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Computed tomography perfusion in liver and spleen for hepatitis B virus-related portal hypertension:A correlation study with hepatic venous pressure gradient

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World Journal of Gastroenterology 2022年第42期28卷 6068-6077页

作者： Lei Wang Yu Zhang Yi-Fan Wu zhen-dong yue zhen-Hua Fan Chun-Yan Zhang Fu-Quan Liu Jian dong Department of Intervention Therapy Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China Interventional Radiology Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China Department of Radiology Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China

BACKGROUND Hepatic venous pressure gradient(HVPG)is the gold standard for diagnosis of portal hypertension(PH).However,its use can be limited because it is an invasive ***,it is necessary to explore a non-invasive method to assess *** To investigate the correlation of computed tomography(CT)perfusion of the liver with HVPG and Child-Pugh score in hepatitis B virus(HBV)-related *** Twenty-eight patients(4 female,24 male)with gastroesophageal variceal bleeding induced by HBV-related PH were recruited in our *** patients received CT perfusion of the liver before transjugular intrahepatic portosystemic stent-shunt(TIPS)*** parameters of CT perfusion of the liver,including liver blood flow(LBF),liver blood volume(LBV),hepatic artery fraction,splenic blood flow and splenic blood volume were *** was recorded during TIPS *** of liver perfusion with Child-Pugh score and HVPG were analyzed,and the receiver operating characteristic curve was *** on HVPG(>12 mmHg vs≤12 mmHg),patients were divided into moderate and severe groups,and all parameters were *** Based on HVPG,18 patients were classified into the moderate group and 10 patients were classified into the severe *** Child-Pugh score,HVPG,LBF and LBV were significantly higher in the moderate group compared to the severe group(all P<0.05).LBF and LBV were negatively associated with HVPG(r=-0.473,P<0.05 and r=-0.503,P<0.01,respectively),whereas splenic blood flow was positively associated with hepatic artery fraction(r=0.434,P<0.05).LBV was negatively correlated with Child-Pugh ***-Pugh score was not related to *** a cutoff value of 17.85 mL/min/100 g for LBV,the sensitivity and specificity of HVPG≥12 mmHg for diagnosis were 80%and 89%,*** LBV and LBF were negatively correlated with HVPG and Child-Pugh *** perfusion imaging is a potential non-invasive quantitative predictor for PH i

关键词： Hepatic venous pressure gradient Portal hypertension Computed tomography perfusion Hepatitis B Liver cirrhosis

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Alterations in the gut microbiome after transjugular intrahepatic portosystemic shunt in patients with hepatitis B virus-related portal hypertension

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World Journal of Gastroenterology 2024年第31期30卷 3668-3679页

作者： Hong-Wei Zhao Jin-Long Zhang Fu-Quan Liu zhen-dong yue Lei Wang Yu Zhang Cheng-Bin dong zhen-Chang Wang Department of Radiology Beijing Friendship HospitalCapital Medical UniversityBeijing 100050China Department of Radiology Beijing Tongren HospitalCapital Medical UniversityBeijing 100730China Department of Interventional Radiology Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China

BACKGROUND Gut microbiota(GM)affects the progression and response to treatment in liver *** GM composition is diverse and associated with different etiologies of liver ***,alterations in GM alterations are observed in patients with portal hypertension(PH)secondary to cirrhosis,with hepatitis B virus(HBV)infection being a major cause of cirrhosis in ***,understanding the role of GM alterations in patients with HBV infection-related PH is *** To evaluate GM alterations in patients with HBV-related PH after transjugular intrahepatic portosystemic shunt(TIPS)*** This was a prospective,observational clinical *** were 30 patients(with a 100%technical success rate)recruited in the present *** with esophagogastric variceal bleeding due to HBV infection-associated PH who underwent TIPS were *** samples were obtained before and one month after TIPS treatment,and GM was analyzed using 16S ribosomal RNA amplicon *** One month after TIPS placement,8 patients developed hepatic encephalopathy(HE)and were assigned to the HE group;the other 22 patients were assigned to the non-HE *** was no substantial disparity in the abundance of GM at the phylum level between the two groups,regardless of TIPS treatment(all,P>0.05).However,following TIPS placement,the following results were observed:(1)The abundance of Haemophilus and Eggerthella increased,whereas that of Anaerostipes,Dialister,Butyricicoccus,and Oscillospira declined in the HE group;(2)The richness of Eggerthella,Streptococcus,and Bilophila increased,whereas that of Roseburia and Ruminococcus decreased in the non-HE group;and(3)Members from the pathogenic genus Morganella appeared in the HE group but not in the non-HE *** Intestinal microbiota-related synergism may predict the risk of HE following TIPS placement in patients with HBVrelated *** microbiome therapies may be useful for preventing and trea

