Radiological score for hemorrhage in patients with portal hypertension_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIE Jun ^1,2 , GE Wei ¹ ,  YU Decai ¹ , WANG Yi ³ , CAO Yajuan ¹ , XIE Min ¹ , ZHANG Ming ³ , DING Yitao ¹

1. Department of General Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, P.R.China;
2. Baoying Hospital of Traditional Chinese Medicine of Yangzhou City, Yangzhou, Jiangsu 225800, P.R.China;
3. Department of Digestion, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, P.R.China;

Corresponding author：

YU Decai, Email: dryudecai@qq.com

Keywords：

portal hypertension; radiology; hemorrhage; risk assessment

DOI：

10.7507/1007-9424.201602023

Video：

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Objective To explore predictive value of radiological indexes for hemorrhage in patients with portal hypertension. Methods The clinical data and radiological data of patients with portal hypertension accompanied with hepatitis B from June 2008 to June 2014 in the Nanjing Drum Tower Hospital were analyzed retrospectively. Patients with hepatocellular carcinoma, portal vein thrombosis, or portal hypertension due to other causes, such as autoimmune hepatitis, pancreatitis, or hematological diseases were excluded. Results Ninety-eight patients were studied and subsequently divided into a hemorrhage group (n=57) and a non-hemorrhage group (n=41). There were no statistical differences in the clinical indexes such as the age, prothrombin time, serum albumin, serum creatinine, serum sodium, white blood cell count, and blood platelet count (P>0.05). However, the differences were statistically significant in the serum total bilirubin, hemoglobin, and liver function with theP values of 0.023, 0.000, and 0.039, respectively. For the radiological indexes, the hemorrhage was correlated with the diameter of posterior gastric vein (P=0.028 3) or grading of esophageal varices (P=0.022 1). Logistic procedure was used to construct the model with stepwise selection and finally the diameter of inferior mesenteric vein, diameter of posterior gastric vein, grading of esophageal varices, and diameter of short gastric vein were enrolled into this model. These indexes were scored, the risk of bleeding increased with increasing the points. Then the model was validated with 26 patients with portal hypertension from July 2014 to December 2014, the area under the receiver operating characteristic curve was 0.884 9 by this radiological model. Conclusions A radiological scoring model is constructed including diameter of inferior mesenteric vein, grading of esophageal varices, diameter of posterior gastric vein, and diameter of short gastric vein, which might predict risk of hemorrhage in patients with portal hypertension. However, further protective study of large sample is needed to validate this model.

Citation： XIEJun, GEWei, YUDecai, WANGYi, CAOYajuan, XIEMin, ZHANGMing, DINGYitao. Radiological score for hemorrhage in patients with portal hypertension. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2017, 24(2): 232-237. doi: 10.7507/1007-9424.201602023 Copy

