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Current Medical Imaging Nov 2023Portal vein size and hemodynamics can be altered in patients with portal hypertension. Elastography for liver stiffness has been proposed as a potential predictor of...
INTRODUCTION
Portal vein size and hemodynamics can be altered in patients with portal hypertension. Elastography for liver stiffness has been proposed as a potential predictor of portal hypertension. However, the relationship between liver stiffness measured using point shear wave elastography (pSWE) and portal vein diameter and Doppler parameters remains unclear. Therefore, this observational study aimed to investigate the correlation between liver ultrasound pSWE and portal vein hemodynamics in healthy participants.
METHODS
Twenty-five healthy men with no underlying medical conditions and who were not on regular medications were enrolled in the study. Liver stiffness, portal vein diameter, and Doppler parameters were measured using ultrasound EPIQ Elite with a curved-array transducer (C5-1 MHz) equipped with pSWE and Doppler imaging. Real-time pSWE measurements were taken from the liver. Portal vein diameter and Doppler parameters were measured in a longitudinal view of the extra-hepatic segment. Spearman correlation was used to assess the association between liver pSWE and portal vein diameter as well as Doppler parameters, with a significance level set at < 0.05.
RESULTS
There was no significant correlation between liver stiffness and portal vein diameter (p = 0.67) or Doppler parameters, including peak systolic velocity (p = 0.89), end-diastolic velocity (p = 0.65), and resistive index (p = 0.86).
CONCLUSION
Our findings suggest no direct correlation between liver stiffness measured using pSWE and portal vein hemodynamics in healthy adults. Further studies are warranted to investigate the relationship between liver pSWE and the hemodynamics of portal veins in patients with liver diseases.
PubMed: 37936440
DOI: 10.2174/0115734056267877231026102925 -
Journal of Hepatology May 2024
Meta-Analysis
Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; Liver Transplantation; Portal Vein; Venous Thrombosis
PubMed: 37939856
DOI: 10.1016/j.jhep.2023.10.031 -
International Journal of Surgery... May 2024Besides the increased risk of perioperative morbidity, graft failure, and mortality, the majority of PVT are diagnosed at liver transplantation (LT). Improving...
BACKGROUND AND AIMS
Besides the increased risk of perioperative morbidity, graft failure, and mortality, the majority of PVT are diagnosed at liver transplantation (LT). Improving preoperative management and patient selection may lead to better short-term and long-term outcomes and reduce the risk of a futile LT. The authors aimed to identify predictors of adverse outcomes after LT in patients with nonmalignant portal vein thrombosis (PVT) and improve donor to recipient matching by analyzing the results of the Italian cohort of LT recipients.
METHODS
Adult patients who underwent LT in Italy between January 2000 and February 2020 diagnosed with PVT pre-LT or at time of LT were considered eligible for inclusion. Based on a survey encompassing all 26 surgeons participating in the study, a binary composite outcome was defined. Patients were classified as having the composite event if at least one of these conditions occurred: operative time more than 600 min, estimated blood loss greater than 5000 ml, more than 20 ICU days, 90 days mortality, 90 days retransplant.
RESULTS
Seven hundred fourteen patients were screened and 698 met the inclusion criteria. The analysis reports the results of 568 patients that fulfilled the criteria to enter the composite outcome analysis.Overall, 156 patients (27.5%) developed the composite outcome. PVT stage 3/4 at transplant and need for any surgical correction of PVT are independent predictors of the composite outcome occurrence. When stratified by PVT grade, overall survival at 1-year ranges from 89.0% with PVT grade 0/1 to 67.4% in patients with PVT grade 3/4 at LT ( P <0.001). Nevertheless, patients with severe PVT can improve their survival when identified risk factors are not present.
CONCLUSIONS
Potential LT candidates affected by PVT have a benefit from LT that should be adequately balanced on liver function and type of inflow reconstruction needed to mitigate the incidence of adverse events. Nonetheless, the absence of specific risk factors may improve the outcomes even in patients with PVT grades 3-4.
Topics: Humans; Liver Transplantation; Portal Vein; Male; Female; Retrospective Studies; Middle Aged; Venous Thrombosis; Adult; Italy; Postoperative Complications; Aged; Patient Selection; Treatment Outcome
PubMed: 38445440
DOI: 10.1097/JS9.0000000000001149 -
Neonatology Mar 2024Neonatal portal vein thrombosis (PVT) is frequently related to umbilical venous catheterization (UVC), but risk factors remain unclear. This study aims to analyze the...
