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Value of perfusion parameters and histogram analysis of triphasic computed tomography in pre-operative prediction of histological grade of hepatocellular carcinoma

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Chinese Medical Journal 2021年第10期134卷 1181-1190页

作者： Shao Chun-Chun Zhao Fang Yu Yi-Fan Zhu Lin-Lin Pang Guo-Dong Department of Evidence-Based Medicine The Second HospitalCheeloo College of MedicineShandong UniversityJinanShandong 250033China Department of Radiology Qilu HospitalCheeloo College of MedicineShandong UniversityJinanShandong 250012China Healthcare Big Data Institute of Shandong University JinanShandong 250000China Department of Epidemiology and Health Statistics School of Public HealthShandong UniversityJinanShandong 250000China Department of Radiology The Second HospitalCheeloo College of MedicineShandong UniversityJinanShandong 250033China

Background:Pre-operative non-invasive histological evaluation of hepatocellular carcinoma(HCC)remains a challenge.Tumor perfusion is significantly associated with the development and aggressiveness of HCC.The purpose of the study was to evaluate the clinical value of quantitative liver perfusion parameters and corresponding histogram parameters derived from traditional triphasic enhanced computed tomography(CT)scans in predicting histological grade of HCC.Methods:Totally,52 patients with HCC were enrolled in this retrospective study and underwent triple-phase enhanced CT imaging.The blood perfusion parameters were derived from triple-phase CT scans.The relationship of liver perfusion parameters and corresponding histogram parameters with the histological grade of HCC was analyzed.Receiver operating characteristic(ROC)curve analysis was used to determine the optimal ability of the parameters to predict the tumor histological grade.Results:The variance of arterial enhancement fraction(AEF)was significantly higher in HCCs without poorly differentiated components(NP-HCCs)than in HCCs with poorly differentiated components(P-HCCs).The difference in hepatic blood flow(HF)between total tumor and total liver flow(ΔHF=HFtumor-HFliver)and relative flow(rHF=ΔHF/HF_(liver))were significantly higher in NP-HCCs than in P-HCCs.The difference in portal vein blood supply perfusion(PVP)between tumor and liver tissue(ΔPVP)and theΔPVP/liver PVP ratio(rPVP)were significantly higher in patients with NP-HCCs than in patients with P-HCCs.The area under ROC(AUC)ofΔPVP and rPVP were both 0.697 with a high sensitivity of 84.2%and specificity of only 56.2%.TheΔHF and rHF had a higher specificity of 87.5%with an AUC of 0.681 and 0.673,respectively.The combination of rHF and rPVP showed the highest AUC of 0.732 with a sensitivity of 57.9%and specificity of 93.8%.The combined parameter ofΔHF and rPVP,rHF and rPVP had the highest positive predictive value of 0.903,and that of rPVP andΔPVP had the highest negative predictive value of 0.781.Conclu

关键词： Hepatocellular carcinoma perfusion Computed tomography Histological grade Histogram

Haemodynamic analysis of adult patients with moyamoya disease: CT perfusion and DSA gradings

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Stroke & Vascular Neurology 2021年第1期6卷 41-47页

作者： Zhiyong Shi Guofeng Ma Dong Zhang Department of Neurosurgery Beijing Tiantan HospitalCapital Medical UniversityBeijingChina Department of Radiology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina

Object Moyamoya disease(MMD)is a common and chronic progressive stenotic-occlusive cerebrovascular disease in Eastern Asia.To evaluate the hemispheric haemodynamic status of adult patients with MMD,we explored the potential risk factors of hemispheric perfusion alterations with CT perfusion(CTP)and DSA.Methods We retrospectively reviewed 44 male and 44 female(176 hemispheres)adult patients with MMD who had both DSA and CTP.Data on cerebral blood perfusion(CBF),cerebral blood volume(CBV),mean transmit time(MTT),time to peak(TTP)of cerebral hemisphere and cerebellum were gathered and difference of relative haemodynamic parameters between different subgroups were assessed with independent sample t analysis,one-way analysis of variance and general linear regression analysis.Results Parameters in regional CBF(rCBF)of frontal,temporal lobe and basal ganglia in female was more superior than male.rCBF,regional MTT(rMTT)and regional TTP(rTTP)in adult MMD patients with haemorrhage were superior than the ischaemic.With the increase of age,significant difference could be seen in rCBF and rCBV of thalamus.However,with progress of arterial stenosis,significant difference could only be obsevrved in rCBV,rMTT and rTTP,whereas rCBF had no significant difference.For increase of moyamoya vessels,significant decrease of rCBF could be seen in temporal and parietal lobe.With the increase of compensatory artery numbers,no significant difference could be seen in rCBF parameters(p>0.05).Conclusions In adult MMD patients,age,gender and clinical type were potential risk factors for the change of cerebral perfusion.When arterial stenosis is worsened,moyamoya vessels could alter perfusion of temporal and parietal lobe,but not frontal lobe.Extracranial/intracranial compensatory arteries could maintain microcirculation stability in frontal lobe and basal ganglia,indicating that the protection from extracranial compensatory arteries,a theoretic base for surgery treatment if necessary.

