Measurement Of Stenosis Research Articles

Clinical outcome in lumbar decompression surgery for spinal canal stenosis in the aged population: a prospective Swiss multicenter cohort study.

This is a prospective, multicenter cohort study including 8 medical centers in the metropolitan area of the Canton Zurich, Switzerland. To examine whether outcome and quality of life might improve after decompression surgery for degenerative lumbar spinal stenosis (DLSS) even in patients older than 80 years and to compare data with a younger patient population from our own patient collective. Lumbar decompression surgery without fusion has been shown to improve quality of life in lumbar spinal canal stenosis. In the population older than 80 years, treatment recommendations for DLSS show conflicting results. Eight centers in the metropolitan area of Zurich, Switzerland agreed on the classification of DLSS, surgical principles, and follow-up protocols. Patients were followed from baseline, at 6 months, and 12 months. Baseline characteristics were analyzed with 5 different questionnaires "Spinal Stenosis Measure, Feeling Thermometer, Numeric Rating Scale, 5D-3L, and Roland and Morris Disability Questionnaire." In addition, our study population was compared with a younger control group. Furthermore, we calculated the minimal clinically important differences. Thirty-seven patients with an average age of 82.5 ± 2.5 years reached the 12-month follow-up. Spinal Stenosis Measure scores, the Feeling Thermometer, the Numeric Rating Scale, and the Roland and Morris Disability Questionnaire showed significant improvements at the 6-month and 12-month follow-ups (P < 0.001). One EQ-5D-3Lsubgroup "anxiety/depression" showed no significant improvement (P = 0.109) at 12-month follow-up. The minimal clinically important difference for the "Symptom Severity scale" in the Spinal Stenosis Measure was achieved with improvement of 70% in the older patient population. Patients 80 years or older can expect a clinically meaningful improvement after lumbar decompression for symptomatic DLSS. Our patient population showed significant positive development in quality of life in the short- and long-term follow-ups. 3.

Abstract T P180: Ultrasound Characteristics of Symptomatic Carotid Plaques: A Systematic Review and Meta-analysis

Background and Purpose: Ultrasound is the most commonly used imaging modality for assessment of carotid artery stenosis. A number of studies have demonstrated that surface irregularities, heterogeneous echotexture and hypoechoic plaques are risk factors for acute ischemic stroke. We performed a systematic review and meta-analysis of the literature to better define the risk of stroke based off of the sonographic characteristics of carotid plaques. Materials and Methods: We performed a comprehensive literature search evaluating the association of carotid plaque characteristics on ultrasound with ischemic outcomes. We included both case-control and cohort studies examining the relationship between complex plaque and acute ischemic stroke. Complex plaque was defined as plaque that had any of the following characteristics: heterogeneous plaque echogenicity, hypoechoic plaque, plaque neovascularization, plaque surface irregularity, plaque ulceration, and intraplaque motion. Meta-analyses using the random-effects model were performed for complex plaque and each of the individual complex plaque characteristics. Results: A total of 1013 articles were screened and 30 studies with 11528 patients (3054 symptomatic and 8474 asymptomatic) were included. The odds ratios for the association between complex plaque and ischemic symptoms was 5.18 (95%CI=4.63-5.79). Heterogeneous echotexture (OR=11.72, 95%CI=9.82-13.98), intraplaque motion (OR=1.57, 95%CI=1.02-2.41), plaque echolucency (OR=3.23, 95%CI=2.72-3.84), plaque neovascularity (OR=5.66, 95%CI=3.15-10.16) and plaque ulceration (OR=2.65, 95%CI=1.89-3.73) were all associated with ischemic symptoms. Surface irregularity without frank ulceration was not associated with ischemic symptoms (OR=1.35, 95%CI=0.98-1.86). Conclusions: Complex plaque, heterogeneous plaque echogenicity, hypoechoic plaque, plaque neovascularization, plaque ulceration and intraplaque motion are associated with ischemic symptoms. Assessment of carotid plaque on ultrasound provides stroke risk information beyond measurement of luminal stenosis.

Correlation of Carotid Intraplaque Hemorrhage and Stroke Using 1.5 T and 3 T MRI.

