Aims:The renewing Baveno VII consensus proposed criteria for the diagnosis of clinically significant portal hypertension(CSPH)in patients with compensated advanced chronic liver disease(cACLD).The performance of a com...Aims:The renewing Baveno VII consensus proposed criteria for the diagnosis of clinically significant portal hypertension(CSPH)in patients with compensated advanced chronic liver disease(cACLD).The performance of a combined model of spleen stiffness measurement(SSM)by spleen-dedicated 100 Hz(SSM@100 Hz)or conventional 50 Hz(SSM@50 Hz)and Baveno VII criteria to rule-in or rule-out CSPH had not been well validated.This study aims to compare the performance of the combined model with Baveno VIIcriteria alone to rule-in and rule-out CSPH in cACLD.Methods:This international multicenter study included cACLD patients who underwent paired liver stiffness measurement(LSM),SSM@100 Hz or SSM@50 Hz,platelet count(PLT),and hepatic venous pressure gradient(HVPG).CSPH was defined as HVPG≥10 mmHg.Patients with SSM@100 Hz were prospectively recruited from China between August 2021 and March 2022,while a globalcohort of patients with SSM@50 Hz from Croatia,Japan,and Singapore was retrospectively included between December 2014 and June2022.The diagnostic performance of different models was assessed using sensitivity,specificity,positive predictive value,and negativepredictive value.Results:A total of 206 patients with cACLD were recruited from seven university centers and 110 patients were included in the finalanalysis(54 from the SSM@100 Hz cohort and 56 from the SSM@50 Hz cohort).The success rate of SSM@100 Hz was significantlyhigher than that of SSM@50 Hz(103/105[98.1%]vs.86/101[85.1%];p<0.001).While the combined model(SSM>50 kPa orLSM≥25 kPa)and Baveno VII criteria(LSM≥25 kPa)had a positive predictive value and specificity>90%to rule-in CSPH,thecombined model correctly ruled-in more cACLD patients with CSPH compared to Baveno VII criteria alone(35/110[31.8%]vs.22/110[20.0%];p<0.001).Furthermore,the combined model(SSM<21 kPa or[LSM≤15 kPa and PLT≥150×10^(9)/L])and Baveno VIIcriteria(LSM≤15 kPa and PLT≥150×10^(9)/L)had a sensitivity and negative predictive value>90%to rule-out CSPH.Compared to theBaveno VII criteria alone,the combined model correctly ruled-out more patients without CSPH,although there was no statisticaldifference(39/110[35.5%]vs.34/110[30.9%];p=0.063).The findings remained broadly similar when subgroup analyses were per-formed in the SSM@100 Hz cohort and the SSM@50 Hz cohort.Notably,the combined model reduced patients in the gray zonecompared to Baveno VII criteria alone(36/110[32.7%]vs.54/110[49.1%];p<0.001).Conclusions:Whether using SSM@100Hz or SSM@50Hz,the combined model of SSM and Baveno VII criteria was superior toBaveno VII criteria alone to rule-in and rule-out CSPH in cACLD patients,which may guide therapeutic decisions by mini-mizing cACLD patients in the gray zone.Trial Registration:ClinicalTrials.gov;No.NCT05251272.展开更多
Background and Aims:This study aimed to determine the performance of the non-invasive score using noncontrastenhanced MRI(CHESS-DIS score)for detecting portal hy-pertension in cirrhosis.Methods:In this international m...Background and Aims:This study aimed to determine the performance of the non-invasive score using noncontrastenhanced MRI(CHESS-DIS score)for detecting portal hy-pertension in cirrhosis.Methods:In this international multicenter,diagnostic study(ClinicalTrials.gov,NCT03766880),patients with cirrhosis who had hepatic venous pressure gradient(HVPG)measurement and noncontrast-enhanced MRI were prospectively recruited from four university hospitals in China(n=4)and Turkey(n=1)between December 2018 and April 2019.A cohort of patients was retrospectively recruited from a university hospital in Italy between March 2015 and November 2017.After segmentation of the liver on fat-suppressed T1-weighted MRI maps,CHESS-DIS score was calculated automatically by an in-house developed code based on the quantification of liver surface nodularity.Results:A total of 149 patients were included,of which 124 were from four Chinese hospitals(training cohort)and 25 were from two international hospitals(validation cohort).A positive correlation between CHESS-DIS score and HVPG was found with the correlation coefficients of 0.36(p<0.0001)and 0.55(p<0.01)for the training and validation cohorts,respectively.The area under the receiver operating characteristic curve of CHESS-DIS score in detection of clinically significant portal hypertension(CSPH)was 0.81 and 0.9 in the training and validation cohorts,respectively.The intra-class correlation coefficients for assessing the inter-and intra-observer agreement were 0.846 and 0.841,respectively.Conclusions:A non-invasive score using noncontrast-enhanced MRI was developed and proved to be significantly correlated with invasive HVPG.Besides,this score could be used to detect CSPH in patients with cirrhosis.展开更多
基金funded by the Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0508800)The Key Research and Development Program of Jiangsu Province(BE2023767a)+3 种基金the Fundamental Research Fund of Southeast University(3290002303A2)Changjiang Scholars Talent Cultivation Project of Zhongda Hospital of Southeast University(2023YJXYYRCPY03),Research Personnel Cultivation Programme of Zhongda Hospital Southeast University(CZXM-GSP-RC125,CZXM-GSP-RC119)China Postdoctoral Science Foundation(2024M750461),National Natural Science Foundation of China(82402413)Natural Science Foundation of Jiangsu Province(BK20241681).
