT associated with CMV disease. METHODS We conducted a French multicenter retrospective study comparing patients with recent PVT and CMV disease ("CMV positive"; n = 23) to patients with recent PVT for whom CMV testing was negative ("CMV negative"; n = 53) or unavailable ("CMV unknown"; n = 297). RESULTS Compared to patients from the "CMV negative" and "CMV unknown" groups, patients from the "CMV positive" group were younger, more frequently had fever, and had higher heart rate, lymphocyte count and serum ALT levels (p ≤0.01 for all). The prevalence of immunosuppression did not differ between the 3 groups (4%, 4% and 6%, respectively). Extension of PVT was similar between the 3 groups. Thirteen out of 23 "CMV positive" patients had another risk factor for thrombosis. Besides CMV disease, the number of risk factors for thrombosis was similar between the 3 groups. Heterozygosity for the prothrombin G20210A gene variant was more frequent in "CMV positive" patients (22%) than in the "CMV negative" (4%, p = 0.01) and "CMV unknown" (8%, p = 0.03) groups. Recanalization rate was not influenced by CMV status. CONCLUSIONS In patients with recent PVT, features of mononucleosis syndrome should raise suspicion of CMV disease. CMV disease does not influence thrombosis extension nor recanalization. More than half of "CMV positive" patients have another risk factor for thrombosis, with a particular link to the prothrombin G20210A gene variant. LAY SUMMARY Patients with cytomegalovirus (CMV)-associated portal venous system thrombosis have similar thrombosis extension and evolution as patients without CMV disease. However, patients with CMV-associated portal venous system thrombosis more frequently have the prothrombin G20210A gene variant, suggesting that these entities act synergistically to promote thrombosis.
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Affiliation(s)
- Chloé De Broucker
- Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de recherche sur l'inflammation, Inserm, UMR 1149, Paris, France
| | - Aurélie Plessier
- Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de recherche sur l'inflammation, Inserm, UMR 1149, Paris, France
| | - Isabelle Ollivier-Hourmand
- Service d'Hépato-Gastroentérologie et Nutrition, Centre Hospitalo-Universitaire Côte de Nacre, Caen, France
| | - Sébastien Dharancy
- Service d'Hépatologie et de Gastroentérologie, Hôpital Huriez, Centre Hospitalo-Universitaire de Lille, Lille, France
| | - Christophe Bureau
- Service d'Hépatologie, Centre Hospitalo-Universitaire de Toulouse, Université Paul Sabatier Toulouse 3, Toulouse, France
| | - Jean-Paul Cervoni
- Service d'hépatologie et de soins intensifs digestifs, Centre Hospitalo-Universitaire Régional Jean-Minjoz, Besançon, France
| | - Philippe Sogni
- Université de Paris, APHP, Service d'Hépatologie, Hôpital Cochin, Paris, France
| | - Odile Goria
- Service d'Hépatologie et de Gastroentérologie, Hôpital Charles Nicolle, Centre Hospitalo-Universitaire de Rouen, Rouen, France
| | - Olivier Corcos
- Université de Paris, AP-HP, Hôpital Beaujon, Service de Gastroentérologie Assistance Nutritive, DMU DIGEST, Paris, France
| | - Riccardo Sartoris
- Service de radiologie, CHU Paris Nord-Val de Seine - Hôpital Beaujon, Clichy, France
| | - Maxime Ronot
- Service de radiologie, CHU Paris Nord-Val de Seine - Hôpital Beaujon, Clichy, France
| | - Valérie Vilgrain
- Service de radiologie, CHU Paris Nord-Val de Seine - Hôpital Beaujon, Clichy, France
| | - Emmanuelle de Raucourt
- Service d'hématologie biologique, CHU Paris Nord-Val de Seine - Hôpital Beaujon, Clichy, France
| | - Kamal Zekrini
- Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de recherche sur l'inflammation, Inserm, UMR 1149, Paris, France
| | - Hortense Davy
- Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de recherche sur l'inflammation, Inserm, UMR 1149, Paris, France
| | - François Durand
- Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de recherche sur l'inflammation, Inserm, UMR 1149, Paris, France
| | - Audrey Payancé
- Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de recherche sur l'inflammation, Inserm, UMR 1149, Paris, France
| | - Nadira Fidouh-Houhou
- Université de Paris, Department of Virology Unit, APHP, Bichat-Claude Bernard University Hospital, Paris, France
| | - Yazdan Yazdanpanah
- Université de Paris, APHP, Bichat-Claude Bernard University Hospital, Department of Infectious and Tropical Diseases, IAME, Inserm, Umr 1137, Paris, France
| | - Dominique Valla
- Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de recherche sur l'inflammation, Inserm, UMR 1149, Paris, France
| | - Pierre-Emmanuel Rautou
- Université de Paris, AP-HP, Hôpital Beaujon, Service d'Hépatologie, DMU DIGEST, Centre de Référence des Maladies Vasculaires du Foie, FILFOIE, ERN RARE-LIVER, Centre de recherche sur l'inflammation, Inserm, UMR 1149, Paris, France.