关键词： perfusion patients alterations

Relationship between MRI pertusion and clinical severity in multiple sclerosis

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Neural Regeneration Research 2020年第4期15卷 646-652页

作者： Maria Marcella Laganà Laura Pelizzari Francesca Baglio IRCCS Fondazione Don Carlo Gnocchi

perfusion alterations within several brain regions have been shown in multiple sclerosis patients using different magnetic resonance imaging(MRI)techniques.Furthermore,MRI-derived brain perfusion metrics have been investigated in association with multiple sclerosis phenotypes,physical disability,and cognitive impairment.However,a review focused on these aspects is still missing.Our aim was to review all the studies investigating the relationship between perfusion MRI and clinical severity during the last fifteen years to understand the clinical relevance of these findings.perfusion differences among phenotypes were observed both with 1.5T and 3T scanners,with progressive multiple sclerosis presenting with lower perfusion values than relapsing-remitting multiple sclerosis patients.However,only 3T scanners showed a statistically significant distinction.Controversial results about the association between MRI-derived perfusion metrics and physical disability scores were found.However,the majority of the studies showed that lower brain perfusion and longer transit time are associated with more severe physical disability and worse cognitive performances.

关键词： brain perfusion cerebral blood flow cognition disability magnetic resonance imaging MRI multiple sclerosis phenotypes progressive relapsing remitting

Resuscitation incoherence and dynamic circulation-perfusion coupling in circulatory shock

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Chinese Medical Journal 2019年第10期132卷 1218-1227页

作者： Huai-Wu He Yun Long Da-Wei Liu Can Ince Department of Critical Care Medicine Peking Union Medical College Hospital Peking Union Medical College Chinese Academy of Medical Science Beijing 100730 China Department of Intensive Care Erasmus MC University Hospital Rotterdam Rotterdam 3015 CE the Netherlands

Objective: Poor tissue perfusion/cellular hypoxia may persist despite restoration of the macrocirculation (Macro). This article reviewed the literatures of coherence between hemodynamics and tissue perfusion in circulatory shock. Data sources: We retrieved information from the PubMed database up to January 2018 using various search terms or/and their combinations, including resuscitation, circulatory shock, septic shock, tissue perfusion, hemodynamic coherence, and microcirculation (Micro). Study selection: The data from peer-reviewed journals printed in English on the relationships of tissue perfusion, shock, and resuscitation were included. Results: A binary (coherence/incoherence, coupled/uncoupled, or associated/disassociated) mode is used to describe resuscitation coherence. The phenomenon of resuscitation incoherence (RI) has gained great attention. However, the RI concept requires a more practical, systematic, and comprehensive framework for use in clinical practice. Moreover, we introduce a conceptual framework of RI to evaluate the interrelationship of the Macro, Micro, and cell. The RI is divided into four types (Type 1: Macro-Micro incoherence + impaired cell;Type 2: Macro-Micro incoherence + normal cell;Type 3: Micro-Cell incoherence + normal Micro;and Type 4: both Macro-Micro and Micro-cell incoherence). Furthermore, we propose the concept of dynamic circulation-perfusion coupling to evaluate the relationship of circulation and tissue perfusion during circulatory shock. Conclusions: The concept of RI and dynamic circulation-perfusion coupling should be considered in the management of circulatory shock. Moreover, these concepts require further studies in clinical practice.

关键词： Circulatory shock Shock Tissue perfusion Microcirculation Hemodynamic coherence Resuscitation incoherence

Rationale and study design for one-stop assessment of renal artery stenosis and renal microvascular perfusion with contrast-enhanced ultrasound for patients with suspected renovascular hypertension

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Chinese Medical Journal 2019年第1期132卷 63-68页

作者： Jun-Hong Ren Na Ma Si-Yu Wang You-Jing Sun Yue-Wei Zhang Fa-Jin Guo Yong-Jun Li Tian-Hui Li Hu Ai Wen-Duo Zhang Peng Li Wei-Hua Ma Department of Sonography Beijing HospitalNational Center of GerontologyBeijing 100730China Vascular Department Beijing HospitalNational Center of GerontologyBeijing 100730China Nephrology Department Beijing HospitalNational Center of GerontologyBeijing 100730China Department of Cardiology Beijing HospitalNational Center of GerontologyBeijing 100730China Beijing Hospital National Center of GerontologyBeijing 100730China

