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Wang C, Huang Y, Liu C, Liu F, Hu X, Kuang X, An W, Liu C, Liu Y, Liu S, He R, Wang H, Qi X. Diagnosis of Clinically Significant Portal Hypertension Using CT- and MRI-based Vascular Model. Radiology 2023; 307:e221648. [PMID: 36719293 DOI: 10.1148/radiol.221648] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Currently, the hepatic venous pressure gradient (HVPG) remains the reference standard for diagnosis of clinically significant portal hypertension (CSPH) but is limited by its invasiveness and availability. Purpose To investigate a vascular geometric model for noninvasive diagnosis of CSPH (HVPG ≥10 mm Hg) in patients with liver cirrhosis for both contrast-enhanced CT and MRI. Materials and Methods In this retrospective study, consecutive patients with liver cirrhosis who underwent HVPG measurement from August 2016 to April 2019 were included. Patients without hepatic diseases were included and marked as non-CSPH to balance the ratio of CSPH 1:1. A variety of vascular parameters were extracted from the portal vein, hepatic vein, aorta, and inferior vena cava and then entered into a vascular geometric model for identification of CSPH. Diagnostic performance was assessed with the area under the receiver operating characteristic curve (AUC). Results The model was developed and tested with retrospective data from 250 patients with liver cirrhosis and 273 patients without clinical evidence of hepatic disease at contrast-enhanced CT examination, including 213 patients with CSPH (mean age, 49 years ± 12 [SD]; 138 women) and 310 patients without CSPH (mean age, 50 years ± 9; 177 women). For external validation, an MRI data set with 224 patients with cirrhosis (mean age, 49 years ± 10; 158 women) and a CT data set with 106 patients with cirrhosis (mean age, 53 years ± 12; 71 women) were analyzed. Significant reductions in mean whole-vessel volumes were observed in the portal vein (ranging from 36.9 cm3 ± 16.0 to 29.6 cm3 ± 11.1; P < .05) and hepatic vein (ranging from 35.3 cm3 ± 21.5 to 22.4 cm3 ± 15.7; P < .05) when CSPH occurred. Similarly, the mean whole-vessel lengths were shorter in patients with CSPH (portal vein: 1.7 m ± 1.2 vs 3.0 m ± 2.4, P < .05; hepatic vein: 0.9 m ± 1.5 vs 1.8 m ± 1.5, P < .05) than in those without CSPH. The proposed vascular model performed well in the internal test set (mean AUC, 0.90 ± 0.02) and external test sets (mean AUCs, 0.84 ± 0.12 and 0.87 ± 0.11). Conclusion A contrast-enhanced CT- and MRI-based vascular model was proposed with good diagnostic consistency for hepatic venous pressure gradient measurement. ClinicalTrials.gov registration nos. NCT03138915 and NCT03766880 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Roldán-Alzate and Reeder in this issue.
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Affiliation(s)
- Chengyan Wang
- From the Human Phenome Institute (C.W., X.H., X.K., H.W.) and Institute of Science and Technology for Brain-inspired Intelligence (H.W.), Fudan University, Shanghai, China; Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China (Y.H., Chuan Liu, X.Q.); Department of Radiology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Changchun Liu, W.A.); Department of Interventional Therapy, Beijing Shijitan Hospital, Beijing, China (F.L.); Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China (Y.L.); and Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China (S.L., R.H.)
| | - Yifei Huang
- From the Human Phenome Institute (C.W., X.H., X.K., H.W.) and Institute of Science and Technology for Brain-inspired Intelligence (H.W.), Fudan University, Shanghai, China; Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China (Y.H., Chuan Liu, X.Q.); Department of Radiology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Changchun Liu, W.A.); Department of Interventional Therapy, Beijing Shijitan Hospital, Beijing, China (F.L.); Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China (Y.L.); and Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China (S.L., R.H.)
| | - Changchun Liu
- From the Human Phenome Institute (C.W., X.H., X.K., H.W.) and Institute of Science and Technology for Brain-inspired Intelligence (H.W.), Fudan University, Shanghai, China; Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China (Y.H., Chuan Liu, X.Q.); Department of Radiology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Changchun Liu, W.A.); Department of Interventional Therapy, Beijing Shijitan Hospital, Beijing, China (F.L.); Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China (Y.L.); and Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China (S.L., R.H.)