Carotid therosclerotic disease causes approximately 25% of the nearly 690,000 ischemic strokes each year in the United States. Current risk stratification based on percent stenosis does not provide specific information on the actual risk of stroke for most individuals. Prospective randomized studies have found only 10 to 12% of asymptomatic patients will have a symptomatic stroke within 5 years. Measurements of percent stenosis do not determine plaque stability or composition. Reports have concluded that cerebral ischemic events associated with carotid plaque are intimately associated with plaque instability. Analysis of retrospective studies has found that plaque composition is important in risk stratification. Only MRI has the ability to identify and measure the detailed components and morphology of carotid plaque and provides more detailed information than other currently available techniques. MRI can accurately detect carotid hemorrhage, and MRI identified carotid hemorrhage correlates with acute stroke.

Digital subtraction angiography (DSA) is superior to duplex ultrasound in diagnosis of extracranial carotid stenosis - a comparative study

Digital subtraction angiography (DSA) is the gold standard investigation to assess the extracranial stenosis of carotid vessels. But this is an invasive diagnostic tool. So it is still a controversial issue whether duplex ultrasound is an alternative to DSA for measurement of stenosis of carotid vessels. This prospective crossectional observational study was conducted in the department of Neurology, BSMMU, Dhaka from May 2012 to April 2013 to assess the diagnostic accuracy of duplex ultrasound and its potential to replace DSA before performing carotid endarterectomy (CEA) and carotid stenting. Total of 38 patients, 33 patients of nondisabling ischaemic stroke and 5 patients with history of TIAs whose extracranial carotid stenosis was &gt;50% on duplex ultrasound were selected for DSA. DSA was done on these vessels and stenosis was measured using NASCET criteria. Results of USD and DSA were compared to determine the sensitivity, specificity and accuracy of duplex ultrasound (USD). At 70% stenosis of right internal carotid artery and left internal carotid artery the sensitivity, specificity and accuracy were 93.8%, 63.7%, 89.5% and 93.3%, 75%, 89.5% respectively. This level of diagnostic efficiency of USD is less than that of DSA of carotid arteries. It was found in this study that, USD underestimates or overestimates the degree of carotid stenosis. DSA was safe and effective in determining stenosis in this study &amp; there was no 67 complication. So before taking any decision for carotid endarterectomy or carotid artery stenting, digital subtraction angiography of carotid vessels should be done. DOI: http://dx.doi.org/10.3329/bmj.v43i2.21385 Bangladesh Med J. 2014 May; 43 (2): 67-71

Abstract 20015: Value of Quantitative Atherosclerotic Plaque Assessment Using CCTA to Predict Lesion-specific Ischemia, Data from 407 Coronary Lesions

Introduction: While coronary computed tomographic angiography (CCTA) demonstrates high diagnostic performance for identification and exclusion of high-grade anatomic stenosis, it is unable to effectively discriminate coronary lesions that causes ischemia. Hypothesis: To study whether quantitative assessment of CCTA offer incremental information for discrimination of lesion ischemia beyond stenosis measures. Methods: 252 consecutive patients with suspected or known coronary artery disease (CAD) from 17 centers in 5 countries were enrolled (mean age 63±9 years, 71% male). Patients underwent CCTA and invasive coronary angiography (ICA), with 407 coronary lesions interrogated by invasive fractional flow reserve (FFR) at the time of maximum hyperemia. For these coronary lesions, we evaluated % diameter stenosis (%DS), % area stenosis (%AS), minimal luminal diameter (MLD, mm), minimal luminal area (MLA, mm 2 ), and plaque burden at MLA by CCTA. Plaque burden (PB, %) was defined as (vessel area–lumen area)/vessel areaх100. Lesion-specific ischemia by FFR was defined as a value ≤0.8. Results: In quantitative analysis area under the receiver operating characteristic curves (AUC) value of %DS, %AS, MLD, MLA, and PB for prediction of ischemia were 0.72 (95% confidence interval (CI) 0.68-0.77, p&lt;0.001), 0.73 (95% CI 0.68-0.77, p&lt;0.001), 0.75 (95% CI 0.70-0.79, p&lt;0.001), 0.75 (95% CI 0.70-0.79, p&lt;0.001), and 0.77 (95% CI 0.73-0.81, p&lt;0.001), respectively. PB showed significantly improved AUC when compared to % area stenosis (p=0.002). However, PB didn’t show incremental power over MLA (p=0.213). There also was no significant difference in AUC between MLA and % area stenosis (p=0.330) Conclusions: Quantitative plaque assessment using CCTA could predict lesion-specific ischemia with good discrimination. Plaque burden showed incremental value over % area stenosis for ischemia prediction.

