Varices on computed tomography are surrogate of clinically significant portal hypertension and can predict survival in compensated cirrhosis patients

Lee, Dong Hoon; Ahn, Jhii Hyun; Chung, Jin Wook; Kim, Young Ju; Whan, Seung; Kim, Moon Young; Baik, Soon Koo

doi:10.1111/jgh.14319

Cited by 11 publications

(15 citation statements)

References 24 publications

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“…Group 2 in this study) was 10.3 mmHg, higher than cutoff value of 10 mmHg indicating the presence of CSPH, and significantly higher than that in patients who had neither standard CSPH surrogate nor varices on CT (i.e. group 3 in this study) 16 . Therefore, considering the results of our and previous study, the presence of varices on CT should be regarded as the sign of CSPH surrogate, and the criteria for CSPH surrogate should be revised to include all the portosystemic collaterals found on CT 16 …”

Section: Discussioncontrasting

confidence: 49%

“…group 3 in this study) 16 . Therefore, considering the results of our and previous study, the presence of varices on CT should be regarded as the sign of CSPH surrogate, and the criteria for CSPH surrogate should be revised to include all the portosystemic collaterals found on CT 16 …”

Section: Discussionmentioning

confidence: 93%

“…According to these preoperative laboratory, EGD, and CT findings, we classified our patients into three groups: group 1 included the patients having standard CSPH surrogate defined as the presence of varices on EGD and/or the presence of thrombocytopenia (platelet count < 100K/mm 3 ) associated with splenomegaly (spleen long diameter > 12 cm) 1 ; group 2 included the patients who had varices on CT but did not meet the standard surrogate for CSPH (Fig. 2); and group 3 included the patients who met neither inclusion criteria for group 1 nor those for group 2 16 . After initial analysis regarding the comparison of postoperative outcome as well as OS after HR for HCC among these three groups, patients were re‐classified into two groups according to the presence or absence of CT‐enhanced CSPH surrogate defined as the presence of either standard CSPH surrogate or varices on CT (i.e.…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, CT can reveal the intra‐abdominal portosystemic collateral vessels developed in areas other than the gastro‐esophagus, including splenic varices with/without splenorenal shunt or paraumbilical varices that EGD cannot show. According to the result of a recent study evaluating the prognostic role of varices on CT using HVPG measurement as a reference of standard in compensated cirrhosis patients, varices seen on CT were a significant sign of CSPH surrogate and could predict poor OS for patients with compensated cirrhosis 16 . However, whether presence of varices on CT could also be a significant prognostic factor for HCC patients and, thereby, have a potential to improve the predictive ability of current standard CSPH surrogate in surgical patient cohort has not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Varices on computed tomography as predictor of survival after hepatic resection in patients with single hepatocellular carcinoma

Lee

Chung

Joo

et al. 2020

J of Gastro and Hepatol

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Background and AimThe aim of this study was to evaluate whether presence of varices on computed tomography (CT) could predict treatment outcome for hepatocellular carcinoma patients.MethodsWe enrolled 241 patients with single hepatocellular carcinoma ≤ 5 cm treated by surgery. With the use of preoperative CT/endoscopy, patients were classified into the following: presence of standard clinically significant portal hypertension (CSPH) surrogate, defined as varices on esophagogastroduodenoscopy and/or thrombocytopenia with splenomegaly (group 1, n = 47); varices on CT without standard CSPH surrogate (group 2, n = 45); and none of both (group 3, n = 149). Development of posthepatectomy liver failure and overall survival (OS) were evaluated for each patient group, and patients were re‐classified into two groups according to presence of CT‐enhanced CSPH surrogate, defined as standard surrogate and/or varices on CT. Predictive power of each survival model was compared using Harrell's C‐index.ResultsPosthepatectomy liver failure rate in group 2 was similar to that in group 1 (53.3% [24/45] vs. 55.3% [26/47]; P = 1.000) but significantly higher than that in group 3 (53.3% [24/45] vs. 28.2% [42/149], P = 0.002). Seven‐year OS rates in group 2 were similar to those in group 1 (55.6% vs. 60.8%, P = 0.988) but significantly lower than those in group 3 (55.6% vs. 83.3%, P = 0.001). Presence of standard CSPH surrogate (hazard ratio = 1.89 [1.08–3.30], P = 0.025) and CT‐enhanced CSPH surrogate (hazard ratio = 2.60 [1.56–4.39], P < 0.001) were significant predicting factor for OS. However, CT‐enhanced CSPH surrogate had significantly higher Harrell's C‐index than standard surrogate (0.619 vs. 0.553, P = 0.034).ConclusionThe presence of CT‐enhanced CSPH surrogate including varices on CT was the significant predictive of poor OS, providing better predictive power than standard surrogate.

