Virtual Hepatic Venous Pressure Gradient with CT Angiography (CHESS 1601): A Prospective Multicenter Study for the Noninvasive Diagnosis of Portal Hypertension
Virtual Hepatic Venous Pressure Gradient with CT Angiography (CHESS 1601): A Prospective Multicenter Study for the Noninvasive Diagnosis of Portal Hypertension
复制标题
CT 血管造影虚拟肝静脉压力梯度 (CHESS 1601)：门静脉高压无创诊断的前瞻性多中心研究
DOI：
10.1148/radiol.2018180425
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发表时间：
2019-02-01
期刊：
影响因子：
19.7
通讯作者：
Li, Zhiwei
中科院分区：
文献类型：
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作者：
Qi, Xiaolong;An, Weimin;Li, Zhiwei
目的：建立和验证基于CT血管造影图像的肝静脉压力梯度(HVPG)计算模型，称为虚拟HVPG，以实现对肝硬变患者门脉高压的非侵入性诊断。材料和方法：在这项前瞻性多中心诊断试验(ClinicalTrials.gov编号：NCT02842697)中，102名连续的合格参与者(平均年龄47岁[范围，21-75岁]；68名男性，平均年龄44岁[范围，21-73岁]；34名女性，平均年龄52岁[范围，24-75岁])在2016年8月至2017年4月期间从三个高容量肝中心招募。所有患有各种原因的肝硬变的受试者都接受了经颈静脉高压静脉压测量、多普勒超声和CT血管成像。结果：在训练队列(n=29)中，虚拟HVPG预测临床显著门脉高压症(CSPH)的受试者工作特征曲线(AUC)下面积为0.83(95%可信区间[CI]：0.58，1.00)。在验证队列(n=73)中前瞻性地确认了诊断性能，AUC为0.89(95%CI：0.81，0.96)。观察者间和观察者内的一致性分别为0.88和0.96，表明虚拟HVPG测量具有良好的重复性。虚拟HVPG与侵袭性HVPG有较好的相关性(R=0.61，P
Purpose: To develop and validate a computational model for estimating hepatic venous pressure gradient (HVPG) based on CT angiographic images, termed virtual HVPG, to enable the noninvasive diagnosis of portal hypertension in patients with cirrhosis.Materials and Methods: In this prospective multicenter diagnostic trial (ClinicalTrials.gov identifier: NCT02842697), 102 consecutive eligible participants (mean age, 47 years [range, 21-75 years]; 68 men with a mean age of 44 years [range, 21-73 years] and 34 women with a mean age of 52 years [range, 24-75 years]) were recruited from three high-volume liver centers between August 2016 and April 2017. All participants with cirrhosis of various causes underwent transjugular HVPG measurement, Doppler US, and CT angiography. Virtual HVPG was developed with a three-dimensional reconstructed model and computational fluid dynamics.Results: In the training cohort (n = 29), the area under the receiver operating characteristic curve (AUC) of virtual HVPG in the prediction of clinically significant portal hypertension (CSPH) was 0.83 (95% confidence interval [CI]: 0.58, 1.00). The diagnostic performance was prospectively confirmed in the validation cohort (n = 73), with an AUC of 0.89 (95% CI: 0.81, 0.96). Inter-and intraobserver agreement was 0.88 and 0.96, respectively, suggesting the good reproducibility of virtual HVPG measurements. There was good correlation between virtual HVPG and invasive HVPG (R = 0.61, P