title: Accurate computed tomography-based portal pressure assessment in patients with hepatocellular carcinoma.
abstract: OBJECTIVE
  Liver resection is generally restricted to patients without clinically significant portal hypertension (Hepatic Venous Pressure Gradient - HVPG - ⩽10mmHg) and several teams perform transjugular HVPG measurements as part of the pre-operative work-up. The present study investigates whether a non-invasive Computed Tomography (CT)-based assessment could be as accurate as the invasive transjugular measurement.
  
  
  METHODS
  A cohort of patients with hepatocellular carcinoma (HCC) treated by resection (n=36) or transplantation (n=39) was selected (mean age: 61±9.2years, male/female ratio: 4/1). Pre-operative CTs were read by two independent investigators, and potential CT-based HVPG predictors were compared to the transjugular HVPG measurements. A validation was conducted on another cohort of 70 non-surgical patients.
  
  
  RESULTS
  The invasive HVPG values were significantly correlated to liver/spleen volume ratio, spleen volume, platelet count, and peri-hepatic ascites (p<0.001), which all showed high inter-observer agreements (intra-class correlation coefficients ⩾0.927, Kappa ⩾0.945). The presence of a HVPG >10mmHg was best predicted by the liver/spleen volume ratio (AUC: 0.883 [0.805-0.960]) and the peri-hepatic ascites (p<0.001). These two variables were combined into an accurate model for predicting HVPG >10mmHg (AUC: 0.911 [0.847-0.975]), with sensitivity, specificity, and positive and negative predictive values of 92%, 79%, 91%, and 81%. The model was also accurate in the validation cohort with an AUC of 0.820 [0.719-0.921]. The computed formula was:
  
  
  CONCLUSIONS
  The proposed CT-based model showed a high accuracy in the prediction of HVPG and, if further confirmed by prospective validation, could replace the invasive transjugular assessment in patients not requiring a biopsy of the non-tumoral liver.
authors.affiliation: Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland. Electronic address: Pouya.Iranmanesh@hcuge.ch.
authors.forename: Pouya
authors.initials: P
authors.lastname: Iranmanesh
authors.affiliation: Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland.
authors.forename: Oscar
authors.initials: O
authors.lastname: Vazquez
authors.affiliation: Department of Radiology, Geneva University Hospitals and Faculty of Medicine, Switzerland.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Terraz
authors.affiliation: Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland.
authors.forename: Pietro
authors.initials: P
authors.lastname: Majno
authors.affiliation: Department of Gastroenterology and Hepatology, Geneva University Hospitals and Faculty of Medicine, Switzerland.
authors.forename: Laurent
authors.initials: L
authors.lastname: Spahr
authors.affiliation: Department of Clinical Epidemiology, Geneva University Hospitals and Faculty of Medicine, Switzerland.
authors.forename: Antoine
authors.initials: A
authors.lastname: Poncet
authors.affiliation: Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.affiliation: Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland.
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
authors.affiliation: Department of Digestive Surgery, Geneva University Hospitals and Faculty of Medicine, Switzerland. Electronic address: Christian.Toso@hcuge.ch.
authors.forename: Christian
authors.initials: C
authors.lastname: Toso
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000000981:diagnostic imaging; D007601:Jugular Veins / Q000000981:diagnostic imaging / Q000503:physiopathology; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D012189:Retrospective Studies; D013154:Spleen / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Computed tomography; Hepatic venous pressure gradient; Hepatocellular carcinoma; Liver resection; Liver transplantation; Portal hypertension