CT perfusion imaging of the liver and the spleen in patients with cirrhosis: Is there a correlation between perfusion and portal venous hypertension?
OBJECTIVE
To correlate hepatic and splenic CT perfusion parameters with hepatic venous pressure gradient (HVPG) measurements in patients with cirrhosis.


METHODS
Twenty-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.


RESULTS
The 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.


CONCLUSIONS
CT perfusion in patients with cirrhosis showed a strong correlation between SCL and HVPG and may be used for detection of severe portal hypertension.


CONCLUSIONS
• 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.
Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, Graz, A-8036, Austria.
Emina
E
Talakić
Department of Surgery, Division of Transplantation Surgery, Medical University of Graz, Graz, Austria.
Silvia
S
Schaffellner
Department of Surgery, Division of Transplantation Surgery, Medical University of Graz, Graz, Austria.
Daniela
D
Kniepeiss
Department of Surgery, Division of Transplantation Surgery, Medical University of Graz, Graz, Austria.
Helmut
H
Mueller
Department of Internal Medicine, Division of Gastoenterology and Hepatology, Medical University of Graz, Auenbruggerplatz 15, 8036, Graz, Austria.
Rudolf
R
Stauber
Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Auenbruggerplatz 2, Graz, 8036, Austria.
Franz
F
Quehenberger
Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9, Graz, A-8036, Austria. helmut.schoellnast@medunigraz.at.
Helmut
H
Schoellnast
D000465:Algorithms; D005260:Female; D006503:Hepatic Veins; D006801:Humans; D006975:Hypertension, Portal / Q000000981:diagnostic imaging*; D008099:Liver / Q000098:blood supply / Q000000981:diagnostic imaging*; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging; D017082:Portal Pressure; D011169:Portal Vein / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D013154:Spleen / Q000098:blood supply / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
CT-perfusion; Cirrhosis; Liver; Portal hypertension; Spleen