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Section: Discussioncontrasting

confidence: 49%

Section: Discussionmentioning

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Varices on computed tomography as predictor of survival after hepatic resection in patients with single hepatocellular carcinoma

Lee

Chung

Joo

et al. 2020

J of Gastro and Hepatol

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“…Demographics and laboratory test findings of the study population were reviewed—this included data pertaining to age, gender, source of liver disease, presence of antiviral treatment and portal hypertension, tumor segment and size, duration of hospital stay, and AFP level. The presence of portal hypertension was determined as the presence of gastroesophageal varices on endoscopy and/or the presence of thrombocytopenia (platelet count <100,000/mm 3 ) with splenomegaly (>12 cm in its largest dimension) 21 …”

Section: Methodsmentioning

confidence: 99%

Tumor Stiffness Measurements on MR Elastography for Single Nodular Hepatocellular Carcinomas Can Predict Tumor Recurrence After Hepatic Resection

Park

Yoon

Lee

et al. 2020

Magnetic Resonance Imaging

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BackgroundTumor stiffness (TS), measured by magnetic resonance elastography (MRE), could be associated with tumor mechanical properties and tumor grade.PurposeTo determine whether TS obtained using MRE is associated with survival in patients with single nodular hepatocellular carcinoma (HCC) after hepatic resection (HR).Study TypeRetrospective.PopulationIn all, 95 patients with pathologically confirmed HCCs.Field Strength/Sequence1.5T/3D spin‐echo echo‐planar imaging MRE.AssessmentTS values of the whole tumor (TS‐WT) and of a solid portion of the tumor (TS‐SP) after excluding the necrotic area were measured on stiffness maps. Known imaging prognostic factors of HCC were also analyzed. After surgery, pathologic findings were evaluated from resected pathology specimens.Statistical TestsFisher's exact test and the Mann–Whitney U‐test were performed to determine the significance of differences according to the tumor grade. Overall survival (OS) / recurrence‐free survival (RFS) analyses were performed using Kaplan–Meier analyses and Cox multivariable models.ResultsThe average TS‐WT was 2.14 ± 0.74 kPa, and the average TS‐SP was 2.51 ± 1.07 kPa. The cumulative incidence of RFS was 73.1%, 63.1%, and 57.3% at 1, 3, and 5 years, respectively. The TS‐WT, TS‐SP, and tumor size (≥5 cm) were significant prognostic factors for RFS (P < 0.001; P < 0.001; P = 0.017, respectively). The estimated overall 1‐, 3‐, and 5‐year survival rates were 95.7%, 86.9%, and 80.8%, respectively. The alpha‐fetoprotein changes, platelets, tumor size (≥5 cm), and vascular invasion in pathology were significant predictive factors for overall survival (all P < 0.05). Tumor necrosis, TS‐WT, TS‐SP, and vascular invasion in pathology were significantly correlated with poorly differentiated HCC (all P < 0.05).Data ConclusionThe TS‐WT, TW‐SP, and tumor size (≥5 cm) were significant predictive factors of RFS after HR in patients with HCC.Level of EvidenceTechnical Efficacy Stage 5J. MAGN. RESON. IMAGING 2021;53:587–596.

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Obliteration of portal venules contributes to portal hypertension in biliary cirrhosis

Shan,

Zhao,

Wood‐Trageser

et al. 2024

The Journal of Pathology

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The effects of the obliteration of portal venules (OPV) in cirrhotic portal hypertension are poorly understood. To investigate its contribution to portal hypertension in biliary cirrhosis and its underlying mechanism, we evaluated OPV using two‐dimensional (2D) histopathology in liver explants from patients with biliary atresia (BA, n = 63), primary biliary cholangitis (PBC, n = 18), and hepatitis B‐related cirrhosis (Hep‐B‐cirrhosis, n = 35). Then, three‐dimensional (3D) OPV was measured by X‐ray phase‐contrast CT in two parallel models in rats following bile duct ligation (BDL) or carbon tetrachloride (CCl4) administration, representing biliary cirrhosis and post‐necrotic cirrhosis, respectively. The portal pressure was also measured in the two models. Finally, the effects of proliferative bile ducts on OPV were investigated. We found that OPV was significantly more frequent in patients with biliary cirrhosis, including BA (78.57 ± 16.45%) and PBC (60.00 ± 17.15%), than that in Hep‐B‐cirrhotic patients (29.43 ± 14.94%, p < 0.001). OPV occurred earlier, evidenced by the paired liver biopsy at a Kasai procedure (KP), and was irreversible even after a successful KP in the patients with BA. OPV was also significantly more frequent in the BDL models than in the CCl4 models, as shown by 2D and 3D quantitative analysis. Portal pressure was significantly higher in the BDL model than that in the CCl4 model. With the proliferation of bile ducts, portal venules were compressed and irreversibly occluded, contributing to the earlier and higher portal pressure in biliary cirrhosis. OPV, as a pre‐sinusoidal component, plays a key role in the pathogenesis of portal hypertension in biliary cirrhosis. The proliferated bile ducts and ductules gradually take up the ‘territory’ originally attributed to portal venules and compress the portal venules, which may lead to OPV in biliary cirrhosis. © 2024 The Pathological Society of Great Britain and Ireland.

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Varices on computed tomography are surrogate of clinically significant portal hypertension and can predict survival in compensated cirrhosis patients

Abstract: The presence of varices on CT was a significant sign for CSPH, predicting poor OS outcome in patients with compensated cirrhosis.

Cited by 11 publications

References 24 publications

Varices on computed tomography as predictor of survival after hepatic resection in patients with single hepatocellular carcinoma

Varices on computed tomography as predictor of survival after hepatic resection in patients with single hepatocellular carcinoma

Tumor Stiffness Measurements on MR Elastography for Single Nodular Hepatocellular Carcinomas Can Predict Tumor Recurrence After Hepatic Resection

Obliteration of portal venules contributes to portal hypertension in biliary cirrhosis

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