Abstract
PurposeTo evaluate if the hepatic arterial perfusion index (HPI) in liver parenchyma of cirrhotic patients can serve as a surrogate parameter for stratifying the degree of esophageal varices and related bleeding risks.MethodsCT image data of sixty-six patients (59 men; mean age 68 years ± 10 years) with liver cirrhosis (Child–Pugh class A (35/66, 53%), B (25/66, 38%), and C (6/66, 9%) who underwent perfusion CT (PCT) for hepatocellular carcinoma (HCC) screening between April 2010 and January 2019 were retrospectively identified. HPI, a parameter calculated by a commercially available CT liver perfusion analysis software that is based on the double maximum slope model, using time attenuation curve to determine perfusion, was correlated with the degree of esophageal varices diagnosed at endoscopy and the number of bleeding events.ResultsEta correlation coefficient for HPI/presence of esophageal varices was very weak (0.083). Spearman-Rho for HPI/grading of esophageal varices was very weak (0.037 (p = 0.804)). Kendall-Tau-b for HPI/grading of esophageal varices was very weak (0.027 (p = 0.807)). ANOVA and Bonferroni post-hoc-tests showed no significant difference of HPI between different grades of esophageal varices (F (3, 62) = 1.676, p = 0.186). Eta correlation coefficient for HPI/bleeding event was very weak (0.126).ConclusionThe stratification of the degree of esophageal varices and the related bleeding risk by correlation with the HPI as a surrogate parameter for portal venous hypertension was not possible for patients with liver cirrhosis in Child–Pugh class A and B.Graphic abstract
Highlights
Patients with cirrhotic liver disease may develop portosystemic collateral vessels due to increased resistance within the portal venous system
The purpose of our study was to evaluate if the hepatic perfusion index (HPI) in liver parenchyma of cirrhotic patients can serve as a surrogate parameter for stratifying the degree of esophageal varices and related bleeding risks
A total of 384 patients with liver cirrhosis who underwent perfusion computed tomography (PCT) between April 2010 and January 2019 for hepatocellular carcinoma screening were identified from a local database
Summary
Patients with cirrhotic liver disease may develop portosystemic collateral vessels due to increased resistance within the portal venous system. Esophageal variceal bleeding is a potentially life-threatening complication with high mortality rates demanding emergency treatment [1]. In addition to other prognostic risk factors such as Child–Pugh score and MELD score, the presence of HCC is an independent risk factor for re-bleeding [2]. Prophylactic endoscopic monitoring and treatment of varices are often carried out to reduce variceal bleeding and improve survival [3]. An endoscopic maintenance program may not be feasible in every patient, especially in those with advanced HCC, due to their poor health status [2]. Amtirano et al promoted the identification of high-risk patients [2]
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