| | - Fuquan Liu
- From the Human Phenome Institute (C.W., X.H., X.K., H.W.) and Institute of Science and Technology for Brain-inspired Intelligence (H.W.), Fudan University, Shanghai, China; Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China (Y.H., Chuan Liu, X.Q.); Department of Radiology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Changchun Liu, W.A.); Department of Interventional Therapy, Beijing Shijitan Hospital, Beijing, China (F.L.); Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China (Y.L.); and Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China (S.L., R.H.)
| | - Xumei Hu
- From the Human Phenome Institute (C.W., X.H., X.K., H.W.) and Institute of Science and Technology for Brain-inspired Intelligence (H.W.), Fudan University, Shanghai, China; Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China (Y.H., Chuan Liu, X.Q.); Department of Radiology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Changchun Liu, W.A.); Department of Interventional Therapy, Beijing Shijitan Hospital, Beijing, China (F.L.); Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China (Y.L.); and Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China (S.L., R.H.)
| | - Xutong Kuang
- From the Human Phenome Institute (C.W., X.H., X.K., H.W.) and Institute of Science and Technology for Brain-inspired Intelligence (H.W.), Fudan University, Shanghai, China; Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China (Y.H., Chuan Liu, X.Q.); Department of Radiology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Changchun Liu, W.A.); Department of Interventional Therapy, Beijing Shijitan Hospital, Beijing, China (F.L.); Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China (Y.L.); and Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China (S.L., R.H.)
| | - Weimin An
- From the Human Phenome Institute (C.W., X.H., X.K., H.W.) and Institute of Science and Technology for Brain-inspired Intelligence (H.W.), Fudan University, Shanghai, China; Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China (Y.H., Chuan Liu, X.Q.); Department of Radiology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Changchun Liu, W.A.); Department of Interventional Therapy, Beijing Shijitan Hospital, Beijing, China (F.L.); Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China (Y.L.); and Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China (S.L., R.H.)
| | - Chuan Liu
- From the Human Phenome Institute (C.W., X.H., X.K., H.W.) and Institute of Science and Technology for Brain-inspired Intelligence (H.W.), Fudan University, Shanghai, China; Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China (Y.H., Chuan Liu, X.Q.); Department of Radiology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Changchun Liu, W.A.); Department of Interventional Therapy, Beijing Shijitan Hospital, Beijing, China (F.L.); Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China (Y.L.); and Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China (S.L., R.H.)
| | - Yanna Liu
- From the Human Phenome Institute (C.W., X.H., X.K., H.W.) and Institute of Science and Technology for Brain-inspired Intelligence (H.W.), Fudan University, Shanghai, China; Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China (Y.H., Chuan Liu, X.Q.); Department of Radiology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Changchun Liu, W.A.); Department of Interventional Therapy, Beijing Shijitan Hospital, Beijing, China (F.L.); Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China (Y.L.); and Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China (S.L., R.H.)
| | - Shanghao Liu
- From the Human Phenome Institute (C.W., X.H., X.K., H.W.) and Institute of Science and Technology for Brain-inspired Intelligence (H.W.), Fudan University, Shanghai, China; Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China (Y.H., Chuan Liu, X.Q.); Department of Radiology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Changchun Liu, W.A.); Department of Interventional Therapy, Beijing Shijitan Hospital, Beijing, China (F.L.); Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China (Y.L.); and Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China (S.L., R.H.)
| | - Ruiling He
- From the Human Phenome Institute (C.W., X.H., X.K., H.W.) and Institute of Science and Technology for Brain-inspired Intelligence (H.W.), Fudan University, Shanghai, China; Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China (Y.H., Chuan Liu, X.Q.); Department of Radiology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Changchun Liu, W.A.); Department of Interventional Therapy, Beijing Shijitan Hospital, Beijing, China (F.L.); Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China (Y.L.); and Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China (S.L., R.H.)