Background:Renal artery stenosis (RAS) is always associated with abnormalities in renal microvascular perfusion (RMP).However,few imaging methods can simultaneously evaluate the degree of luminal stenosis and RMP.Thus,this study will aim to evaluate the feasibility of using contrast-enhanced ultrasound (CEUS) for assessing both RAS and RMP to achieve a one-stop assessment of patients with suspected renovascular hypertension. Methods:This will be a single-center diagnostic study with a sample size of 440.Patients with chronic kidney disease (CKD) and suspected of having resistant hypertension will be eligible.Patients with Stages 1–3 CKD will undergo CEUS and computed tomography (CT) angiography (CTA).Values obtained by CEUS and CTA for diagnosing low-grade (lumen reduced by <60%) and high-grade (lumen reduced by ≥60%) RAS will be compared.Moreover,all patients will also undergo radionuclide imaging.The diagnostic value for RAS will be assessed by the receiver operating characteristic curve,including the accuracy,sensitivity,specificity,positive predictive values,negative predictive values,and area under the ROC.Pearson correlation analysis will be performed to assess the association between CEUS findings for RMP and glomerular filtration rate measured by a radionuclide imaging method. Conclusion:The data gathered from this study will be used to evaluate the feasibility of expanding clinical applications of CEUS for evaluation of patients with suspected renovascular hypertension.

关键词： Renovascular hypertension contrast-enhanced ultrasound renal artery stenosis renal microvascular perfusion

Predictive Score Model for Delayed Graft Function Based on Hypothermic Machine perfusion Variables in Kidney Transplantation

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Chinese Medical Journal 2018年第22期131卷 2651-2657页

作者： Chen-Guang Ding Yang Li Xiao-Hui Tian Xiao-Jun Hu Pu-Xun Tian Xiao-Ming Ding He-Li Xiang Jin Zheng Wu-Jun Xue Department of Kidney Transplantation Nephropathy HospitalThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi 710061China Institute of Organ Transplantation Xi'an Jiaotong UniversityXi'anShaanxi 710061China

Background: Hypothermic machine perfusion(HMP) is being used more often in cardiac death kidney transplantation; however, the significance of assessing organ quality and predicting delayed graft function(DGF) by HMP parameters is still controversial. Therefore,we used a readily available HMP variable to design a scoring model that can identify the highest risk of DGF and provide the guidance and advice for organ allocation and DCD kidney assessment.Methods: From September 1, 2012 to August 31, 2016, 366 qualified kidneys were randomly assigned to the development and validation cohorts in a 2:1 distribution. The HMP variables of the development cohort served as candidate univariate predictors for DGF. The independent predictors of DGF were identified by multivariate logistic regression analysis with a P < 0.05. According to the odds ratios(ORs) value, each HMP variable was assigned a weighted integer, and the sum of the integers indicated the total risk score for each kidney. The validation cohort was used to verify the accuracy and reliability of the scoring model.Results: HMP duration(OR = 1.165, 95% confidence interval [CI ]: 1.008–1.360, P = 0.043), resistance(OR = 2.190, 95%CI: 1.032–10.20, P < 0.001), and flow rate(OR = 0.931, 95% CI: 0.894–0.967, P = 0.011) were the independent predictors of identified DGF. The HMP predictive score ranged from 0 to 14, and there was a clear increase in the incidence of DGF, from the low predictive score group to the very high predictive score group. We formed four increasingly serious risk categories(scores 0–3, 4–7, 8–11, and 12–14)according to the frequency associated with the different risk scores of DGF. The HMP predictive score indicates good discriminative power with a c?statistic of 0.706 in the validation cohort, and it had significantly better prediction value for DGF compared to both terminal flow(P = 0.012) and resistance(P = 0.006).Conclusion: The HMP predictive score is a good noninvasive tool for assessing the quality of DCD kidneys, and it is potentially usef

关键词： Delayed Graft Function Donation after Cardiac Death Hypothermic Machine perfusion Kidney Transplantation

Contrast-Enhanced Ultrasonography： A Promising Method for Blood Flow and perfusion Evaluation in Critically III Patients

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Chinese Medical Journal 2018年第10期131卷 1135-1137页

作者： Jun Wu De-Chang Chen Department of Critical Care Medicine School of Medicine Ruijin Hospital Shanghai Jiaotong University Shanghai 200025 China

INTRODUCTION The microcirculation is attracting more and more attention due to its central role in prognosis of critically ill patients. Monitoring perfusion of patients on intensive care units is of highest priority to guide diagnostic and treatment strategies to optimize organ perfusion, subsequently leading to an individualized therapy.