Abstract 20149: Effect of Mitral Valve Area Following Surgical Repair for Degenerative Mitral Regurgitation on Exercise Hemodynamics and Functional Consequences

Introduction: Mitral valve (MV) area is the key measure of mitral stenosis (MS) in rheumatic MV disease, but its role in the follow-up of patients who had MV repair for degenerative mitral regurgitation (MR) remains uncertain. Our objective is to evaluate the relationships of MV area with hemodynamic effects at rest and during exercise, and with functional measures in patients following MV repair for degenerative MR. Methods: We prospectively assessed 110 patients who had MV repair for degenerative MR and no more than mild residual MR. Patients with aortic valve disease and ventricular dysfunction were excluded. The patients underwent comprehensive echo assessment at rest and during supine bicycle exercise. Brain natriuretic peptide (BNP) levels and SF36 questionnaires were also performed. MV area was calculated using the continuity equation. The patients were divided into 2 groups for comparison (MV area &lt; 1.5 cm 2 vs &gt; 1.5 cm 2 ). Results: 22 patients (20%) had MV area &lt; 1.5 cm 2 . The 2 groups were similar in age. Patients with MVR &lt; 1.5 cm 2 had worse resting and exercise hemodynamics, more limited exercise capacity and higher BNP levels compared to those with larger MV area (Table). These patients also had lower scores in physical functioning, vitality (p=0.01) and social function (p=0.04), based on the SF36 questionnaires. Multivariate analysis showed that MV area is an independent predictor of exercise capacity (p=0.003). Conclusion: In patients following MV repair for degenerative MR, MV area is a useful measure of MS severity because it is associated with resting and exercise hemodynamics and functional consequences. MV area should be routinely measured in this clinical setting, and refinement in MV repair techniques is needed to optimize MV area in addition to eliminate MR.

Comparison of coronary CT angiography with conventional coronary angiography in the diagnosis of coronary artery disease

Noninvasive CT coronary angiography is a promising coronary imaging technique. In spite of the unprecedented temporal and spatial resolution and the inability to perform therapeutic interventions in the same session multi-detector computed tomography (MDCT) has been considering a promising alternative, non invasive tool for coronary artery imaging due to its high sensitivity and specificity for the detection of significant coronary artery stenosis. To evaluate the diagnostic accuracy of 64-slice MDCT for assessing haemodynamically significant stenoses of the coronary arteries in comparison with the conventional standard cardiac angiography. Fifty patients scheduled for conventional coronary angiography at the department of Radiology and Imaging, United Hospital, Dhaka were enrolled between July 2007 and June 2008. All patients underwent both conventional and MDCT angiography within mean 10.70 days. Overall sensitivity of 64-slice MDCT for the detection of stenosis ≤ 50%, stenosis > 50%, and stenosis > 75% was 90.0%, 83.8%, and 80.7%, respectively, and specificity was 96.5%, 98.4%, and 98.3% respectively and accuracy was 96.0 %, 96.5%, and 96.6% respectively. Contrast-enhanced 64-slice MDCT allows the identification of coronary stenosis with excellent accuracy. Measurements of stenosis derived by MDCT correlated well with conventional angiogram. A major limitation is the insufficient ability of CT to exactly quantify the degree of stenosis.

