CT-derived liver and spleen volume accurately diagnose clinically significant portal hypertension in patients with hepatocellular carcinoma

作者：Mario Romero‐Cristóbal, Ana Clemente, Enrique de Ramón, Luís Téllez, E. Canales Lachén, Olga Ortega Lobete, Elena Velilla-Aparicio, María‐Vega Catalina, Luis Ibáñez, Sonia Alonso López, Arturo Colón Rodríguez, Ana‐María Matilla, Magdalena Salcedo, Agustı́n Albillos, Rafael Bañares, Diego Rincón · 发表于：JHEP Reports · 年份：2022 · DOI：10.1016/j.jhepr.2022.100645 · 被引用次数：26 · 研究领域：Liver Disease and Transplantation、Hepatocellular Carcinoma Treatment and Prognosis、Liver Disease Diagnosis and Treatment

Background & Aims: Clinically significant portal hypertension (CSPH) is a landmark in the natural history of cirrhosis, influencing clinical decisions in patients with hepatocellular carcinoma (HCC). Previous small series suggested that splanchnic volume measurements may predict portal hypertension. We aimed to evaluate whether volumetry obtained by standard multidetector computerised tomography (MDCT) can predict CSPH in patients with HCC. Methods: We included 175 patients with HCC, referred for hepatic venous pressure gradient (HVPG) evaluation, in whom contemporary MDCT was available. Liver volume, spleen volume (SV) and liver segmental volume ratio (LSVR: volume of the segments I-III/volume of the segments IV-VIII) were calculated semi-automatically from MDCT. Other non-invasive tests (NITs) were also employed. Results: Volume parameters could be measured in almost 100% of cases with an excellent inter-observer agreement (intraclass correlation coefficient >0.950). SV and LSVR were independently associated with CSPH (HVPG ≥10 mmHg) and did not interact with aetiology. The volume Index (VI), calculated as the product of SV and LSVR, predicted CSPH (AUC 0.83; 95% CI 0.77-0.89). Similar results were observed in an external cohort (n = 23) (AUC 0.87; 95% CI 0.69-1.00). Setting a sensitivity and specificity of 98%, VI could have avoided 35.9% of HVPG measurements. The accuracy of VI was similar to that of other NITs. VI also accurately predicted HVPG greater than 12, 14, 16 an...