文摘Aims:The renewing Baveno VII consensus proposed criteria for the diagnosis of clinically significant portal hypertension(CSPH)in patients with compensated advanced chronic liver disease(cACLD).The performance of a combined model of spleen stiffness measurement(SSM)by spleen-dedicated 100 Hz(SSM@100 Hz)or conventional 50 Hz(SSM@50 Hz)and Baveno VII criteria to rule-in or rule-out CSPH had not been well validated.This study aims to compare the performance of the combined model with Baveno VIIcriteria alone to rule-in and rule-out CSPH in cACLD.Methods:This international multicenter study included cACLD patients who underwent paired liver stiffness measurement(LSM),SSM@100 Hz or SSM@50 Hz,platelet count(PLT),and hepatic venous pressure gradient(HVPG).CSPH was defined as HVPG≥10 mmHg.Patients with SSM@100 Hz were prospectively recruited from China between August 2021 and March 2022,while a globalcohort of patients with SSM@50 Hz from Croatia,Japan,and Singapore was retrospectively included between December 2014 and June2022.The diagnostic performance of different models was assessed using sensitivity,specificity,positive predictive value,and negativepredictive value.Results:A total of 206 patients with cACLD were recruited from seven university centers and 110 patients were included in the finalanalysis(54 from the SSM@100 Hz cohort and 56 from the SSM@50 Hz cohort).The success rate of SSM@100 Hz was significantlyhigher than that of SSM@50 Hz(103/105[98.1%]vs.86/101[85.1%];p<0.001).While the combined model(SSM>50 kPa orLSM≥25 kPa)and Baveno VII criteria(LSM≥25 kPa)had a positive predictive value and specificity>90%to rule-in CSPH,thecombined model correctly ruled-in more cACLD patients with CSPH compared to Baveno VII criteria alone(35/110[31.8%]vs.22/110[20.0%];p<0.001).Furthermore,the combined model(SSM<21 kPa or[LSM≤15 kPa and PLT≥150×10^(9)/L])and Baveno VIIcriteria(LSM≤15 kPa and PLT≥150×10^(9)/L)had a sensitivity and negative predictive value>90%to rule-out CSPH.Compared to theBaveno VII criteria alone,the combined model correctly ruled-out more patients without CSPH,although there was no statisticaldifference(39/110[35.5%]vs.34/110[30.9%];p=0.063).The findings remained broadly similar when subgroup analyses were per-formed in the SSM@100 Hz cohort and the SSM@50 Hz cohort.Notably,the combined model reduced patients in the gray zonecompared to Baveno VII criteria alone(36/110[32.7%]vs.54/110[49.1%];p<0.001).Conclusions:Whether using SSM@100Hz or SSM@50Hz,the combined model of SSM and Baveno VII criteria was superior toBaveno VII criteria alone to rule-in and rule-out CSPH in cACLD patients,which may guide therapeutic decisions by mini-mizing cACLD patients in the gray zone.Trial Registration:ClinicalTrials.gov;No.NCT05251272.
基金the National Natural Science Foundation of China(81830053,82001780)Guangzhou Industry-Academia-Research Collaborative Innovation Major Project(201704020015)+2 种基金Natural Science Foundation of Jiangsu Province of China(BK20200361)President Foundation of Nanfang Hospital,Southern Medical University(2017Z012)Distinguished Young Scholars of Gansu Province(20JR10RA713).
文摘Background and Aims:This study aimed to determine the performance of the non-invasive score using noncontrastenhanced MRI(CHESS-DIS score)for detecting portal hy-pertension in cirrhosis.Methods:In this international multicenter,diagnostic study(ClinicalTrials.gov,NCT03766880),patients with cirrhosis who had hepatic venous pressure gradient(HVPG)measurement and noncontrast-enhanced MRI were prospectively recruited from four university hospitals in China(n=4)and Turkey(n=1)between December 2018 and April 2019.A cohort of patients was retrospectively recruited from a university hospital in Italy between March 2015 and November 2017.After segmentation of the liver on fat-suppressed T1-weighted MRI maps,CHESS-DIS score was calculated automatically by an in-house developed code based on the quantification of liver surface nodularity.Results:A total of 149 patients were included,of which 124 were from four Chinese hospitals(training cohort)and 25 were from two international hospitals(validation cohort).A positive correlation between CHESS-DIS score and HVPG was found with the correlation coefficients of 0.36(p<0.0001)and 0.55(p<0.01)for the training and validation cohorts,respectively.The area under the receiver operating characteristic curve of CHESS-DIS score in detection of clinically significant portal hypertension(CSPH)was 0.81 and 0.9 in the training and validation cohorts,respectively.The intra-class correlation coefficients for assessing the inter-and intra-observer agreement were 0.846 and 0.841,respectively.Conclusions:A non-invasive score using noncontrast-enhanced MRI was developed and proved to be significantly correlated with invasive HVPG.Besides,this score could be used to detect CSPH in patients with cirrhosis.