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Liu Y, Tang T, Örmeci N, Huang Y, Wang J, Li X, Li Z, An W, Liu D, Zhang C, Liu C, Liu J, Liu C, Wang G, Mosconi C, Cappelli A, Bruno A, Akçalar S, Çelebioğlu E, Üstüner E, Bilgiç S, Ellik Z, Asiller ÖÖ, Li L, Zhang H, Kang N, Xu D, He R, Wang Y, Bu Y, Gu Y, Ju S, Golfieri R, Qi X. Noncontrast-enhanced MRI-based Noninvasive Score for Portal Hypertension (CHESS1802): An International Multicenter Study. J Clin Transl Hepatol 2021; 9:818-827. [PMID: 34966645 PMCID: PMC8666380 DOI: 10.14218/jcth.2021.00177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/10/2021] [Accepted: 08/29/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIMS This study aimed to determine the performance of the non-invasive score using noncontrast-enhanced MRI (CHESS-DIS score) for detecting portal hypertension in cirrhosis. METHODS In this international multicenter, diagnostic study (ClinicalTrials.gov, NCT03766880), patients with cirrhosis who had hepatic venous pressure gradient (HVPG) measurement and noncontrast-enhanced MRI were prospectively recruited from four university hospitals in China (n=4) and Turkey (n=1) between December 2018 and April 2019. A cohort of patients was retrospectively recruited from a university hospital in Italy between March 2015 and November 2017. After segmentation of the liver on fat-suppressed T1-weighted MRI maps, CHESS-DIS score was calculated automatically by an in-house developed code based on the quantification of liver surface nodularity. RESULTS A total of 149 patients were included, of which 124 were from four Chinese hospitals (training cohort) and 25 were from two international hospitals (validation cohort). A positive correlation between CHESS-DIS score and HVPG was found with the correlation coefficients of 0.36 (p<0.0001) and 0.55 (p<0.01) for the training and validation cohorts, respectively. The area under the receiver operating characteristic curve of CHESS-DIS score in detection of clinically significant portal hypertension (CSPH) was 0.81 and 0.9 in the training and validation cohorts, respectively. The intraclass correlation coefficients for assessing the inter- and intra-observer agreement were 0.846 and 0.841, respectively. CONCLUSIONS A non-invasive score using noncontrast-enhanced MRI was developed and proved to be significantly correlated with invasive HVPG. Besides, this score could be used to detect CSPH in patients with cirrhosis.
