CT perfusion imaging of the liver and the spleen in patients with cirrhosis: Is there a correlation between perfusion and portal venous hypertension?

Abstract

ObjectivesTo correlate hepatic and splenic CT perfusion parameters with hepatic venous pressure gradient (HVPG) measurements in patients with cirrhosis.MethodsTwenty-one patients with cirrhosis (males, 17; females, 4; mean ± SD age, 57 ± 7 years) underwent hepatic and splenic perfusion CT on a 320-detector row volume scanner as well as invasive measurement of HVPG. Different CT perfusion algorithms (maximum slope analysis and Patlak plot) were used to measure hepatic arterial flow (HAF), portal venous flow (PVF), hepatic perfusion index (HPI), splenic arterial flow (SAF), splenic blood volume (SBV) and splenic clearance (SCL). Hepatic and splenic perfusion parameters were correlated with HVPG, and sensitivity and specificity for detection of severe portal hypertension (≥12 mmHg) were calculated.ResultsThe Spearman correlation coefficient was −0.53 (p < 0.05) between SAF and HVPG, and −0.68 (p < 0.01) between HVPG and SCL. Using a cut-off value of 125 ml/min/100 ml for SCL, sensitivity for detection of a HVPG of ≥12 mmHg was 94%, and specificity 100%. There was no significant correlation between hepatic perfusion parameters and HVPG.ConclusionCT perfusion in patients with cirrhosis showed a strong correlation between SCL and HVPG and may be used for detection of severe portal hypertension.Key points• SAF and SCL are statistically significantly correlated with HVPG • SCL showed stronger correlation with HVPG than SAF • 125 ml/min/100 ml SCL-cut-off yielded 94 % sensitivity, 100 % specificity for severe PH • HAF, PVF and HPI showed no statistically significant correlation with HVPG

Noninvasive prediction of portal pressure with MR elastography and DCE‐MRI of the liver and spleen: Preliminary results

“…The published data on spleen perfusion quantification in PH is limited, with variable results . The absence of correlation between spleen blood flow and HVPG is not in accordance with two previous studies, which found a decrease of splenic blood flow in PH . Similarly, a relationship between spleen K trans and HVPG was also observed previously, but not reproduced in our study .…”

“…None of the spleen DCE‐MRI parameters correlated with HVPG measurements, with only a trend found for spleen TTP. The published data on spleen perfusion quantification in PH is limited, with variable results . The absence of correlation between spleen blood flow and HVPG is not in accordance with two previous studies, which found a decrease of splenic blood flow in PH .…”

“…The increase of the liver resistance and portal pressure are responsible for a decrease in portal flow and an increase in arterial flow, as shown previously by Annet et al Contrary to Annet et al, we did not find any significant correlation or modification in the portal blood flow, arterial blood flow, or arterial fraction in PH and clinically significant PH . Of note, these correlations were not always described in other studies . These discrepancies could be explained by the high variability of the modeled DCE‐MRI parameters and the small sample size .…”

“…As expected, the spleen volume and craniocaudal spleen diameter were significantly higher in PH; however, it did not correlate significantly with HVPG. The increase of spleen diameter and volume have been previously described, with variable accuracy . Both, and especially the spleen diameter, are attractive because they are easy to obtain.…”

“…25 Of note, these correlations were not always described in other studies. 35,36 These discrepancies could be explained by the high variability of the modeled DCE-MRI parameters and the small sample size. 37 Yet we found that liver upslope, liver TTP, and liver DV correlated significantly with HVPG measurements.…”