Clinical Correlation of Anatomical Location of Nonthrombotic Iliac Vein Lesion

Nonthrombotic iliac vein lesions are an active area of research. The advantages of intravascular ultrasound (IVUS) imaging include allowing the exact localization of these lesions. We chose to use IVUS to explore the anatomical location of nonthrombotic iliac vein lesions (NIVLs) and correlate it with clinical findings. Over the course of 7 months, we performed 217 iliofemoral IVUS-assisted studies in 141 women and 76 men. The average ± standard deviation age of examined population was 68 ± 14 years (range, 22-96 years). We used IVUS intraoperatively to measure and record the area of the involved iliofemoral veins. The measurement of stenosis was compared with the adjacent nonstenotic iliofemoral veins. If >50% cross-sectional area or diameter reduction was found by IVUS imaging, it was treated with appropriate balloon size (range 10 × 40 to 16 × 60) and stent (12-to 24-mm diameter × 40-to 90-mm length). We used the Boston Scientific Mobile Cart System IVUS to perform these measurements. We identified 233 lesions: 115 in left lower extremity (LLE) and 118 in the right lower extremity (RLE). The CEAP scores in the LLE were C1: 0; C2: 35; C3: 40; C4: 15; C5: 20; and C6: 6; with the most common site being the proximal common iliac vein in 37.4% (20.86% females and 16.5% males). The CEAP scores in the RLE were C1: 0; C2: 31; C3: 42; C4: 14; C5: 23; and C6: 7; and the most common site was in the middle external iliac vein in 31.35% (20.4% females and 11.01% males). The least common site of the NIVL in the LLE was in the distal external iliac vein in 2.6% (2.6% females and 0% males). In the RLE, the least common site of NIVL was also in the distal external vein 7.62% (5.93% females and 1.69% males). No correlation between age, laterality, gender, or CEAP score were noted. This analysis gives an insight into understanding the anatomical location of the NIVL, which is often an undiagnosed cause of lower extremity venous diseases. Despite multiple questions yet to be answered, the results give an insight to clinicians and researches to guide their treatment and research.

A New Carotid 3D MRI Sequence for Stenosis Measurement and Plaque Characterization at the Same Time

A New Carotid 3D MRI Sequence for Stenosis Measurement and Plaque Characterization at the Same Time

A new model of arteriovenous fistula to study hemodialysis access complications.

This report presents a new animal model of arteriovenous fistula (AVF) with attention given to surgical techniques as well as hemodynamic and pathologic measurements. Of note, this model was created with a tunneled central catheter with the purpose of studying therapeutic interventions, including hemodialysis. Side-common carotid artery to end-external jugular vein AVFs were created in eight minipigs. A tunneled central catheter was also placed in the internal jugular vein. After 28 days, hemodynamic measurements of AVF flow and stenosis were performed. The minipigs were then euthanized and the AVFs were harvested for pathologic measurements of neointimal hyperplasia and thrombus volumes. In order to account for variable size of the AVFs, percentage luminal stenosis and degree of intima-media thickening were calculated. After 28 days, all eight AVFs remained patent. On average, 19% of arterial blood flow that approached the AVF traveled through the anastomosis. The average luminal stenosis by angiogram was 61.1%. The average neointimal hyperplasia and thrombus volumes were 1.4×10(8) and 3.8×10(8) μm3, respectively. The average luminal stenosis and intima-media thickening were 65.2% and 430.4 μm, respectively. This AVF model is ideal because of the relative ease of surgery and husbandry, lack of complications, as well as consistent and rapid development of the neointimal lesion which underlies AVF failure.

Standards of the Polish Ultrasound Society - update. Examination of extracranial carotid and vertebral arteries.

The role of a standard is to describe examination techniques, recommended norms as well as principles necessary to obtain results and draw appropriate conclusions, rather than a description of pathologies. The paper presents a technique for carotid artery examination as well as currently recommended standards. According to San Francisco Consensus from 2003, a significant stenosis of 70% may be detected when systolic velocity in the internal carotid artery stenosis is >230 cm/s, and the diastolic velocity is >100 cm/s. The common carotid artery velocity is also taken into account. Hemodynamic evaluation is therefore the primary method for the assessment of the degree of internal carotid artery stenosis. It is important that the examination is performed at an insonation angle of 60° as measurements at higher angles result in an exponential increase in measurement error. Also, an extended version of standards involving measurements performed behind stenosis, which are used in some clinics, is included in the paper. The paper further presents guidelines for the description of the identified pathologies, which ensure that the findings prove unambiguous for clinicians, especially when stenosis eligible for surgical intervention is detected. Morphological measurement of stenosis (according to NASCET criteria) is only of supplementary character (confirming morphological grounds for the increase of velocity) and has no critical importance, especially due to high measurement divergence. Description of atherosclerotic plaques, especially hypoechoic ones, which are considered potentially unstable and may lead to a raised risk of stroke, is a very important element of examination. The paper is based on Standards of the Polish Ultrasound Society and updated based on the latest literature reports.

