Predictive Value of Imaging Characteristics for Underlying Portal Hypertension

Presented During:   Tips and Portal Hypertension I
Sun, 4/3/2016: 4:03 PM  - 4:12 PM 
Vancouver Convention Centre  
Room: 224  

Final ID:

106 

Submission Number:

1509 

Abstract Type:

Original Scientific Research-Oral or Poster 

Authors:

B. Weis1, R. Johnson2, K. Vaheesan3, G. Hyun4, B. Dang4, I. Moreno2, S. Gadani5, M. Mikhayel6, B. Weis7

Institutions:

1N/A, Brentwood, MO, 2Saint Louis University Hospital, Saint Louis, MO, 3Saint Louis University Hospital, Saint Louis, MO, 4Saint Louis University Medical School, Saint Louis , MO, 5Saint Louis University Hospital, Ellisville, MO, 6Saint Louis University Hospital, Saint Louis , MO, 7Saint Louis University Hospital, Brentwood, MO

Abstract Presenter:

Blake Alexander Weis, MD  
N/A
Brentwood, MO

Co-Author(s):

Brian Dang, BSc  
Saint Louis University Medical School
Saint Louis , MO
Sameer D. Gadani, MD  
Saint Louis University Hospital
Ellisville, MO
Gina Hyun, BSc  
Saint Louis University Medical School
Saint Louis , MO
Rotimi Johnson, MD  
Saint Louis University Hospital
Saint Louis, MO
Madi Mikhayel, MD  
Saint Louis University Hospital
Saint Louis , MO
Ismael P. Moreno, MD  
Saint Louis University Hospital
Saint Louis, MO
Kirubahara Vaheesan, MD  
Saint Louis University Hospital
Saint Louis, MO
Blake Alexander Weis, MD  
Saint Louis University Hospital
Brentwood, MO

Purpose:

Liver cancer patients undergo transjugular liver biopsy with pressure measurements to evaluate for portal hypertension (PH) and cirrhosis before surgical resection of the tumor. Although this method serves as the gold standard in diagnosis of PH, the process creates delay in patient treatment. Enlargement of the spleen and portal vein are commonly seen on cross sectional imaging in patients with portal hypertension. The objective of this study was to determine if imaging characteristics alone can be used as accurate predictors of portal hypertension. In select patients, this may help decrease the time interval from imaging to therapy.

Materials:

The study was approved by the Institutional Review Board. Cross sectional imaging was reviewed, a total of 72 patients (44 male, 28 female). These patients underwent transjugular liver biopsy with pressure measurements of the right atrium (RA), free hepatic vein pressure (FP), and wedged hepatic vein pressure (WP). A pressure gradient was calculated by subtracting the WP-RA. Pressure gradients > or = 6 mm Hg were deemed to have portal hypertension.

Results:

A Satterhwaite t-test for unequal variances was used to compare pressure gradients with anterior-posterior measurements of the main portal vein on cross sectional imaging in centimeters. There was a significant correlation between increasing portal vein size and pressure gradients > or = 6 (P>.0001). Of the 67 patients with pressure gradients > or = 6, the mean portal vein measurement was determined to be 1.63 cm. The cranio-caudal (CC) measurements of the spleen on sagittal reconstruction of cross sectional studies were also obtained in centimeters. There was no significant correlation between CC of the spleen and pressure gradients > or = 6 (P > 0.7216). Average spleen size in the patient's with portal hypertension was 15.0 cm.

Conclusions:

There is significant correlation in increasing portal vein size on cross sectional imaging and underlying portal hypertension. In select patients, portal vein size can be used as a predictor of underlying portal hypertension. Spleen size did not demonstrate significant correlation with portal hypertension.

Abstract Categories:

TIPS and Portal Hypertension

Keywords:

Liver cancer
Portal hypertension
Transjugular liver biopsy