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Nardelli S, Riggio O, Turco L, Gioia S, Puzzono M, Bianchini M, Ridola L, Aprile F, Gitto S, Pelle G, Di Martino M, Marzocchi G, Caporali C, Spagnoli A, Di Rocco A, Schepis F. Relevance of Spontaneous Portosystemic Shunts Detected with CT in Patients with Cirrhosis. Radiology 2021; 299:133-140. [PMID: 33529134 DOI: 10.1148/radiol.2021203051] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Cirrhosis leads to portal hypertension and to the consequent formation of spontaneous portosystemic shunts (SPSSs), leading to complications related to the diversion of portal blood into the systemic circulation, which is called portosystemic shunt syndrome. Purpose To investigate the characteristics of patients with cirrhosis and an SPSS and secondarily to assess the prognostic impact of SPSSs on portal hypertension-related complications and transplant-free survival. Materials and Methods A retrospective database review of patients with cirrhosis (observed from March 2015 to July 2019) was performed to identify patients with CT imaging and outcomes data. For each patient, clinical and biochemical data were collected, and the presence, types, and sizes of SPSSs were investigated with CT. Patients were followed for a mean of 27.5 months ± 22.8. Multivariable logistic analysis was used to identify the clinical characteristics associated with the presence of SPSSs (any size) and presence of SPSSs 1 cm or larger. Competitive risk analysis (Fine and Gray model) was used to identify the association between SPSSs and complications and mortality. Results Two hundred twenty-two patients with cirrhosis (157 male, 65 female; mean age, 62 years ± 12 [standard deviation]) were evaluated. An SPSS was found in 141 of 222 patients (63.5%), and 40 of 222 (18%) had a shunt diameter of at least 1 cm. At presentation, variables independently associated with the presence of SPSSs (any size) were portal vein thrombosis (odds ratio, 5.5; P = .008) and Child-Pugh class C (odds ratio, 3.0; P = .03). Previous hepatic encephalopathy (odds ratio, 4.4; P = .001) and portal vein thrombosis (odds ratio, 5.3; P = .001) were the only variables associated with SPSSs larger than 1 cm. Patients with SPSSs of any size had higher mortality (subdistribution hazard ratio, 1.9; P < .001) and higher frequency of hepatic encephalopathy (subdistribution hazard ratio, 2.3; P = .023), gastrointestinal bleeding (subdistribution hazard ratio, 2.9; P = .039), and portal vein thrombosis (subdistribution hazard ratio, 7.6; P = .005). Conclusion The presence of spontaneous portosystemic shunts on CT images in patients with cirrhosis was associated with higher mortality and complications, including portal vein thrombosis, hepatic encephalopathy, and gastrointestinal bleeding. © RSNA, 2021 See also the editorial by Reeder in this issue.
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Affiliation(s)
- Silvia Nardelli
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
| | - Oliviero Riggio
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
| | - Laura Turco
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
| | - Stefania Gioia
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
| | - Marta Puzzono
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
| | - Marcello Bianchini
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
| | - Lorenzo Ridola
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
| | - Francesca Aprile
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
| | - Stefano Gitto
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
| | - Giuseppe Pelle
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
| | - Michele Di Martino
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
| | - Guido Marzocchi
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
| | - Cristian Caporali
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
| | - Alessandra Spagnoli
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
| | - Arianna Di Rocco
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
| | - Filippo Schepis
- From the Department of Translational and Precision Medicine (S.N., O.R., S. Gioia, M.P., L.R., F.A.), Department of Radiological Sciences, Oncology, and Anatomical Pathology (M.D.M.), and Department of Public Health and Infectious Diseases (A.S., A.D.R.), Sapienza University of Rome, Viale dell'Università 37, 00161 Rome, Italy; Departments of Gastroenterology (L.T., M.B., S. Gitto, F.S.) and Radiology (G.M., C.C.), University of Modena and Reggio Emilia, Modena, Italy; Department of Interventional Radiology, Santa Maria Goretti Hospital, Latina, Italy (G.P.); and Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy (S. Gitto)
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