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Affiliation(s)
- Yanna Liu
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- CHESS Center, The Sixth People’s Hospital of Shenyang, Shenyang, Liaoning, China
- Department of Infectious Disease, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Tianyu Tang
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China
| | - Necati Örmeci
- Istanbul Health and Technology University, Zytinburnu/İstanbul, Turkey
| | - Yifei Huang
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Jitao Wang
- CHESS Working Party, Xingtai People’s Hospital, Xingtai, Hebei, China
| | - Xiaoguo Li
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Zhiwei Li
- Department of Hepatobiliary Surgery, The Third People’s Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Weimin An
- Department of Radiology, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Dengxiang Liu
- CHESS Working Party, Xingtai People’s Hospital, Xingtai, Hebei, China
| | - Chunqing Zhang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Changchun Liu
- Department of Radiology, Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Jinqiang Liu
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China
| | - Chuan Liu
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Guangchuan Wang
- Department of Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Cristina Mosconi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Italy
| | - Alberta Cappelli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Italy
| | - Antonio Bruno
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Italy
| | - Seray Akçalar
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Emrecan Çelebioğlu
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Evren Üstüner
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Sadık Bilgiç
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Zeynep Ellik
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Özgün Ömer Asiller
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Lei Li
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Haijun Zhang
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Ning Kang
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Dan Xu
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Ruiling He
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
| | - Yan Wang
- CHESS Center, The Sixth People’s Hospital of Shenyang, Shenyang, Liaoning, China
| | - Yang Bu
- Department of Hepatobiliary Surgery, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, Ningxia, China
| | - Ye Gu
- CHESS Center, The Sixth People’s Hospital of Shenyang, Shenyang, Liaoning, China
| | - Shenghong Ju
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China
- Correspondence to: Xiaolong Qi, CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, Gansu, China. ORCID: https://orcid.org/0000-0002-3559-5855. Tel: +86-18588602600, Fax: +86-931-8619-797, E-mail: ; Rita Golfieri, Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. ORCID: https://orcid.org/0000-0001-8809-9989. Tel: +39-51-2142-311, Fax: +39-51-6362-699, E-mail: ; Shenghong Ju, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China. ORCID: https://orcid.org/0000-0001-5041-7865. Tel/Fax: +86-25-8327-2121, E-mail:
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, University of Bologna, Italy
- Correspondence to: Xiaolong Qi, CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, Gansu, China. ORCID: https://orcid.org/0000-0002-3559-5855. Tel: +86-18588602600, Fax: +86-931-8619-797, E-mail: ; Rita Golfieri, Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. ORCID: https://orcid.org/0000-0001-8809-9989. Tel: +39-51-2142-311, Fax: +39-51-6362-699, E-mail: ; Shenghong Ju, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China. ORCID: https://orcid.org/0000-0001-5041-7865. Tel/Fax: +86-25-8327-2121, E-mail:
| | - Xiaolong Qi
- CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, Gansu, China
- CHESS Center, The Sixth People’s Hospital of Shenyang, Shenyang, Liaoning, China
- Correspondence to: Xiaolong Qi, CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, 1 Donggang West Road, Lanzhou, Gansu, China. ORCID: https://orcid.org/0000-0002-3559-5855. Tel: +86-18588602600, Fax: +86-931-8619-797, E-mail: ; Rita Golfieri, Department of Experimental, Diagnostic and Specialty Medicine – DIMES, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. ORCID: https://orcid.org/0000-0001-8809-9989. Tel: +39-51-2142-311, Fax: +39-51-6362-699, E-mail: ; Shenghong Ju, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China. ORCID: https://orcid.org/0000-0001-5041-7865. Tel/Fax: +86-25-8327-2121, E-mail:
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Liver surface nodularity on non-contrast MRI identifies advanced fibrosis in patients with NAFLD. Eur Radiol 2021; 32:1781-1791. [PMID: 34533606 DOI: 10.1007/s00330-021-08261-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To evaluate the diagnostic performance of liver surface nodularity (LSN) for the assessment of advanced fibrosis in patients with non-alcoholic fatty liver disease (NAFLD). METHODS We retrospectively analysed patients with pathologically proven NAFLD who underwent liver MRI. Demographic, clinical, and laboratory data (including FIB-4 scores) were gathered. The SAF score was used to assess NAFLD. MRI-proton density fat fraction (PDFF) and LSN were determined on pre-contrast MR sequences. ROC curve analysis was performed to evaluate the diagnostic performance of MRI-LSN for the diagnosis of advanced (F3-F4) liver fibrosis. RESULTS The final population included 142 patients. Sixty-seven (47%) patients had non-alcoholic steatohepatitis (NASH), and 52 (37%) had advanced fibrosis. The median MRI-PDFF increased with the grades of steatosis: 8.1%, 18.1%, and 31% in S1, S2, and S3 patients, respectively (p < 0.001). The area under the ROC curve (AUC) of MRI-LSN ≥ 2.50 was 0.838 (95%CI 0.767-0.894, sensitivity 67.3%, specificity 88.9%, positive and negative predictive values 77.8% and 82.5%, respectively) for the diagnosis of advanced fibrosis. Combining FIB-4 and MRI-LSN correctly classified 103/142 (73%) patients. This was validated in an external cohort of 75 patients. CONCLUSIONS MRI-LSN has good diagnostic performance in diagnosis of advanced fibrosis in NAFLD patients. A combination of FIB-4 and MRI-LSN derived from pre-contrast MRI could be helpful to detect advanced fibrosis. KEY POINTS • MRI-LSN ≥ 2.5 was accurate for the diagnosis of advanced hepatic fibrosis in NAFLD patients. • The combination of FIB-4 and MRI-LSN improved the detection of advanced fibrosis. • MRI-LSN can be easily derived by unenhanced MRI sequences that are routinely acquired.
