Computed tomography-based score model/nomogram for predicting technical and midterm outcomes in transjugular intrahepatic portosystemic shunt treatment for symptomatic portal cavernoma  

作　　者：Xiang-Ke Niu Sushant Kumar Das Hong-Lin Wu Yong Chen 

机构地区：[1]Department of Radiology,Affiliated Hospital of Chengdu University,Chengdu 610081,Sichuan Province,China [2]Department of Radiology,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan Province,China [3]Department of Interventional Radiology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,Guangdong Province,China

出　　处：《World Journal of Clinical Cases》2020年第5期887-899,共13页世界临床病例杂志

基　　金：Supported by Health and Family Planning Commission of Chengdu,China,No.2015080;Health and Family Planning Commission of Sichuan Province,China,No.17PJ430

摘　　要：BACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS)may be technically difficult in patients with cavernous transformation of the portal vein(CTPV).Computed tomography(CT)is widely used for assessing the situation of the portal vein and its tributaries before TIPS,and an ultrasound-based Yerdel grading system has been developed,which is deemed useful for liver transplantation.Therefore,we hypothesized that a CT-based CTPV scoring system could be useful for predicting technical and midterm outcomes in TIPS treatment for symptomatic portal cavernoma.AIM To investigate the clinical significance of a CT-based score model/nomogram for predicting technical success and midterm outcome in TIPS treatment for symptomatic CTPV.METHODS Patients with symptomatic CTPV who had undergone TIPS from January 2010 to June 2017 were retrospectively analysed.The CTPV was graded with a score of 1-4 based on contrast-CT imaging findings of the diseased vessel.Outcome measures were technical success rate,stent patency rate,and midterm survival.Cohen’s kappa statistic,the Kaplan-Meier and log-rank tests,and uni-and multivariable analyses were performed.A nomogram was constructed and verified by calibration and decision curve analysis.RESULTS A total of 76 patients(45 men and 31 women;mean age,52.3±14.7 years)were enrolled in the study.The inter-reader agreement(κ)of the CTPV score was 0.81.TIPS was successfully placed in 78%of patients(59/76).The independent predictor of technical success was CTPV score(odds ratio[OR]=5.56,95%confidence interval[CI]:3.55-9.67,P=0.002).The independent predictors of primary TIPS patency were CTPV score and splenectomy(OR=9.22,95%CI:4.78-13.45,P=0.009;OR=4.67,95%CI:2.59-7.44,P=0.017).The survival rates differed significantly between the TIPS success and failure groups.The clinical nomogram was made up of patient age,model for end-stage liver disease score,and CTPV score.The calibration curves and decision curve analysis verified the usefulness of the CTPV score-based nomogram for clinical practBACKGROUND Transjugular intrahepatic portosystemic shunt(TIPS) may be technically difficult in patients with cavernous transformation of the portal vein(CTPV). Computed tomography(CT) is widely used for assessing the situation of the portal vein and its tributaries before TIPS, and an ultrasound-based Yerdel grading system has been developed, which is deemed useful for liver transplantation. Therefore, we hypothesized that a CT-based CTPV scoring system could be useful for predicting technical and midterm outcomes in TIPS treatment for symptomatic portal cavernoma.AIM To investigate the clinical significance of a CT-based score model/nomogram for predicting technical success and midterm outcome in TIPS treatment for symptomatic CTPV.METHODS Patients with symptomatic CTPV who had undergone TIPS from January 2010 to June 2017 were retrospectively analysed. The CTPV was graded with a score of 1-4 based on contrast-CT imaging findings of the diseased vessel. Outcome measures were technical success rate, stent patency rate, and midterm survival.Cohen’s kappa statistic, the Kaplan-Meier and log-rank tests, and uni-and multivariable analyses were performed. A nomogram was constructed and verified by calibration and decision curve analysis.RESULTS A total of 76 patients(45 men and 31 women; mean age, 52.3 ± 14.7 years) were enrolled in the study. The inter-reader agreement(κ) of the CTPV score was 0.81.TIPS was successfully placed in 78% of patients(59/76). The independent predictor of technical success was CTPV score(odds ratio [OR] = 5.56, 95%confidence interval [CI]: 3.55-9.67, P = 0.002). The independent predictors of primary TIPS patency were CTPV score and splenectomy(OR = 9.22, 95%CI:4.78-13.45, P = 0.009; OR = 4.67, 95%CI: 2.59-7.44, P = 0.017). The survival rates differed significantly between the TIPS success and failure groups. The clinical nomogram was made up of patient age, model for end-stage liver disease score,and CTPV score. The calibration curves and decision curve analysis verified the usefulness

关 键 词：Portosystemic shunt Transjugular intrahepatic Liver cirrhosis Portal hypertension Oesophageal and gastric varices BLEEDING Shunt dysfunction 

分 类 号：R735.7[医药卫生—肿瘤]