Comparing the Diagnostic Accuracy of Contrast-Enhanced Computed Tomographic Angiography and Gadolinium-Enhanced Magnetic Resonance Angiography for the Assessment of Hemodynamically Significant Transplant Renal Artery Stenosis

To compare diagnostic accuracy of contrast-enhanced computed tomographic angiography (CTA) and gadolinium-enhanced magnetic resonance angiography (MRA) for the assessment of hemodynamically significant transplant renal artery stenosis (TRAS). After institutional review board approval, records of 27 patients with TRAS confirmed on digital subtraction angiography (DSA) were retrospectively reviewed. A total of 13 patients had MRA and 14 had CTA before DSA. Two board-certified fellowship-trained radiologists, one each from interventional radiology and body imaging blindly reviewed the DSA and CTA or MRA data, respectively. Sensitivity (SN), specificity (SP), positive predictive value, and negative predictive value of MRA and CTA were estimated using 50% stenosis as the detection threshold for significant TRAS. These parameters were compared between modalities using the Fisher exact test. Bias between MRA or CTA imaging and DSA was tested using the Wilcoxon signed-rank test. Two patients were excluded from the MRA group owing to susceptibility artifacts obscuring the TRAS. The correlation between MRA and DSA measurements of stenosis was r = 0.57 (95% CI:-0.02, 0.87; P = 0.052) and between CTA and DSA measurements was r = 0.63 (95% CI: 0.14, 0.87; P = 0.015); the difference between the 2 techniques was not significant (P = 0.7). Both imaging modalities tended to underestimate the degree of stenosis when compared with DSA. MRA group (SN and SP: 56% and 100%, respectively) and CTA group (SN and SP: 81% and 67%, respectively). There were no significant differences in detection performance between modalities (P>0.3 for all measures). We did not find that either modality had any advantage over the other in terms of measuring or detecting significant stenosis. Accordingly, MRA may be preferred over CTA after positive color Doppler ultrasound screening when not contraindicated owing to lack of ionizing radiation or nephrotoxic iodinated contrast. However, susceptibility of artifacts owing to surgical clips at the anastomosis may limit diagnostic utility of MRA as found in 2 of 13 patients. Trend towards no significant difference between the CTA and enhanced MRA in the detection of hemodynamically significant TRAS.

The glycolytic switch in the development and progression of colorectal cancer

The glycolytic switch in the development and progression of colorectal cancer

Optimizing Image Contrast Display Improves Quantitative Stenosis Measurement in Heavily Calcified Coronary Arterial Segments on Coronary CT Angiography: A Proof-of-Concept and Comparison to Quantitative Invasive Coronary Angiography

Blooming artifact from calcified plaques often renders measurement of stenosis impossible on coronary computed tomographic angiography (CTA). We sought to evaluate the impact of modifying window level on reducing blooming artifact, and its impact on stenosis quantification. We analyzed 125 calcified segments from 53 patients who underwent CTA and invasive coronary angiography (ICA). Segmental stenosis on CTA was measured using three window settings: width of 1000 Hounsfield units (HU) and level of 200 HU ("default"), 1500/200 HU ("widened"), and width and level based on the mean HU of the calcified plaque and pericoronary fat ("calcium-specific"). Segmental stenosis on ICA was quantified by a blinded experienced reader. ICA found ≥50% stenosis in 30 segments. Displaying segments with widened and calcium-specific settings improved overall accuracy of detecting ≥50% stenosis (P's < 0.001) by increasing the rate of accurately quantifying <50% stenosis (P's < 0.001), and improved correlation of stenosis quantification to ICA (P's < 0.05). There was no difference in stenosis quantification accuracy between widened and calcium-specific window settings. Limits of agreement between CTA stenosis quantification and ICA narrowed with widened and calcium-specific settings. We showed for the first time that in calcified segments, widening display window width significantly improved CTA quantification of stenosis compared to ICA.