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EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis - 2021 update. J Hepatol 2021; 75:659-689. [PMID: 34166721 DOI: 10.1016/j.jhep.2021.05.025] [Citation(s) in RCA: 725] [Impact Index Per Article: 241.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 02/07/2023]
Abstract
Non-invasive tests are increasingly being used to improve the diagnosis and prognostication of chronic liver diseases across aetiologies. Herein, we provide the latest update to the EASL Clinical Practice Guidelines on the use of non-invasive tests for the evaluation of liver disease severity and prognosis, focusing on the topics for which relevant evidence has been published in the last 5 years.
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9
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Liver surface nodularity: a novel predictor of post-hepatectomy liver failure in patients with colorectal liver metastases following chemotherapy. Eur Radiol 2021; 31:5830-5839. [PMID: 33666699 DOI: 10.1007/s00330-020-07683-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The goal of this study was to assess the relationship between liver surface nodularity (LSN), chemotherapy-associated liver injury (CALI), and clinically relevant post-hepatectomy liver failure (CR-PHLF) (i.e., ≥ grade B) in patients undergoing hepatectomy for colorectal liver metastases (CLM). METHODS Preoperative CT scans of patients who underwent chemotherapy followed by hepatectomy for CLM between 2010 and 2017 were retrospectively analyzed. LSN was measured using semi-automated CT software CT images in patients who had available preoperative CT scans within 6 weeks before hepatectomy, and was computed based on the means of one to 10 measurements by two abdominal radiologists consensually. The association of LSN, CALI, and CR-PHLF was analyzed. RESULTS Two hundred fifty-six patients were analyzed (149 men and 107 women; overall median age, 61 [range, 29-88 years]). A total of 26 patients (10.2%) developed CR-PHLF. The optimal LSN cut-off value for detecting CR-PHLF was 2.5, as determined by receiver operative characteristic analysis (p < 0.001). LSN ≥ 2.5 was associated with prolonged chemotherapy (> 6 cycles, p = 0.018), but not with CALIs. After propensity score matching, LSN remained significantly associated with CR-PHLF (p = 0.031). Furthermore, multivariate analysis identified LSN ≥ 2.50 and future liver remnant (FLR) < 30% as significant preoperative predictors of CR-PHLF in 102 patients undergoing major hepatectomy. LSN ≥ 2.50 was more frequent in patients undergoing major hepatectomy despite FLR ≥ 30% (p = 0.008). CONCLUSION LSN quantified on CT is an independent surrogate of CR-PHLF in patients who undergo chemotherapy followed by hepatectomy for CLM and may provide a valuable additional tool in the preoperative assessment of these patients. KEY POINTS • LSN was not associated with chemotherapy- associated liver injury but high LSN (defined ≥ 2.5) was associated with prolonged chemotherapy (> 6 cycles). • High LSN was an independent predictor of clinically relevant postoperative liver failure in patients undergoing hepatectomy for CRLM. • LSN ≥ 2.50 was more frequent in patients with PHLF after major hepatectomy despite a future liver remnant ≥ 30%.
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Kennedy P, Bane O, Hectors SJ, Fischman A, Schiano T, Lewis S, Taouli B. Noninvasive imaging assessment of portal hypertension. Abdom Radiol (NY) 2020; 45:3473-3495. [PMID: 32926209 PMCID: PMC10124623 DOI: 10.1007/s00261-020-02729-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/16/2020] [Accepted: 08/30/2020] [Indexed: 02/07/2023]
Abstract
Portal hypertension (PH) is a spectrum of complications of chronic liver disease (CLD) and cirrhosis, with manifestations including ascites, gastroesophageal varices, splenomegaly, hypersplenism, hepatic hydrothorax, hepatorenal syndrome, hepatopulmonary syndrome and portopulmonary hypertension. PH can vary in severity and is diagnosed via invasive hepatic venous pressure gradient measurement (HVPG), which is considered the reference standard. Accurate diagnosis of PH and assessment of severity are highly relevant as patients with clinically significant portal hypertension (CSPH) are at higher risk for developing acute variceal bleeding and mortality. In this review, we discuss current and upcoming noninvasive imaging methods for diagnosis and assessment of severity of PH.