1.	Park DK, Um SH, Lee JW,et al. Clinical significance of variceal hemorrhage in recent years in patients with liver cirrhosis and esophageal varices. J Gastroenterol Hepatol, 2004, 19(9): 1042-1051.
2.	Hicken BL, Sharara AI, Abrams GA,et al. Hepatic venous pressure gradient measurements to assess response to primary prophylaxis in patients with cirrhosis: a decision analytical study. Aliment Pharmacol Ther, 2003, 17(1): 145-153.
3.	Thalheimer U, Mela M, Patch D,et al. Monitoring target reduction in hepatic venous pressure gradient during pharmacological therapy of portal hypertension: a close look at the evidence. Gut, 2004, 53(1): 143-148.
4.	Chu Q, Li Z, Zhang SM,et al. Relationship between encephalopathy and portal vein-vena cava shunt: value of computed tomography during arterial portography. World J Gastroenterol, 2004, 10(13): 1939-1942.
5.	Willmann JK, Weishaupt D, Bohm T,et al. Detection of submucosal gastric fundal varices with multi-detector row CT angiography. Gut, 2003, 52(6): 886-892.
6.	Miller L, Banson FL, Bazir K,et al. Risk of esophageal variceal bleeding based on endoscopic ultrasound evaluation of the sum of esophageal variceal cross-sectional surface area. Am J Gastroenterol, 2003, 98(2): 454-459.
7.	Lai L, Poneros J, Santilli J,et al. EUS-guided portal vein catheterization and pressure measurement in an animal model: a pilot study of feasibility. Gastrointest Endosc, 2004, 59(2): 280-283.
8.	栾立, 段红霞, 刘严明, 等. CT 测量脾脏指数预判肝硬化食管静脉曲张及出血的可能. 实用放射学杂志, 2006, 22(4): 421-423.
9.	Shimizu T, Namba R, Matsuoka T,et al. Esophageal varices before and after endoscopic variceal ligation: evaluation using helical CT. Eur Radiol, 1999, 9(8): 1546-1549.
10.	Fisher MR, Gore RM. Computed tomography in the evaluation of cirrhosis and portal hypertension. J Clin Gastroenterol, 1985, 7(2): 173-181.
11.	Kim YJ, Raman SS, Yu NC,et al. Esophageal varices in cirrhotic patients: evaluation with liver CT. AJR Am J Roentgenol, 2007, 188(1): 139-144.
12.	Mifune H, Akaki S, Ida K,et al. Evaluation of esophageal varices by multidetector-row CT: correlation with endoscopic ‘red color sign’. Acta Med Okayama, 2007, 61(5): 247-254.
13.	Nunoi H, Hirooka M, Ochi H,et al. Portal biliopathy diagnosed using color Doppler and contrast-enhanced ultrasound. Intern Med, 2013, 52(10): 1055-1059.
14.	Schiedermaier P, Layer G, Sauerbruch T. Impact of the continuous infusion of Levovist on color Doppler sonography in portal hypertension. AJR Am J Roentgenol, 2002, 178(1): 61-65.
15.	Escorsell A, Bordas JM, Feu F,et al. Endoscopic assessment of variceal volume and wall tension in cirrhotic patients: effects of pharmacological therapy. Gastroenterology, 1997, 113(5): 1640-1646.
16.	Miller L, Banson FL, Bazir K,et al. Risk of esophageal variceal bleeding based on endoscopic ultrasound evaluation of the sum of esophageal variceal cross-sectional surface area. Am J Gastroenterol, 2003, 98(2): 454-459.
17.	Clark KE, Foley WD, Lawson TL,et al. CT evaluation of esophageal and upper abdominal varices. J Comput Assist Tomogr, 1980, 4(4): 510-515.
18.	Alempijevic T, Bulat V, Djuranovic S,et al. Right liver lobe/albumin ratio: contribution to non-invasive assessment of portal hypertension. World J Gastroenterol, 2007, 13(40): 5331-5335.
19.	Zhu K, Meng X, Pang P,et al. Gastric varices in patients with portal hypertension: evaluation with multidetector row CT. J Clin Gastroenterol, 2010, 44(5): e108-e115.
20.	Lee YT, Chan FK, Ching JY,et al. Diagnosis of gastroesophageal varices and portal collateral venous abnormalities by endosonography in cirrhotic patients. Endoscopy, 2002, 34(5): 391-398.
21.	Sgouros SN, Bergele C, Avgerinos A. Endoscopic ultrasonography in the diagnosis and management of portal hypertension. Where are we next? Dig Liver Dis, 2006, 38(5): 289-295.