关键词： Contrast-Enhanced Ultrasonography Critically Ill Patients perfusion

Beneficial Effect of Moderately Increasing Hypothermic Machine perfusion Pressure on Donor after Cardiac Death Renal Transplantation

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Chinese Medical Journal 2018年第22期131卷 2676-2682页

作者： Chen-Guang Ding Pu-Xun Tian Xiao-Ming Ding He-Li Xiang Yang Li Xiao-Hui Tian Feng Han Qian-Hui Tai Qian-Long Liu Jin Zheng Wu-Jun Xue Department of Renal Transplantation Nephropathy HospitalThe First Affiliated Hospital of Xi'an Jiaotong UniversityXi'anShaanxi 710061China Institute of Organ Transplantation Xi'an Jiaotong UniversityXi'anShaanxi 710061China

Background:Vascular resistance and flow rate during hypotherrnic machine perfusion (HMP)of kidneys is correlated with graft function. We aimed to determine the effects of increasing HMP pressure versus maintaining the initial pressure on kidney transplantation outcomes. Methods:We retrospectively reviewed the data of 76 primary transplantation patients who received HMP-preserved kidneys from 48 donors after cardiac death between September 1,2013,and August 31,2015.HMP pressure was increased from 30 to 40mmHg (1mmHg =0.133kPa)in kidneys with poor flow and/or vascular resistance (increased pressure [IP]group;36 patients);otherwise,the initial pressure was maintained (constant pressure group;40 patients).Finally,the clinical characteristics and transplantation outcomes in both groups were assessed. Results:Delayed graft function (DGF)incidence,1-year allograft,patient survival,kidney function recovery time,and serum creatinine level on day 30 were similar in both groups,with improved flow and resistance in the IP group.Among patients with DGF,kidney function recovery time and DGF duration were ameliorated in the IP group.Multivariate logistic regression analysis revealed that donor hypertension (odds ratio [OR]:1.43,95%confidence interval [CI]:1.02-2.06,P =0.035),donor terminal serum creatinine (OR:1.27,95%C7:1.06-1.62,P =0.023),warm ischemic time (OR:3.45,95%CI:1.97-6.37,P =0.002),and terminal resistance (OR:3.12,95%CI:1.76-6.09,P =0.012)were independent predictors of DGF.Cox proportional hazards analysis showed that terminal resistance (hazard ratio:2.06,95%C1:1.32-5.16,P =0.032)significantly affected graft survival. Conclusion:Increased HMP pressure improves graft perfusion but does not affect DGF incidence or 1-year graft survival.

关键词： Delayed Graft Function Donor after Cardiac Death Hypothermic Machine perfusion Kidney Transplantation

Liver graft preservation methods during cold ischemia phase and normothermic machine perfusion

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World Journal of Gastrointestinal Surgery 2019年第3期11卷 126-142页

作者： Konstantin Y Tchilikidi Department of Surgery Altai State Medical University

The growing demand for donor organs requires measures to expand donor pool.Those include extended criteria donors, such as elderly people, steatotic livers,donation after cardiac death, etc. Static cold storage to reduce metabolic requirements developed by Collins in late 1960 s is the mainstay and the golden standard for donated organ protection. Hypothermic machine perfusion provides dynamic organ preservation at 4°C with protracted infusion of metabolic substrates to the graft during the ex vivo period. It has been used instead of static cold storage or after it as short perfusion in transplant center. Normothermic machine perfusion(NMP) delivers oxygen, and nutrition at physiological temperature mimicking regular environment in order to support cellular function. This would minimize effects of ischemia/reperfusion injury.Potentially, NMP may help to estimate graft functionality before implantation into a recipient. Clinical studies demonstrated at least its non-inferiority or better outcomes vs static cold storage. Regular grafts donated after brain death could be safely preserved with convenient static cold storage. Except for prolonged ischemia time where hypothermic machine perfusion started in transplant center could be estimated to provide possible positive reconditioning effect. Use of hypothermic machine perfusion in regular donation instead of static cold storage or in extended criteria donors requires further investigation. Multicenter randomized clinical trial supposed to be completed in December 2021. Extended criteria donors need additional measures for graft storage and assessment until its implantation. NMP is actively evaluating promising method for this purpose.Future studies are necessary for precise estimation and confirmation to issue clinical practice recommendations.

关键词： Liver graft preservation Graft preservation solutions Static cold storage Hypothermic machine perfusion Normothermic machine perfusion Ischemia-reperfusion injury Marginal grafts Donation after cardiac death Extended criteria donors Transpla complications