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Souhami A, Sartoris R, Rautou PE, Cauchy F, Bouattour M, Durand F, Giannelli V, Gigante E, Castera L, Valla D, Soubrane O, Vilgrain V, Ronot M. Similar performance of liver stiffness measurement and liver surface nodularity for the detection of portal hypertension in patients with hepatocellular carcinoma. JHEP Rep 2020; 2:100147. [PMID: 32885156 PMCID: PMC7452899 DOI: 10.1016/j.jhepr.2020.100147] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/22/2020] [Accepted: 06/30/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND & AIMS We compare the performance of liver surface nodularity (LSN) and liver stiffness measurements (LSM) using transient elastography (TE) for the detection of clinically significant portal hypertension (CSPH) in patients with cirrhosis and hepatocellular carcinoma (HCC). METHODS All patients with cirrhosis and HCC who underwent computed tomography, LSM and hepatic venous pressure gradient (HVPG) measurements within 30 days between 2015 and 2018 were included. The estimation of CSPH by LSN and LSM, and the LSM-spleen-size-to-platelet ratio score (LSPS) were evaluated and compared. RESULTS In total, 140 patients were included (109 men [78%], mean age 63 ± 9 years old), including 39 (28%) with CSPH. LSN measurements were valid in 130 patients (93%) and significantly correlated with HVPG (r = 0.68; p <0.001). Patients with CSPH had higher LSN measurements compared with those without [3.1 ± 0.4 vs. 2.5 ± 0.3, p <0.001; area under the receiver operating characteristic (AUROC): 0.87 ± 0.31]. LSM and LSPS were valid in 132 patients (94%) and significantly correlated with HVPG (r = 0.75, p <0.001; AUROC 0.87 ± 0.04 and r = 0.68, p <0.001; AUROC 0.851 ± 0.04, respectively). There was no significant difference in the diagnostic performance between LSN and LSM-LSPS (DeLong, p = 0.28, 0.37, and 0.65, respectively) in patients with both valid tests (n = 122). LSN <2.50 had a 100% negative predictive value for CSPH. A 2-step algorithm combining LSN and LSPS for the diagnosis of CSPH classified 108/140 patients (77%) with an 8% error. CONCLUSIONS The diagnostic performance and feasibility of LSN measurements were similar to those of LSM for the detection of CSPH in patients with compensated cirrhosis and HCC. Combining LSN and LSPS accurately detected CSPH in >75% of patients. Such a combination could be useful in centres where the HVPG measurement is unavailable. LAY SUMMARY The diagnostic performance and feasibility of liver surface nodularity was similar to that of liver stiffness measurement (LSM) for the detection of clinically significant portal hypertension in patients with compensated cirrhosis. Thus, liver surface nodularity could be an option for the preoperative detection of clinically significant portal hypertension in patients with hepatocellular carcinoma. Combining liver surface nodularity with LSM-spleen-size-to-platelet ratio score resulted in the accurate detection of clinically significant portal hypertension in >75% of patients, thus limiting the need for HVPG measurements.