1. Park DK, Um SH, Lee JW,et al. Clinical significance of variceal hemorrhage in recent years in patients with liver cirrhosis and esophageal varices. J Gastroenterol Hepatol, 2004, 19(9): 1042-1051.
2. Hicken BL, Sharara AI, Abrams GA,et al. Hepatic venous pressure gradient measurements to assess response to primary prophylaxis in patients with cirrhosis: a decision analytical study. Aliment Pharmacol Ther, 2003, 17(1): 145-153.
3. Thalheimer U, Mela M, Patch D,et al. Monitoring target reduction in hepatic venous pressure gradient during pharmacological therapy of portal hypertension: a close look at the evidence. Gut, 2004, 53(1): 143-148.
4. Chu Q, Li Z, Zhang SM,et al. Relationship between encephalopathy and portal vein-vena cava shunt: value of computed tomography during arterial portography. World J Gastroenterol, 2004, 10(13): 1939-1942.
5. Willmann JK, Weishaupt D, Bohm T,et al. Detection of submucosal gastric fundal varices with multi-detector row CT angiography. Gut, 2003, 52(6): 886-892.
6. Miller L, Banson FL, Bazir K,et al. Risk of esophageal variceal bleeding based on endoscopic ultrasound evaluation of the sum of esophageal variceal cross-sectional surface area. Am J Gastroenterol, 2003, 98(2): 454-459.
7. Lai L, Poneros J, Santilli J,et al. EUS-guided portal vein catheterization and pressure measurement in an animal model: a pilot study of feasibility. Gastrointest Endosc, 2004, 59(2): 280-283.
8. 栾立, 段红霞, 刘严明, 等. CT 测量脾脏指数预判肝硬化食管静脉曲张及出血的可能. 实用放射学杂志, 2006, 22(4): 421-423.
9. Shimizu T, Namba R, Matsuoka T,et al. Esophageal varices before and after endoscopic variceal ligation: evaluation using helical CT. Eur Radiol, 1999, 9(8): 1546-1549.
10. Fisher MR, Gore RM. Computed tomography in the evaluation of cirrhosis and portal hypertension. J Clin Gastroenterol, 1985, 7(2): 173-181.
11. Kim YJ, Raman SS, Yu NC,et al. Esophageal varices in cirrhotic patients: evaluation with liver CT. AJR Am J Roentgenol, 2007, 188(1): 139-144.
12. Mifune H, Akaki S, Ida K,et al. Evaluation of esophageal varices by multidetector-row CT: correlation with endoscopic ‘red color sign’. Acta Med Okayama, 2007, 61(5): 247-254.
13. Nunoi H, Hirooka M, Ochi H,et al. Portal biliopathy diagnosed using color Doppler and contrast-enhanced ultrasound. Intern Med, 2013, 52(10): 1055-1059.
14. Schiedermaier P, Layer G, Sauerbruch T. Impact of the continuous infusion of Levovist on color Doppler sonography in portal hypertension. AJR Am J Roentgenol, 2002, 178(1): 61-65.
15. Escorsell A, Bordas JM, Feu F,et al. Endoscopic assessment of variceal volume and wall tension in cirrhotic patients: effects of pharmacological therapy. Gastroenterology, 1997, 113(5): 1640-1646.
16. Miller L, Banson FL, Bazir K,et al. Risk of esophageal variceal bleeding based on endoscopic ultrasound evaluation of the sum of esophageal variceal cross-sectional surface area. Am J Gastroenterol, 2003, 98(2): 454-459.
17. Clark KE, Foley WD, Lawson TL,et al. CT evaluation of esophageal and upper abdominal varices. J Comput Assist Tomogr, 1980, 4(4): 510-515.
18. Alempijevic T, Bulat V, Djuranovic S,et al. Right liver lobe/albumin ratio: contribution to non-invasive assessment of portal hypertension. World J Gastroenterol, 2007, 13(40): 5331-5335.
19. Zhu K, Meng X, Pang P,et al. Gastric varices in patients with portal hypertension: evaluation with multidetector row CT. J Clin Gastroenterol, 2010, 44(5): e108-e115.
20. Lee YT, Chan FK, Ching JY,et al. Diagnosis of gastroesophageal varices and portal collateral venous abnormalities by endosonography in cirrhotic patients. Endoscopy, 2002, 34(5): 391-398.
21. Sgouros SN, Bergele C, Avgerinos A. Endoscopic ultrasonography in the diagnosis and management of portal hypertension. Where are we next? Dig Liver Dis, 2006, 38(5): 289-295.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Radiological score for hemorrhage in patients with portal hypertension

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