关键词： Transjugular intrahepatic portosystemic shunt Hepatic encephalopathy Gut microbiota Hepatitis B virus Portal hypertension

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Iodine-125 implantation with transjugular intrahepatic portosystemic shunt for main portal vein tumor thrombus

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World Journal of Gastrointestinal Oncology 2019年第4期11卷 310-321页

作者： yue Zhang Yi-Fan Wu zhen-dong yue Hong-Wei Zhao Lei Wang zhen-Hua Fan Fu-Liang He Tao Wang Fu-Quan Liu Department of Interventional Therapy Peking University Ninth School of Clinical Medicine Beijing Shijitan Hospital and Capital Medical University Department of Interventional Therapy Beijing Shijitan Hospital and Capital Medical University Department of Interventional Therapy The affiliated Yantai Yuhuangding Hospitalof Qingdao University

BACKGROUND Main portal vein tumor thrombus(MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepatocellular carcinoma(HCC).Therefore, attention should be paid to the treatment of MPVTT and its *** To evaluate the efficacy of transarterial chemoembolization/transarterial embolization(TACE/TAE)+^(125)I seeds implantation with transjugular intrahepatic portosystemic shunt(TIPS) in treating MPVTT and its *** From January 2007 to March 2015, 85 consecutive patients with MPVTT were nonrandomly assigned to undergo treatment with TACE/TAE + TIPS and ^(125)I implantation(TIPS-^(125)I group) or TACE/TAE + TIPS only(TIPS only group) in Beijing Shijitan Hospital, and all clinical data were collected. During 24 mo follow-up, the incidence of overall survival, stent stenosis and symptom recurrence was analyzed to evaluate the efficacy of TIPS-^(125)*** During 24 mo follow-up of all patients, we collected data at 6, 12 and 24 mo. The rates of survival were 80%, 45%, and 20%, respectively, in the TIPS-^(125)I group,whereas those in the TIPS only group were 64.4%, 24.4%, and 4.4%, respectively(P < 0.05). The rates of symptom recurrence were 7.5%, 22.5%, and 35%,respectively, in the TIPS-^(125)I group, whereas those in the TIPS only group were31.1%, 62.2%, and 82.2%(P < 0.05). The rates of stent restenosis were 12.5%,27.5%, and 42.5%, respectively, in the TIPS-^(125)I group, and 42.2%, 68.9%, and84.4%, respectively, in the TIPS only group(P < 0.05). TIPS-^(125)I was found to be significantly favorable in treating MPVTT and its complications in patients with *** TACE/TAE+^(125)I combined with TIPS is effective in treating MPVTT and its complications, improving quality of life of patients and reducing mortality.

关键词： Iodine-125 Transjugular intrahepatic portosystemic shunt Main portal vein tumor thrombus Metastasis Portal hypertension

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Establishment of a hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% alcohol

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World Journal of Gastroenterology 2015年第32期21卷 9544-9553页

作者： Lei Wang Fu-Liang He Fu-Quan Liu zhen-dong yue Hong-Wei Zhao Department of Interventional Therapy Beijing Shijitan Hospital Capital Medical University

AIM: To determine the feasibility and safety of establishing a porcine hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% ***: Twenty-one healthy Guizhou miniature pigs were randomly divided into three experimental groups and three control groups. The pigs in the three experimental groups were subjected to hepatic arterial perfusion with 7, 12 and 17 m L of 80% alcohol, respectively, while those in the three control groups underwent hepatic arterial perfusion with 7, 12 and 17 m L of saline, respectively. Hepatic arteriography and direct portal phlebography were performed on all animals before and after perfusion, and the portal venous pressure and diameter were measured before perfusion, immediately after perfusion, and at 2, 4 and 6 wk after perfusion. The following procedures were performed at different time points: routine blood sampling, blood biochemistry, blood coagulation and blood ammonia tests before surgery, and at 2, 4 and 6 wk after surgery; hepatic biopsy before surgery, within 6 h after surgery, and at 1, 2, 3, 4 and 5 wk after surgery; abdominal enhanced computed tomography examination before surgery and at 6 wk after surgery; autopsy and multi-point sampling of various liver lobes for histological examination at 6 wk after surgery. RESULTS: In experimental group 1, different degrees of hepatic fibrosis were observed, and one pig developed hepatic cirrhosis. In experimental group 2, there were cases of hepatic cirrhosis, different degrees of increased portal venous pressure, and intrahepatic portal venous bypass, but neither extrahepatic portalsystemic bypass circulation nor death occurred. In experimental group 3, two animals died and threeanimals developed hepatic cirrhosis, and different degrees of increased portal venous pressure and intrahepatic portal venous bypass were also observed, but there was no extrahepatic portal-systemic bypass circulation. CONCLUSION: It is feasible to establish an anima