Computed Tomography Angiography in the Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) Study

Background: The Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) study validated noninvasive imaging tests of intracranial atherosclerosis against catheter angiography in a prospective, blinded, multicenter setting. Critical evaluation of transcranial Doppler (TCD) and magnetic resonance angiography in the SONIA study standardized their performance and interpretation. We performed a similar analysis of computed tomography angiography (CTA) for the detection of intracranial stenosis. Methods: Multicenter standardization of image acquisition and blinded, central interpretation of CTA performance were conducted in concert with the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. Measurements of the intracranial arterial diameter were obtained to derive stenosis values. Correlation with catheter angiography was used to assess CTA performance characteristics. Results: CTA measurements of intracranial stenosis were obtained in 120 vessel segments, with angiographic correlation in 52. CTA was performed as a noninvasive study prior to conventional angiography. CTA stenoses of 50-99% or a flow gap were identified in 15 of 52 vessel segments, stenoses of <50% in 5 of 52, and normal arterial diameters in 32 of 52 vessel segments. Based on the digital subtraction angiography (DSA) stenosis defined as 50-99%, the positive predictive value (PPV) of CTA was only 46.7% (95% CI 21.3-73.4) and the negative predictive value (NPV) was 73.0% (95% CI 55.9-86.2). For DSA stenosis defined as 70-99%, the PPV of CTA was 13.3% (95% CI 1.7-40.5) and the NPV was 83.8% (95% CI 68.0-93.8). Conclusions: CTA can accurately rule out the presence of severe stenosis due to intracranial atherosclerosis and may eliminate the need for angiography in many cases. Further prospective, blinded evaluation of CTA and optimization of cutpoints to predict angiographic disease will facilitate future trials of intracranial atherosclerosis.

Fractional flow reserve and appropriate use criteria

Wide variations in clinical practice raise questions about the under- or over-use of expensive interventional coronary procedures. Appropriate Use Criteria (AUC) for percutaneous coronary intervention (PCI) were developed in 2009 and updated in 2012 to help guide clinicians regarding the decision to revascularize, based on a synthesis of available evidence. Despite these criteria, recent analyses have continued to show high rates of both inappropriate PCI and underutilization of PCI. Fractional flow reserve, which is a physiologic measurement of a coronary artery stenosis, provides objective evidence of the functional significance of a coronary lesion and has the potential to reduce variations in practice.

NOVEL QUANTITATIVE FLUOROPERFUSION ASSESSMENT OF THE PHYSIOLOGIC SIGNIFICANCE OF CORONARY STENOSES DURING DYNAMIC CINE FLUOROSCOPY

While invasive coronary angiography is the standard for defining percent stenosis, fractional or coronary flow reserve (CFR) measurements are required to determine hemodynamic significance. This study aimed to validate a novel fluoroperfusion (FP) method to measure myocardial blood flow (MBF) and

Cross-cultural adaptation of the German version of the spinal stenosis measure

To validate the German version of the spinal stenosis measure (SSM), a disease-specific questionnaire assessing symptom severity, physical function, and satisfaction with treatment in patients with lumbar spinal stenosis. After translation, cross-cultural adaptation, and pilot testing, we assessed internal consistency, test-retest reliability, construct validity, and responsiveness of the SSM subscales. Data from a large Swiss multi-center prospective cohort study were used. Reference scales for the assessment of construct validity and responsiveness were the numeric rating scale, pain thermometer, and the Roland Morris Disability Questionnaire. One hundred and eight consecutive patients were included in this validation study, recruited from five different centers. Cronbach's alpha was above 0.8 for all three subscales of the SSM. The objectivity of the SSM was assessed using a partial credit approach. The model showed a good global fit to the data. Of the 108 patients 78 participated in the test-retest procedure. The ICC values were above 0.8 for all three subscales of the SSM. Correlations with reference scales were above 0.7 for the symptom and function subscales. For satisfaction subscale, it was 0.66 or above. Clinically meaningful changes of the reference scales over time were associated with significantly more improvement in all three SSM subscales (p < 0.001). Conclusion: The proposed version of the SSM showed very good measurement properties and can be considered validated for use in the German language.

Carotid Plaque MRI and Stroke Risk: A Systematic Review and Meta-analysis

Dedicated magnetic resonance imaging (MRI) of plaque composition offers stroke risk information beyond measurement of luminal stenosis in carotid atherosclerotic disease.

A novel noninvasive assessment of hepatic venous pressure gradient and portal pressure computed from computed tomography angiography.