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Key Words
- AUROC, area under the receiver operating characteristic
- CSPH, clinically significant portal hypertension
- HCC, hepatocellular carcinoma
- HPV, hepatic venous pressure
- HVPG, hepatic venous pressure gradient
- LSM, liver stiffness measurements
- LSN, liver surface nodularity
- LSPS, LSM-spleen-size-to-platelet ratio score
- NRI, Net Classification Index Improvement
- PHT, portal hypertension
- TE, transient elastography
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Affiliation(s)
- Alexandra Souhami
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Riccardo Sartoris
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Pierre-Emmanuel Rautou
- Service d'Hépatologie, DHU Unity, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France
- Université de Paris, Centre de Recherche sur l'Inflammation, Inserm, U1149, CNRS, ERL8252, F-75018 Paris, France
- Centre de Référence des Maladies Vasculaires du Foie, French Network for Rare Liver Diseases (FILFOIE), European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Clichy, France
| | - François Cauchy
- Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Mohamed Bouattour
- Service d'Hépatologie, DHU Unity, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France
| | - François Durand
- Service d'Hépatologie, DHU Unity, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France
- Université de Paris, Centre de Recherche sur l'Inflammation, Inserm, U1149, CNRS, ERL8252, F-75018 Paris, France
| | - Valerio Giannelli
- Service d'Hépatologie, DHU Unity, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France
| | - Elia Gigante
- Service d'Hépatologie, DHU Unity, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France
| | - Laurent Castera
- Service d'Hépatologie, DHU Unity, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France
| | - Dominique Valla
- Service d'Hépatologie, DHU Unity, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France
- Université de Paris, Centre de Recherche sur l'Inflammation, Inserm, U1149, CNRS, ERL8252, F-75018 Paris, France
| | - Olivier Soubrane
- Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- Université de Paris, Centre de Recherche sur l'Inflammation, Inserm, U1149, CNRS, ERL8252, F-75018 Paris, France
- INSERM U1149, CRI, Paris, France
| | - Maxime Ronot
- Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France
- Université de Paris, Centre de Recherche sur l'Inflammation, Inserm, U1149, CNRS, ERL8252, F-75018 Paris, France
- INSERM U1149, CRI, Paris, France
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12
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Seror M, Sartoris R, Hobeika C, Bouattour M, Paradis V, Rautou PE, Soubrane O, Vilgrain V, Cauchy F, Ronot M. Computed Tomography-Derived Liver Surface Nodularity and Sarcopenia as Prognostic Factors in Patients with Resectable Metabolic Syndrome-Related Hepatocellular Carcinoma. Ann Surg Oncol 2020; 28:405-416. [PMID: 32965614 DOI: 10.1245/s10434-020-09143-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of this study was to assess the prognostic value of liver surface nodularity (LSN) and sarcopenia from preoperative computed tomography (CT) in patients with resectable metabolic syndrome (MS)-related hepatocellular carcinoma (HCC). METHODS Patients with MS undergoing hepatectomy for HCC between 2006 and 2018 at a single center were retrospectively analyzed. LSN and sarcopenia were assessed on preoperative CT scans, and their association with severe (Clavien-Dindo grade 3-5) postoperative complications was analyzed on multivariate analysis. The influence of LSN and sarcopenia on overall survival (OS) and recurrence-free survival (RFS) was assessed. RESULTS Overall, 110 patients (92 men [84%], mean 67.7 ± 7.7 years of age) were analyzed. Severe postoperative complications occurred in 34/110 (31%) patients. Patients with severe complications had a significantly higher LSN score (area under the receiver operating characteristic curve 0.68 ± 0.05, optimal cut-off > 2.50) and were more frequently sarcopenic (47% vs. 13% without major complications, p < 0.001). Multivariate analysis identified sarcopenia (odds ratio [OR] 6.51, 95% confidence interval [CI] 2.08-20.39; p < 0.001), LSN > 2.50 (OR 7.05, 95% CI 2.13-23.35; p < 0.001), and preoperative portal vein embolization (PVE; OR 6.06, 95% CI 1.71-21.48; p = 0.005) as independent predictors of severe complications. LSN and sarcopenia had no influence on OS. Stratification according to a combination of LSN > 2.50 and sarcopenia predicted the risk of severe postoperative complications from 7% (no sarcopenia and LSN ≤2.50) to 71% (sarcopenia and LSN > 2.50; p < 0.001), as well as RFS from 61 months (95% CI 40-82) to 17 months (95% CI 9-25; p = 0.033). Results remained significant in 52 patients without advanced fibrosis. CONCLUSIONS The combination of LSN and sarcopenia derived from routine preoperative CT seems to help predict severe postoperative complications and stratification of RFS in patients with MS and resectable HCC.