关键词： Alcohol Hepatic arterial perfusion Hepatic cirrhos

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Safety and efficacy of transfemoral intrahepatic portosystemic shunt for portal hypertension: A single-center retrospective study

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World Journal of Clinical Cases 2019年第12期7卷 1410-1420页

作者： Yu Zhang Fu-Quan Liu zhen-dong yue Hong-Wei Zhao Lei Wang zhen-Hua Fan Fu-Liang He Department of Interventional Therapy Peking University Ninth School of Clinical MedicineBeijing Shijitan Hospital and Capital Medical University

BACKGROUND Transfemoral intrahepatic portosystemic shunt (TFIPS) can be performed to treat portal hypertension. However, few studies have evaluated the safety and efficacy of this technique. AIM To retrospectively evaluate the safety and clinical outcomes of TFIPS and compare them with those of typical transjugular intrahepatic portosystemic shunt (TIPS). METHODS This retrospective study was approved by our hospital ethics committee. From November 2012 to November 2015, 19 patients who underwent successful TFIPS placement were included. In addition, 21 patients treated with TIPS during the same period were selected as controls. Data collected included the success rate and complications of TIPS and TFIPS. Continuous data were expressed as the mean ± SD and were compared using the Student’s t test. All categorical data were expressed as count (percentage) and were compared using the χ2 test or Fisher’s exact test. The Kaplan–Meier method was used to calculate cumulative survival rate and survival curves. RESULTS Baseline characteristics were comparable between the two groups. The success rate of TFIPS and TIPS was 95%(19/20) and 100%(21/21), respectively. Effective portal decompression and free antegrade shunt flow was completed in all patients. The portal pressure gradient prior to TIPS and TFIPS placement was 23.91 ± 4.64 mmHg and 22.61 ± 5.39 mmHg, respectively, and it was significantly decreased to 10.85 ± 3.33 mmHg and 10.84 ± 3.33 mmHg after stent placement, respectively. Time–to-event calculated rates of shunt patency at one and two years in the TFIPS and TIPS groups were not statistically different (94.7% vs 95.2% and 94.7% vs 90.5%, respectively). De nova hepatic encephalopathy was 27.5%(11/40) with five patients in the TFIPS group (26.3%) and six patients (28.6%) in the TIPS group experiencing it (P = 0.873). The cumulative survival rates were similar between the two groups: 94.7% and 94.7% at 1 and 2 years, respectively, in the TFIPS group vs 100% and 95.2%

关键词： Transjugular intraheptic portosystemic shunt Transfemoral intraheptic portosystemic shunt Portal hypertension Variceal bleeding

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Computed tomography perfusion in differentiating portal hypertension: A correlation study with hepatic venous pressure gradient

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World Journal of Gastrointestinal Surgery 2023年第4期15卷 664-673页

作者： Jian dong Yu Zhang Yi-Fan Wu zhen-dong yue zhen-Hua Fan Chun-Yan Zhang Fu-Quan Liu Lei Wang Department of Radiology Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China Department of Interventional Radiology Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China