INTRODUCTION
Neonatal portal vein thrombosis (PVT) is frequently related to umbilical venous catheterization (UVC), but risk factors remain unclear. This study aims to analyze the variables associated to PVT in near- to full-term newborns with UVC, with a focus on newborns exposed to controlled therapeutic hypothermia (CTH) for hypoxic ischemic encephalopathy (HIE).
METHODS
This is retrospective cohort study of infants delivered at or after 36 weeks and with a birthweight over 1,500 g. All infants were assessed for UVC location and PVT using ultrasonography performed between day 5 and day 10 after catheterization.
RESULTS
Among 213 eligible patients, PVT was diagnosed in 57 (27%); among them, 54 (95%) were localized in the left portal vein branch. With all significant factors in univariate analysis considered, higher gestational age at birth (adjusted OR 1.35; 95% CI: 1.12-1.64, p = 0.002) and duration of UVC placement (adjusted OR 1.36; 95% CI: 1.11-1.67, p = 0.004) were the main risk factors of PVT. Among 87 infants who were cooled for HIE, 31 (36%) had PVT compared to 26 (21%) in infants without CTH. Using a multivariate model including variables linked to treatment procedures only, an increased PVT incidence was statistically associated with UVC duration (adjusted OR 1.33; 95% CI: 1.08; 1.63, p = 0.01) and CTH (adjusted OR 1.94; 95% CI: 1.04-3.65, p = 0.04).
CONCLUSION
Left PVT was frequently observed in near- to full-term neonates with UVC. Among factors linked to treatment procedures, both duration of UVC and CTH exposure for HIE were found to be independent risk factors of PVT.
PubMed: 38522417
DOI: 10.1159/000537902 -
Briefings in Bioinformatics Nov 2023Portal vein thrombosis (PVT) is a significant issue in cirrhotic patients, necessitating early detection. This study aims to develop a data-driven predictive model for...
BACKGROUND
Portal vein thrombosis (PVT) is a significant issue in cirrhotic patients, necessitating early detection. This study aims to develop a data-driven predictive model for PVT diagnosis in chronic hepatitis liver cirrhosis patients.
METHODS
We employed data from a total of 816 chronic cirrhosis patients with PVT, divided into the Lanzhou cohort (n = 468) for training and the Jilin cohort (n = 348) for validation. This dataset encompassed a wide range of variables, including general characteristics, blood parameters, ultrasonography findings and cirrhosis grading. To build our predictive model, we employed a sophisticated stacking approach, which included Support Vector Machine (SVM), Naïve Bayes and Quadratic Discriminant Analysis (QDA).
RESULTS
In the Lanzhou cohort, SVM and Naïve Bayes classifiers effectively classified PVT cases from non-PVT cases, among the top features of which seven were shared: Portal Velocity (PV), Prothrombin Time (PT), Portal Vein Diameter (PVD), Prothrombin Time Activity (PTA), Activated Partial Thromboplastin Time (APTT), age and Child-Pugh score (CPS). The QDA model, trained based on the seven shared features on the Lanzhou cohort and validated on the Jilin cohort, demonstrated significant differentiation between PVT and non-PVT cases (AUROC = 0.73 and AUROC = 0.86, respectively). Subsequently, comparative analysis showed that our QDA model outperformed several other machine learning methods.
CONCLUSION
Our study presents a comprehensive data-driven model for PVT diagnosis in cirrhotic patients, enhancing clinical decision-making. The SVM-Naïve Bayes-QDA model offers a precise approach to managing PVT in this population.
Topics: Humans; Portal Vein; Risk Factors; Bayes Theorem; Precision Medicine; Liver Cirrhosis; Fibrosis; Venous Thrombosis
PubMed: 38221905
DOI: 10.1093/bib/bbad478 -
Gastroenterology Jun 2024Portal hypertension (PH) is one of the most frequent complications of chronic liver disease. The peripheral 5-Hydroxytryptamine (5-HT) level was increased in cirrhotic...