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Affiliation(s)
- Martin Seror
- Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - Riccardo Sartoris
- Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France.,Université de Paris, Centre de recherche sur l'inflammation, Inserm, U1149, CNRS, ERL8252, Paris, France
| | - Christian Hobeika
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - Mohamed Bouattour
- Department of Hepatology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - Valérie Paradis
- Department of Pathology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France.,Université de Paris, Centre de recherche sur l'inflammation, Inserm, U1149, CNRS, ERL8252, Paris, France
| | - Pierre-Emmanuel Rautou
- Department of Hepatology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France.,Université de Paris, Centre de recherche sur l'inflammation, Inserm, U1149, CNRS, ERL8252, Paris, France
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France
| | - Valérie Vilgrain
- Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France.,Université de Paris, Centre de recherche sur l'inflammation, Inserm, U1149, CNRS, ERL8252, Paris, France
| | - François Cauchy
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France.,Université de Paris, Centre de recherche sur l'inflammation, Inserm, U1149, CNRS, ERL8252, Paris, France
| | - Maxime Ronot
- Department of Radiology, Beaujon Hospital, Assistance Publique Hôpitaux de Paris and Université de Paris, Clichy, France. .,Université de Paris, Centre de recherche sur l'inflammation, Inserm, U1149, CNRS, ERL8252, Paris, France.
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Sartoris R, Lazareth M, Nivolli A, Dioguardi Burgio M, Vilgrain V, Ronot M. CT-based liver surface nodularity for the detection of clinically significant portal hypertension: defining measurement quality criteria. Abdom Radiol (NY) 2020; 45:2755-2763. [PMID: 32270261 DOI: 10.1007/s00261-020-02519-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To establish measurement quality criteria for the noninvasive assessment of clinically significant portal hypertension (CSPH) in patients with cirrhosis using CT-based liver surface nodularity (LSN) measurements. METHODS Seventy-four consecutive patients with cirrhosis (mean 62 ± 13 years), including 30 with CSPH (41%), underwent CT and hepatic venous pressure gradient measurements. Three independent readers performed 15 LSN measurements/patient using dedicated software. LSN was computed based on the median and means of one to 15 measurements. Accuracy for diagnosing CSPH was assessed using receiver operating characteristic (ROC) curve analysis. Variability was assessed by the intra-class correlation coefficient (ICC) and the Bland-Altman plot (BA). Quality criteria were identified to maximize the accuracy of LSN and minimize variability. RESULTS The area under the (AU) ROCs of mean and median LSN measurements based on one to 15 measurements ranged from 0.79 ± 0.05 to 0.91 ± 0.04 and 0.86 ± 0.04 to 0.91 ± 0.03, respectively, with no difference on pair-wise comparisons (all p > 0.05). AUROCs of LSN increased from one to eight and leveled off between eight and 15 measurements. Inter- and intra-reader variability decreased from one to 15 measurements, with only slight improvement after more than eight measurements. Intra- and inter-observer agreements were excellent with eight measurements (ICC = 0.90 [95%CI 0.84-0.94], and ICC = 0.93 [95%CI 0.89-0.95], respectively), and variability for intra-observer and inter-observer agreement was low (BA bias 4.2% (95% limits of agreement [LoA] [- 15.3; + 23.7%]) and 4.8% LoA [ - 17.5; + 27.1%], respectively). CONCLUSIONS CT-based LSN measurement is highly reproducible and accurate. We suggest using at least 8 valid measurements to determine the mean LSN value for the detection of CSPH.
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Affiliation(s)
- Riccardo Sartoris
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, 100 boulevard du Général Leclerc, 92110, Clichy, France
- Faculté de Médecine, Université de Paris, Paris, France
- INSERM U1149, Centre de Recherche de L'Inflammation (CRI), Paris, France
| | - Marie Lazareth
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - Arianna Nivolli
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, 100 boulevard du Général Leclerc, 92110, Clichy, France
| | - Marco Dioguardi Burgio
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, 100 boulevard du Général Leclerc, 92110, Clichy, France
- Faculté de Médecine, Université de Paris, Paris, France
- INSERM U1149, Centre de Recherche de L'Inflammation (CRI), Paris, France
| | - Valérie Vilgrain
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, 100 boulevard du Général Leclerc, 92110, Clichy, France
- Faculté de Médecine, Université de Paris, Paris, France
- INSERM U1149, Centre de Recherche de L'Inflammation (CRI), Paris, France
| | - Maxime Ronot
- Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Paris Nord Val de Seine, Hôpital Beaujon, 100 boulevard du Général Leclerc, 92110, Clichy, France.
- Faculté de Médecine, Université de Paris, Paris, France.
- INSERM U1149, Centre de Recherche de L'Inflammation (CRI), Paris, France.
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