BACKGROUND Hepatic venous pressure gradient(HVPG)is the gold standard for diagnosis of portal hypertension(PH),invasiveness and potential risks in the process of measurement limited its widespread *** To investigate the correlation of computed tomography(CT)perfusion parameters with HVPG in PH,and quantitatively assess the blood supply changes in liver and spleen parenchyma before and after transjugular intrahepatic portosystemic shunt(TIPS).METHODS Twenty-four PH related gastrointestinal bleeding patients were recruited in this study,and all patients were performed perfusion CT before and after TIPS surgery within 2 *** parameters of CT perfusion,including liver blood volume(LBV),liver blood flow(LBF),hepatic arterial fraction(HAF),spleen blood volume(SBV)and spleen blood flow(SBF),were measured and compared before and after TIPS,and the quantitative parameters between clinically significant PH(CSPH)and non-CSPH(NCSPH)group were also *** the correlation of CT perfusion parameters with HVPG were analyzed,with statistical significance as P<*** For all 24 PH patients after TIPS,CT perfusion parameters demonstrated decreased LBV, increased HAF, SBV and SBF, with no statistical difference in LBF. Compared withNCSPH, CSPH showed higher HAF, with no difference in other CT perfusion parameters. HAFbefore TIPS showed positive correlation with HVPG (r = 0.530, P = 0.008), while no correlation wasfound in other CT perfusion parameters with HVPG and Child-Pugh ***, an index of CT perfusion, was positive correlation with HVPG, and higher in CSPH thanNCSPH before TIPS. While increased HAF, SBF and SBV, and decreased LBV, were found afterTIPS, which accommodates a potential non-invasive imaging tool for evaluation of PH.

关键词： Portal hypertension Transjugular intrahepatic portosystemic shunt Hepatic vein pressure gradient Perfusion Computed tomography

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Parallel transjugular intrahepatic portosystemic shunt for controlling portal hypertension complications in cirrhotic patients

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World Journal of Gastroenterology 2014年第33期20卷 11835-11839页

作者： Fu-Liang He Lei Wang zhen-dong yue Hong-Wei Zhao Fu-Quan Liu Department of Interventional Therapy Beijing Shijitan Hospital Capital Medical University

AIM: To evaluate the feasibility of a second parallel transjugular intrahepatic portosystemic shunt (TIPS) to reduce portal venous pressure and control complications of portal hypertension.

关键词： Transjugular intrahepatic portosystemic shunt Portal hypertension Portosystemic pressure gradient

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Hepatic venous pressure gradient: Inaccurately estimates portal venous pressure gradient in alcoholic cirrhosis and portal hypertension

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World Journal of Gastrointestinal Surgery 2023年第11期15卷 2490-2499页

作者： Dan Zhang Tao Wang zhen-dong yue Lei Wang zhen-Hua Fan Yi-Fan Wu Fu-Quan Liu Department of Interventional Therapy Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China Department of Interventional Therapy Yantai Yuhuangding Hospital of Qingdao UniversityYantai 264099Shandong ProvinceChina

BACKGROUND Portal hypertension(PHT)in patients with alcoholic cirrhosis causes a range of clinical symptoms,including gastroesophageal varices and *** hepatic venous pressure gradient(HVPG),which is easier to measure,has replaced the portal venous pressure gradient(PPG)as the gold standard for diagnosing PHT in clinical ***,attention should be paid to the correlation between HVPG and *** Between January 2017 and June 2020,134 patients with alcoholic cirrhosis and PHT who met the inclusion criteria underwent various pressure measurements during transjugular intrahepatic portosystemic shunt *** were assessed using Pearson’s correlation coefficient to estimate the correlation coefficient(r)and determination coefficient(R^(2)).Bland-Altman plots were constructed to further analyze the agreement between the *** were analyzed using paired t tests,and P values<0.05 were considered statistically *** In this study,the correlation coefficient(r)and determination coefficient(R2)between HVPG and PPG were 0.201 and 0.040,respectively(P=0.020).In the 108 patients with no collateral branch,the average wedged hepatic venous pressure was lower than the average portal venous pressure(30.65±8.17 vs.33.25±6.60 mmHg,P=0.002).Hepatic collaterals were identified in 26 cases with balloon occlusion hepatic venography(19.4%),while the average PPG was significantly higher than the average HVPG(25.94±7.42 mmHg vs 9.86±7.44 mmHg;P<0.001).The differences between HVPG and PPG<5 mmHg in the collateral vs no collateral branch groups were three cases(11.54%)and 44 cases(40.74%),*** In most patients,HVPG cannot accurately represent *** formation of hepatic collaterals is a vital reason for the strong underestimation of HVPG.