BACKGROUNDS & AIMS
Portal hypertension (PH) is one of the most frequent complications of chronic liver disease. The peripheral 5-Hydroxytryptamine (5-HT) level was increased in cirrhotic patients. We aimed to elucidate the function and mechanism of 5-HT receptor 1A (HTR1A) in portal vein (PV) on PH.
METHODS
PH models were induced by thioacetamide (TAA) injection, bile duct ligation (BDL) or partial portal vein ligation (PPVL). HTR1A expression was detected using real-time PCR, in situ hybridization and immunofluorescence staining. In situ intraportal infusion was employed to assess the effects of 5-HT, the HTR1A agonist 8-OH-DPAT, and the HTR1A antagonist WAY-100635 on portal pressure (PP). Htr1a knock-out (Htr1a) rats and vascular smooth muscle cell (VSMC)-specific Htr1a knock-out (Htr1a) mice were utilized to confirm the regulatory role of HTR1A on PP.
RESULTS
HTR1A expression was significantly increased in the hypertensive PV of PH model rats and cirrhotic patients. Additionally, 8-OH-DPAT increased but WAY-100635 decreased PP in rats, without affecting liver fibrosis and systemic hemodynamics. Furthermore, 5-HT or 8-OH-DPAT directly induced the contraction of isolated PVs. Genetic deletion of Htr1a in rats and VSMCs-specific Htr1a knock-out in mice prevented the development of PH. Moreover, 5-HT triggered the cAMP pathway-mediated PVSMCs contraction via HTR1A in PV. We also confirmed alverine as an HTR1A antagonist and demonstrated its capacity to decrease PP in TAA-, BDL-, and PPVL-induced portal hypertensive rats.
CONCLUSIONS
Our findings reveal that 5-HT promotes PH by inducing the contraction of PV, and identify HTR1A as a promising therapeutic target for attenuating PH. As an HTR1A antagonist, alverine is expected to become a candidate for clinical PH treatment.
PubMed: 38906512
DOI: 10.1053/j.gastro.2024.06.007 -
Annals of Palliative Medicine Nov 2023A number of therapeutic treatment strategies exist for patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT). The aim of this review is to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
A number of therapeutic treatment strategies exist for patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT). The aim of this review is to provide a current understanding of treatment options and determine the relative effectiveness of treatment options in preventing mortality over 24 months.
METHODS
A search was conducted in PubMed, EMBASE and Cochrane CENTRAL from 2007 to 2022. Articles were screened to identify those that reported on all-cause mortality among treated, non-palliative patients with HCC and PVT. Study quality was assessed using the Cochrane Risk of Bias in Non-Randomized Studies of Interventions tool (ROBINS-1). Mortality rates at prespecified timepoints between 6 and 24 months were extracted and summarized using a random-effects DerSimonian-Laird model. This review was registered a priori on PROSPERO (CRD42022290708).
RESULTS
When comparing radiotherapy (RT) to sorafenib and combined transarterial chemoembolization (TACE), there was a trend that RT yields better survival at 6 months [odds ratio (OR) 0.70, 95% confidence interval (CI): 0.28-1.76]. When comparing sorafenib to Y90 and RT, sorafenib was associated with higher odds for mortality at 6 months (OR 2.20, 95% CI: 1.11-4.39). No significant differences were noticed from 12 to 24 months.
CONCLUSIONS
Future strategies for HCC with PVT should look at the combination of radiation and systemic treatments either concurrently or sequentially.
Topics: Humans; Carcinoma, Hepatocellular; Sorafenib; Liver Neoplasms; Portal Vein; Chemoembolization, Therapeutic; Treatment Outcome; Venous Thrombosis
PubMed: 37953217
DOI: 10.21037/apm-23-463 -
American Journal of Surgery Feb 2024
Topics: Humans; Liver Transplantation; Portal Vein; Liver Diseases; Venous Thrombosis; Perfusion; Death
PubMed: 37777377
DOI: 10.1016/j.amjsurg.2023.09.026 -
Hepatobiliary & Pancreatic Diseases... Jun 2024Despite advances in the diagnosis of patients with hepatocellular carcinoma (HCC), 70%-80% of patients are diagnosed with advanced stage disease. Portal vein tumor... (Review)
Review
BACKGROUND
Despite advances in the diagnosis of patients with hepatocellular carcinoma (HCC), 70%-80% of patients are diagnosed with advanced stage disease. Portal vein tumor thrombus (PVTT) is among the most ominous signs of advanced stage disease and has been associated with poor survival if untreated.