| | - He Wang
- From the Human Phenome Institute (C.W., X.H., X.K., H.W.) and Institute of Science and Technology for Brain-inspired Intelligence (H.W.), Fudan University, Shanghai, China; Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China (Y.H., Chuan Liu, X.Q.); Department of Radiology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Changchun Liu, W.A.); Department of Interventional Therapy, Beijing Shijitan Hospital, Beijing, China (F.L.); Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China (Y.L.); and Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China (S.L., R.H.)
| | - Xiaolong Qi
- From the Human Phenome Institute (C.W., X.H., X.K., H.W.) and Institute of Science and Technology for Brain-inspired Intelligence (H.W.), Fudan University, Shanghai, China; Center of Portal Hypertension, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China (Y.H., Chuan Liu, X.Q.); Department of Radiology, Fifth Medical Center of Chinese People's Liberation Army General Hospital, Beijing, China (Changchun Liu, W.A.); Department of Interventional Therapy, Beijing Shijitan Hospital, Beijing, China (F.L.); Department of Gastroenterology and Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China (Y.L.); and Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China (S.L., R.H.)
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Ternifi R, Wang Y, Gu J, Polley EC, Carter JM, Pruthi S, Boughey JC, Fazzio RT, Fatemi M, Alizad A. Ultrasound high-definition microvasculature imaging with novel quantitative biomarkers improves breast cancer detection accuracy. Eur Radiol 2022; 32:7448-7462. [PMID: 35486168 PMCID: PMC9616967 DOI: 10.1007/s00330-022-08815-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To overcome the limitations of power Doppler in imaging angiogenesis, we sought to develop and investigate new quantitative biomarkers of a contrast-free ultrasound microvasculature imaging technique for differentiation of benign from malignant pathologies of breast lesion. METHODS In this prospective study, a new high-definition microvasculature imaging (HDMI) was tested on 521 patients with 527 ultrasound-identified suspicious breast masses indicated for biopsy. Four new morphological features of tumor microvessels, microvessel fractal dimension (mvFD), Murray's deviation (MD), bifurcation angle (BA), and spatial vascularity pattern (SVP) as well as initial biomarkers were extracted and analyzed, and the results correlated with pathology. Multivariable logistic regression analysis was used to study the performance of different prediction models, initial biomarkers, new biomarkers, and combined new and initial biomarkers in differentiating benign from malignant lesions. RESULTS The new HDMI biomarkers, mvFD, BA, MD, and SVP, were statistically significantly different in malignant and benign lesions, regardless of tumor size. Sensitivity and specificity of the new biomarkers in lesions > 20 mm were 95.6% and 100%, respectively. Combining the new and initial biomarkers together showed an AUC, sensitivity, and specificity of 97% (95% CI: 95-98%), 93.8%, and 89.2%, respectively, for all lesions regardless of mass size. The classification was further improved by adding the Breast Imaging Reporting and Data System (BI-RADS) score to the prediction model, showing an AUC, sensitivity, and specificity of 97% (95% CI: 95-98%), 93.8%, and 89.2%, respectively. CONCLUSION The addition of new quantitative HDMI biomarkers significantly improved the accuracy in breast lesion characterization when used as a complementary imaging tool to the conventional ultrasound. KEY POINTS • Novel quantitative biomarkers extracted from tumor microvessel images increase the sensitivity and specificity in discriminating malignant from benign breast masses. • New HDMI biomarkers Murray's deviation, bifurcation angles, microvessel fractal dimension, and spatial vascularity pattern outperformed the initial biomarkers. • The addition of BI-RADS scores based on US descriptors to the multivariable analysis using all biomarkers remarkably increased the sensitivity, specificity, and AUC in all size groups.
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Affiliation(s)
- Redouane Ternifi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Yinong Wang
- Department of Radiology, Mayo Clinic College of Medicine and Science, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Juanjuan Gu
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Eric C Polley
- Department of Health Science, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jodi M Carter
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Sandhya Pruthi
- Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Judy C Boughey
- Department of Surgery, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Robert T Fazzio
- Department of Radiology, Mayo Clinic College of Medicine and Science, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Mostafa Fatemi
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Department of Radiology, Mayo Clinic College of Medicine and Science, 200 1st Street SW, Rochester, MN, 55905, USA.
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