关键词： Portal hypertension Portal venous pressure gradient Hepatic venous pressure gradient Alcoholic cirrhosis Hepatic collateral

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Comparative study of indocyanine green-R15,Child-Pugh score,and model for end-stage liver disease score for prediction of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt

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World Journal of Gastroenterology 2021年第5期27卷 416-427页

作者： Zhong Wang Yi-Fan Wu zhen-dong yue Hong-Wei Zhao Lei Wang zhen-Hua Fan Yu Zhang Fu-Quan Liu Department of Interventional Therapy Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China

BACKGROUND Hepatic encephalopathy(HE)remains an enormous challenge in patients who undergo transjugular intrahepatic portosystemic shunt(TIPS)*** preoperative indocyanine green retention rate at 15 min(ICG-R15),as one of the liver function assessment tools,has been developed as a prognostic indicator in patients undergoing surgery,but there are limited data on its role in *** To determine whether the ICG-R15 can be used for prediction of post-TIPS HE in decompensated cirrhosis patients with portal hypertension(PHT)and compare the clinical value of ICG-R15,Child-Pugh score(CPS),and model for end-stage liver disease(MELD)score in predicting post-TIPS HE with *** This retrospective study included 195 patients with PHT who underwent elective TIPS at Beijing Shijitan Hospital from January 2018 to June *** patients underwent the ICG-R15 test,CPS evaluation,and MELD scoring 1 wk before *** to whether they developed HE or not,the patients were divided into two groups:HE group and non-HE *** prediction of one-year post-TIPS HE by ICG-R15,CPS and MELD score was evaluated by the areas under the receiver operating characteristic curves(AUCs).RESULTS A total of 195 patients with portal hypertension were included and 23%(45/195)of the patients developed post-TIPS *** ICG-R15 was identified as an independent predictor of post-TIPS *** AUCs for the ICG-R15,CPS,and MELD score for predicting post-TIPS HE were 0.664(95%confidence interval[CI]:0.557-0.743,P=0.0046),0.596(95%CI:0.508-0.679,P=0.087),and 0.641(95%CI:0.554-0.721,P=0.021),*** non-parametric approach(Delong-Delong&Clarke-Pearson)showed that there was statistical significance in pairwise comparison between AUCs of ICG-R15 and MELD score(P=0.0229).CONCLUSION The ICG-R15 has appreciated clinical value for predicting the occurrence of post-TIPS HE and is a choice for evaluating the prognosis of patients undergoing TIPS.

关键词： Hepatic encephalopathy Indocyanine green-R15 Child-Pugh score Model for end-stage liver disease score Transjugular intrahepatic portosystemic shunt Portal hypertention

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Short-term efficacy assessment of transarterial chemoembolization combined with radioactive iodine therapy in primary hepatocellular carcinoma

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World Journal of Gastrointestinal Surgery 2023年第1期15卷 105-113页

作者： Lei Wang Kun Huang Yu Zhang Yi-Fan Wu zhen-dong yue zhen-Hua Fan Fu-Quan Liu Yong-Wu Li Jian dong Department of Interventional Radiology Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China Department of Radiology Chinese Medical University Affiliated First HospitalShenyang 110001Liaoning ProvinceChina Department of Nuclear Medicine The Fifth Center of People’s Liberation Army General HospitalBeijing 100071China Department of Radiology Beijing Shijitan HospitalCapital Medical UniversityBeijing 100038China

BACKGROUND Transarterial chemoembolization(TACE)is an effective treatment for primary hepatocellular carcinoma(PHC).Radioactive iodine therapy has been used in the treatment of advanced PHC,especially in patients with portal vein tumor ***,data on the therapeutic effect of TACE combined with radioactive iodine therapy in PHC are *** To investigate the clinical efficacy of TACE combined with radioactive iodine implantation therapy in advanced PHC via perfusion computed tomography(CT).METHODS For this study,98 advanced PHC patients were recruited and divided randomly into the study and control *** in the study group were treated with TACE combined radioactive iodine implantation *** in the control group were treated with only *** tumor lesion length,clinical effect,serum alpha-fetoprotein(AFP)and CT perfusion parameters were compared before and after therapy,and statistical analysis was *** There was no significant difference in tumor length and serum AFP between the study and control groups(P>0.05)before ***,the tumor length and serum AFP in the study group were lower than those in the control group 1 mo and 3 mo after *** 3 mo of treatment,the complete and partial remission rate of the study group was 93.88%,which was significantly higher than the control group(77.55%)(P0.05).After 3 mo of treatment,all perfusion CT variables were lower in the study group compared to the control group(P<0.05).The survival time of patients in the study group was 22 mo compared to 18 mo in the control group,which was significantly different[log rank(Mantel-Cox)=4.318,P=0.038].CONCLUSION TACE combined with radioactive iodine implantation in the treatment of advanced PHC can in

关键词： Transarterial chemoembolization Radioactive iodine Primary hepatocellular carcinoma Perfusion Computed tomography

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