Cirrhosis is a severe and common digestive disease worldwide and is associated with a poor outcome. Portal hypertension (PHT) is a frequently encountered complication in cirrhotic patients [1–3]. Therefore, evaluation of portal pressure (PP) is urgently needed for the grading and staging of PHT. Direct measurement of PP is rarely performed due to significant invasiveness and potential complications. Hepatic venous pressure gradient (HVPG) is currently treated as the “gold standard” [1–4]. However, the invasiveness and technical difficulty greatly restrict its repeatable application. An index computed from computed tomography angiography (CTA) has recently demonstrated its diagnostic value compared with the “gold standard” [5, 6]. For instance, fractional flow reserve from coronary CTA showed good performance in the diagnosis of functional coronary stenosis in a multicenter randomized clinical controlled trial on 159 vessels in 103 patients [6]. On the basis of our previous study of noninvasive measurement of coronary stenosis by fractional flow reserve [7], this study, for the first time, introduces a novel noninvasive assessment of HVPG (HVPGni) and PP (PPni) computed from three dimensional (3D) hepatic portal venous models reconstructed from CTA to diagnose the severity of PHT in cirrhotic patients. The patient enrolled in the pilot study was a 50-year-old man who showed visible clinical manifestations of PHT, such as ascites and splenomegaly, and was diagnosed with cirrhosis in the decompensated stage. Approval was obtained from the ethical committees of Tongji Hospital and the participant gave written informed consent in advance. The CTA was performed with multi-detector CT scanners (GE Light-Speed Ultra, 120 kV, 220 mA). Original images were spilt into thin layers and exported into imaging control software MIMICS10.0. 3D hepatic portal venous models were reconstructed from surrounding tissues by different CT values, which were then meshed with 3D Flotran elements in the software ANSYS11.0. Given boundary conditions including average velocity of hepatic venous and portal venous flow were measured by color Doppler ultrasound (CDUS) (Philips iU22 x MATRIX Ultrasound System, convex array probe C5-2). Afterwards, finite element analysis and computational fluid dynamics were applied to compute the pressure distribution in the hepatic portal vein in vitro. Clinical data of the decompensated cirrhotic patient were calculated to test the feasibility and accuracy of the novel noninvasive assessment with the clinical diagnosis, CTA and CDUS as reference standards. The CTA images showed that the diameter of the portal vein was 1.6 cm while the normal diameter is ≤ 1.3 cm [2, 3]. Besides, the average velocity of portal venous flow was 12.5 cm/s, which was obviously slower than 22.62 cm/s in normal patients [1, 3, 4] and indicated severe PHT. According to the calculation by the novel assessment, HVPGni and PPni were computed as 65.2 Pa (Figure 1) and 3535.0 Pa (Figure 2), which generally corresponded to the diagnosis of PHT. Furthermore, the pressure and velocity distribution of different sections could be simultaneously obtained. Figure 1 Noninvasive assessment of hepatic ve- 702.835 1493.68 2284.52 3075.36 3866.2 nous pressure gradient in decompensated cirrhosis. Hepatic venous pressure gradient was calculated in vitro with the value of 65.2 Pa Figure 2 Noninvasive assessment of portal pressure in decompensated cirrhosis. Portal pressure was quantified in vitro as 3535.0 Pa and was generally consistent with the clinical diagnosis of portal hypertension The PHT is known as a frequent complication of cirrhosis worldwide which significantly reduces the patient's quality of life. The HVPG is currently considered as the “gold standard” to identify PHT. However, shortcomings, such as invasiveness and technical difficulty, limit its diagnostic worth greatly. In the pilot study, finite element analysis and computational fluid dynamics over the 3D hepatic portal venous model were applied, which potentially developed a novel noninvasive assessment of HVPGni and PPni to evaluate the severity of PHT. Besides, the novel assessment was successfully applied and the diagnostic performance of HVPGni and PPni was overall consistent with the clinical diagnosis, CTA and CDUS. This study introduces, for the first time, a novel noninvasive assessment of HVPGni and PPni computed from hepatic portal venous models, which might be a potential diagnostic tool to evaluate the severity of PHT, grading of cirrhosis and choice of treatment in the future. However, large randomized clinical controlled trials evaluated by both the novel assessment and invasive “gold standard” are needed before the application from bench to bedside.