Hepatic parenchyma and vascular blood flow changes after TIPS with spectral CT iodine density in HBV-related liver cirrhosis

Lei Wang,Yifan Wu,Chunyan Zhang,Fuquan Liu,Zhenhua Fan,Jian Dong,Rengui Wang,Hongwei Zhao,Zhendong Yue,Yu Zhang

doi:10.1038/s41598-021-89764-6

Lei Wang, Yifan Wu + Show 8 more

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https://doi.org/10.1038/s41598-021-89764-6

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Abstract

To compare changes in spectral CT iodine densities of hepatic parenchyma and vessels before and after transjugular intrahepatic portosystemic shunt (TIPS) in hepatitis B virus (HBV)-related liver cirrhosis. Twenty-five patients with HBV-related liver cirrhosis who received TIPS for gastroesophageal varices bleeding were recruited. Each patient underwent three phases contrast CT before and after TIPS within 4 weeks, with the raw data reconstructed at 1.25-mm-thick slices. Iodine density (in milligrams per milliliter) was measured on iodine-based material decomposition image. Multiple regions of interest (ROIs) in liver parenchyma, aorta and portal vein were selected from three slices of images. Portal vein trunk was set as the central one, and mean liver parenchymal iodine densities from arterial phase (AP), venous phase (VP) and equilibrium phase (EP) were recorded. Quantitative indices of iodine density (ID), including normalized ID in liver parenchyma for arterial phase (NIDLAP), ID of liver parenchyma for venous phase (IDLVP), ID of portal vein in venous phase (IDPVP) and liver arterial iodine density fraction (AIF), were measured and compared before and after TIPS. Based on Child–Pugh stage, 4, 12 and 9 patients were classified as grade A, B, and C, respectively. Liver volume was comparable before and after TIPS (1110.5 ± 287.4 vs. 1092.0 ± 276.3, P = 0.28). After TIPS, ID was decreased in aorta (146.0 ± 34.5 vs. 120.9 ± 30.7, P < 0.01) whereas increased in liver parenchyma at arterial phase, as demonstrated by IDAP (9.3 ± 3.1 vs. 13.4 ± 4.4 mg/mL) and AIF (0.40 ± 0.11 vs. 0.58 ± 0.11, P < 0.01). For venous or equilibrium phase, quantitative indices remained stable (23.1 ± 4.5 vs. 23.0 ± 5.3, 19.8 ± 4.1 vs. 19.4 ± 4.6) mg/mL (Ps > 0.05). For portal vein, ID and NID were increased after TIPS (23.1 ± 11.7 vs. 36.5 ± 13.0, 16.4 ± 8.5 vs. 31.8 ± 12.8) (P < 0.01). No positive correlation between iodine density and preoperative Child–Pugh score was observed. Based on iodine density measurement, spectral CT as a noninvasive imaging modality may assess hepatic parenchyma and vascular blood flow changes before and after TIPS in HBV-related liver cirrhosis.Clinical registration number: ChiCTR- DDC-16009986.

Highlights

Hepatitis B virus (HBV) infection is the leading cause of liver cirrhosis in Asian c ountries[1,2,3]
iodine density (ID) in liver parenchyma, N IDLAP and arterial iodine density fraction (AIF) were increased after transjugular intrahepatic portosystemic shunt (TIPS)
ID in liver parenchyma at venous or equilibrium phase was stable after TIPS

Summary

Introduction

Hepatitis B virus (HBV) infection is the leading cause of liver cirrhosis in Asian c ountries[1,2,3]. Blood supply could be decreased in liver parenchyma after TIPS since portal vein blood partially flows directly to inferior vena cava through portal-systemic shunt, which could cause increased risk of hepatic encephalopathy and liver failure[5,8,9]. Noninvasive imaging modalities have been applied in assessment of hepatic blood flow changes in liver lesions, including perfusion CT and M R4,9. Based on iodine density from material decomposition, spectral CT exhibits capability in quantifying liver fat concentration and staging in liver cirrhosis[13,14]. Our purpose is to investigate potential feasibility of spectral CT iodine density as a non-invasive imaging modality in assessment of hepatic blood flow changes after TIPS in patients with HBVrelated liver cirrhosis

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