Heterogeneous hepatic venous pressures in patients with liver cancer.
We carried out hepatic vein catheterization in 73 patients with liver cancer, 52 with primary and 21 with metastatic cancer. A heterogeneous hepatic venous pressure gradient, defined as a difference of greater than 4 mmHg between the highest and lowest values of the pressure gradient in any patient, was found in 46% of the hepatocellular carcinoma cases and 43% of the metastatic cancers. Comparing the diagnostic efficacy of this phenomenon with an elevated alpha-fetoprotein, based on 500 randomly selected catheterizations, showed that the heterogeneous gradient was 46% sensitive and 99% specific for the diagnosis of hepatocellular carcinoma, while the alpha-fetoprotein was 67% sensitive and 99% specific. Positive and negative predictive values were 86 and 95%, respectively, for the heterogeneous gradient, and 83 and 97% for the alpha-fetoprotein. Its expense and relative invasiveness make hepatic vein catheterization an unacceptable routine in patients suspected of having hepatic malignancy. However, we suggest that the unexpected finding of a heterogeneous pressure gradient should trigger a search for hepatic cancer.
Lee
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SS
Unite de Recherches de Physiopathologie Hepatique, INSERM U 24, Hopital Beaujon, Clichy, France.
Koshy
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Hadengue
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Lebrec
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D
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000503:physiopathology*; D002405:Catheterization, Central Venous / Q000379:methods; D005260:Female; D006503:Hepatic Veins / Q000503:physiopathology; D006801:Humans; D006975:Hypertension, Portal / Q000209:etiology*; D008099:Liver / Q000503:physiopathology; D008113:Liver Neoplasms / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D014690:Venous Pressure / Q000502:physiology