Diagnostic Value of Portal Vein Velocity for Portal Hypertension in Patients with Hepatitis B Virus-related Cirrhosis
Changchun Liu 1 , Sizhe Chen 2 , Xinwen Yan 2 , Yi Xiang 2 , Jialiang Hui 2 , Zhao Liu 2 , Qiang Yu 3 , Yongwu Li 2 , Ruping Qi 2 , Yuan Liu 2 , Xu Bai 2 , Yuanzhi Gao 2 , Weimin An 2 , Jinghui Dong 2 , Wen Shen 1
Affiliations
Affiliations
1
Department of Radiology, First Center Hospital Clinic Institute, Tianjin University, Tianjin, 300192. China.
2
Department of Radiology, the Fifth Medical Center of Chinese PLA General Hospital, Beijing, 10039. China.
3
Department of Interventional Radiology, the Fifth Medical Center of Chinese PLA General Hospital, 10039. China.
Background: Portal vein velocity (PVV) has shown reasonable correlation with the presence of portal hypertension in patients with cirrhosis. This study aims to evaluate the value of PVV for diagnosing clinically significant portal hypertension (CSPH) and predicting the risk of variceal hemorrhage (VH) in patients with hepatitis B virus (HBV)-related cirrhosis.
Material and methods: A cohort of 166 consecutive adult patients with HBV-related cirrhosis was recruited in this retrospective study from two high-volume liver centers in China between April 2015 and April 2017. The performance of PVV and other non-invasive parameters for diagnosing CSPH and predicting risk of VH were studied.
Results: PVV demonstrated the best performance for diagnosing CSPH (defined as an HVPG ≥10 mmHg) in patients with HBV-related cirrhosis among the included noninvasive predictors with the area under the receiver operating characteristic curve (AUC), specificity, and sensitivity of 0.745, 50%, and 93.5%, respectively. Other noninvasive markers, including APRI, AAR, LS, FIB-4, and diameter of portal vein, did not show sufficient performance with the AUCs of 0.565, 0.560, 0.544, 0.529, and 0.474, respectively. With regard to predicting the risk of VH (defined as an HVPG ≥12 mmHg), PPV also exhibited a moderate performance with an AUC of 0.762, which was superior to that of the aforementioned markers. By using two cutoff values of PVV to rule-out (11.65 cm/s) and rule-in (20.20 cm/s) CSPH, 30 (33.7%) patients showed definite results categories, with 23 (76.7%) patients were well classified and 7 (23.3%) were misclassified. Fifty-nine (66.3%) patients were with indeterminate results. By using PVV values of 13.10 cm/s and 21.40 cm/s to rule-out and rule-in HVPG ≥ 12mmHg, 34 (38.2%) patients has definite results, among whom 26 (76.5%) were well classified and 8 (23.5%) were misclassified. And 55 (61.8%) patients required further evaluation.
Conclusion: PPV is not good enough to serve as a non-invasive parameter for identifying CSPH and predicting risk of VH in patients with HBV-related cirrhosis.
结果：在纳入的非侵入性预测因素中，PVV表现出在HBV相关性肝硬化患者中诊断CSPH（定义为HVPG≥10 mmHg）的最佳性能，接受者工作特征曲线（AUC）下的面积，特异性和敏感性为0.745 ，50％和93.5％。其他非侵入性标志物，包括APRI，AAR，LS，FIB-4和门静脉直径，在AUC分别为0.565、0.560、0.544、0.529和0.474时，未显示出足够的性能。关于预测VH的风险（定义为HVPG≥12 mmHg），PPV还表现出中等表现，AUC为0.762，优于上述指标。通过使用PVV的两个临界值排除（11.65 cm / s）和排除（20.20 cm / s）CSPH，有30名（33.7％）患者表现出明确的结果类别，其中23名（76.7％）患者被很好分类和7（23.3％）被错误分类。 59名（66.3％）患者的结果不确定。通过使用13.10 cm / s和21.40 cm / s的PVV值来排除和排除≥12mmHg的HVPG，可以明确诊断34例（38.2％）患者，其中26例（76.5％）被很好分类，8例（23.5） ％）被错误分类。有55名（61.8％）患者需要进一步评估。