DATA SOURCES
A systematic search of MEDLINE (PubMed), Embase, Cochrane Library and Database for Systematic Reviews (CDSR), Google Scholar, and National Institute for Health and Clinical Excellence (NICE) databases until December 2022 was conducted using free text and MeSH terms: hepatocellular carcinoma, portal vein tumor thrombus, portal vein thrombosis, vascular invasion, liver and/or hepatic resection, liver transplantation, and systematic review.
RESULTS
Centers of surgical excellence have reported promising results related to the individualized surgical management of portal thrombus versus arterial chemoembolization or systemic chemotherapy. Critical elements to the individualized surgical management of HCC and portal thrombus include precise classification of the portal vein tumor thrombus, accurate identification of the subgroups of patients who may benefit from resection, as well as meticulous surgical technique. This review addressed five specific areas: (a) formation of PVTT; (b) classifications of PVTT; (c) controversies related to clinical guidelines; (d) surgical treatments versus non-surgical approaches; and (e) characterization of surgical techniques correlated with classifications of PVTT.
CONCLUSIONS
Current evidence from Chinese and Japanese high-volume centers demonstrated that patients with HCC and associated PVTT can be managed with surgical resection with acceptable results.
Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; Portal Vein; Treatment Outcome; Retrospective Studies; Hepatectomy; Systematic Reviews as Topic; Thrombosis; Chemoembolization, Therapeutic
PubMed: 37903712
DOI: 10.1016/j.hbpd.2023.10.009 -
European Radiology Dec 2023To develop and validate a CT-based radiomics model for the prediction of the overall survival (OS) of patients with hepatocellular carcinoma (HCC) and portal vein tumor...
CT-based radiomics nomogram for prediction of survival after transarterial chemoembolization with drug-eluting beads in patients with hepatocellular carcinoma and portal vein tumor thrombus.
OBJECTIVES
To develop and validate a CT-based radiomics model for the prediction of the overall survival (OS) of patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT) treated with drug-eluting beads transarterial chemoembolization (DEB-TACE).
METHODS
Patients were retrospectively enrolled from two institutions for the constitution of training (n = 69) and validation (n = 31) cohorts with a median follow-up of 15 months. A total of 396 radiomics features were extracted from each baseline CT image. Features selected by variable importance and minimal depth were used for random survival forest model construction. The performance of the model was assessed using the concordance index (C-index), calibration curves, integrated discrimination index (IDI), net reclassification index (NRI), and decision curve analysis.
RESULTS
Type of PVTT and tumor number were proved to be significant clinical indicators for OS. Arterial phase images were used to extract radiomics features. Three radiomics features were selected for model construction. The C-index for the radiomics model was 0.759 in the training cohort and 0.730 in the validation cohort. To improve the predictive performance, clinical indicators were integrated into the radiomics model to form a combined model with a C-index of 0.814 in the training cohort and 0.792 in the validation cohort. The IDI was significant in both cohorts for the combined model versus the radiomics model in predicting 12-month OS.
CONCLUSIONS
Type of PVTT and tumor number affected the OS of HCC patients with PVTT treated with DEB-TACE. Moreover, the combined clinical-radiomics model had a satisfactory performance.
CLINICAL RELEVANCE STATEMENT
A CT-based radiomics nomogram, which consisted of 3 radiomics features and 2 clinical indicators, was recommended to predict 12-month overall survival of patients with hepatocellular carcinoma and portal vein tumor thrombus initially treated with drug-eluting beads transarterial chemoembolization.
KEY POINTS
• Type of portal vein tumor thrombus and tumor number were significant predictors of the OS. • Integrated discrimination index and net reclassification index provided a quantitative evaluation of the incremental impact added by new indicators for the radiomics model. • A nomogram based on a radiomics signature and clinical indicators showed satisfactory performance in predicting OS after DEB-TACE.
Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; Nomograms; Portal Vein; Retrospective Studies; Chemoembolization, Therapeutic; Thrombosis; Tomography, X-Ray Computed
PubMed: 37436507
DOI: 10.1007/s00330-023-09830-7