预测肝硬化和难治性腹水患者 TIPS 后肝性脑病风险：使用 4D MRI 灌注模型的概念验证研究

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2024-09-01 DOI:10.1016/j.dld.2024.08.007

D. Saltini , A. Piscopo , L. Nocetti , S. Colopi , C. Caporali , M. Bianchini , T. Guasconi , F. Casari , M. Scoppettuolo , F. Prampolini , C. Giglio , A.S. Velasco Mayorga , F. Ascari , A. Colecchia , F. Schepis

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引用次数: 0

摘要

背景经颈静脉肝内门体分流术（TIPS）是治疗肝硬化患者难治性腹水（RA）的一种行之有效的方法。然而，其主要缺点是术后会出现肝性脑病（HE），这是由于门静脉血液分流造成的。根据首过效应，这种分流会降低肝脏代谢肠道物质的能力，导致有毒化合物在大脑中积累。鉴于肝脏灌注依赖于动脉补偿（肝动脉缓冲），因此有效的补偿（也依赖于心脏功能）可能会通过在第二通道代谢过程中对血液进行解毒来降低脑病的风险。材料29例连续患者在TIPS前后接受了DCE-MRI、心脏和肝脏血流动力学评估。结果DIDC模型显示，TIPS后肝总灌注量减少了24%（248毫升/分钟/100毫升 vs 189毫升/分钟/100毫升，P 0.095）。正如预期的那样，TIPS 后观察到门静脉灌注明显减少（减少了 67%；128.6 毫升/分钟/100 毫升 vs 42.4 毫升/分钟/100 毫升，P 0.004），肝动脉分流增加（48% vs 77%，P 0.001）。TIPS后残余肝脏总灌注量与一年期 HE 风险成反比：灌注量≤ 130 毫升/分/100 毫升的患者 HE 风险为 67.6% vs > 130 毫升/分/100 毫升的患者 HE 风险为 36.4% (HR: 2.1, p 0.039)。

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Predicting post-TIPS hepatic encephalopathy risk in patients with cirrhosis and refractory ascites: a proof-of-concept study using a 4D MRI perfusional model

Background

Transjugular intrahepatic portosystemic shunt (TIPS) is a well-established treatment for refractory ascites (RA) in patients with cirrhosis. However, a major drawback is the development of post-procedural hepatic encephalopathy (HE), which results from the diversion of blood from the portal vein. According to the first-pass effect, this diversion reduces the liver's capacity to metabolize substances from the gut, leading to an accumulation of toxic compounds in the brain. Given that liver perfusion relies on arterial compensation (hepatic arterial buffer), it is plausible that effective compensation, which also depends on cardiac function, may reduce the risk of encephalopathy by detoxifying the blood during the second-pass metabolism.

Aims

To evaluate by Dynamic Contrast Enhanced-Magnetic Resonance Imaging (DCE-MRI) the changes in liver perfusion induced by TIPS in patients with RA and their relationship with the risk of HE.

Materials

Twenty-nine consecutive patients underwent DCE-MRI, cardiac and hepatic hemodynamic evaluation before and after TIPS. MRI images were processed by a homemade software using the Dual Input Dual Compartment (DIDC) model, focusing on perfusion parameters.

Results

The DIDC model showed that total hepatic perfusion decreased by 24% after TIPS (248 ml/min/100ml vs 189 ml/min/100ml, p 0.095). As expected, a significant reduction in portal perfusion (decreased by 67%; 128.6 ml/min/100ml vs 42.4 ml/min/100ml, p 0.004) and an increase in hepatic arterial fraction post-TIPS (48% vs 77%, p 0.001) was observed. Post-TIPS residual total hepatic perfusion inversely correlated with one-year HE risk: patients with perfusion ≤ 130 ml/min/100ml had a HE risk of 67.6% vs 36.4% for those > 130 ml/min/100ml (HR: 2.1, p 0.039).

Conclusion

Perfusion MRI is able to elucidate the impact of TIPS on liver perfusion, quantifying the extent of hepatic perfusion and its correlation with the development of post-TIPS HE.

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.