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Objective:To analyze the influencing factors of abnormal 15-minute retention rate of indocyanine green (ICG R15) (≥10%) in patients with hepatocellular carcinoma, and to construct a nomogram model, and to evaluate the prediction efficiency of the nomogram model.Methods:The clinical data of 190 patients with hepatocellular carcinoma in Zhengzhou University People's Hospital from December 2017 to June 2022 were retrospectively analyzed, including 148 males and 42 females, aged (57.8±9.9) years. According to ICG R15, the patients were divided into ICG R15 normal group ( n=134, ICG R15<10%) and ICG R15 abnormal group ( n=56, ICG R15≥10%). Univariate and multivariate logistic regression were used to analyze the influencing factors of abnormal ICG R15, and the nomogram model was established. The predictive ability of the model was evaluated by receiver operating characteristic (ROC) curve and C-index, and the model was verified by calibration curve and decision analysis curve. Results:Abnormal ICG R15 group the proportion of liver cirrhosis, albumin ≤35 g/L, hemoglobin ≤110 g/L, platelet count ≤100×10 9/L, prothrombin time >13 s, alanine aminotransferase >40 U/L, aspartate aminotransferase >40 U/L, total bilirubin >34.2 μmol/L, and the largest tumor diameter >5.0 cm, spleen volume >383.1 cm 3, spleen volume to of non-tumor liver volume (SNLR) >0.276 and liver tumor volume >117.2 cm 3 were higher than that of ICG R15 normal group, and the differences were statistically significant (all P<0.05). Logistic regression analysis showed that liver cirrhosis ( OR=3.89, 95% CI: 1.28-11.80, P=0.016), spleen volume >383.1 cm 3( OR=5.17, 95% CI: 1.38-19.38, P=0.015), SNLR >0.276 ( OR=5.54, 95% CI: 1.44-21.26, P=0.013) and total bilirubin >34.2 μmol/L( OR=10.20, 95% CI: 1.88-55.39, P=0.007) increased the risk of abnormal ICG R15. A nomogram model was constructed based on the above risk factors. The C-index of the model was 0.915 (95% CI: 0.872-0.957), and the area under the ROC curve predicted by the nomogram model was 0.915 (95% CI: 0.871-0.958). The calibration curve showed that the correlation index of the abnormal ICG R15 predicted by the nomogram was similar to actual situation. Decision analysis curve showed high returns. Conclusion:Liver cirrhosis, spleen volume >383.1 cm 3, SNLR>0.276 and total bilirubin >34.2 μmol/L were indepentlent risk factors for abnormal ICG R15 in patients with hepatocellur carcinoma. The clinical prediction model of ICG R15 abnormality constructed by nomogram has good prediction efficiency, which can provide a reference for evaluating preoperative liver reserve function of patients with hepatocellular carcinoma.
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To evaluate the correlation between the radiomics signature of hepatobiliary phase imaging of gadolinium-ethoxybenzyl diethylenetriaminepentaacetic acid(Gd-EOB-DTPA)enhanced magnetic resonance imaging(MRI)and Child-Pugh of liver cirrhosis,establish nomogram prediction model,and assess the predictive value of quantitative assessment of liver reserve function of patients with liver cirrhosis. One hundred patients with liver cirrhosis who met the inclusion criteria were divided into 52 patients with Child-Pugh grade A and 48 patients with Child-Pugh grade B+C according to Child-Pugh classification criteria,and were randomly divided into training set and test set at a proportion of 7∶3.The AK software was used to extract the imaging features of the Gd-EOB-DTPA-enhanced MRI hepatobiliary images of the patients in the training set,and the least absolute shrinkage and selection operator feature selection algorithm was used to reduce the dimension of the data,select the features,and construct the radiomics tags.According to the radiomics label Rad-score,a line chart(nomogram)prediction model was established to predict the Child-Pugh B+C level of liver reserve function.The model was applied to the training set and test set respectively,and the diagnostic efficiency was quantitatively evaluated by receiver operating characteristic(ROC)curve. After dimension reduction and screening of 396 texture feature parameters extracted by AK software,7 image feature parameters were obtained.According to the above characteristics,the radiomics tag Rad-score was constructed and the nomogram prediction model was created.The differences of Rad-score scores between Child-Pugh A and Child-Pugh B+C groups in training set and test set were statistically analyzed by Wilcoxon rank sum test(=0.000, =0.001).The diagnostic efficacy of nomogram prediction model for predicting Child-Pugh B+C grade of liver reserve function in the ROC curve of training set and test set was 0.88 and 0.86 respectively. The nomogram prediction model created according to the radiomics tag Rad-score of patients with liver cirrhosis with different liver reserve functions can be used as a more accurate and reliable auxiliary detection tool for liver reserve function.It provides a new means for clinicians to evaluate liver reserve function more accurately.
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Humans , Contrast Media , Gadolinium DTPA , Liver Cirrhosis , Magnetic Resonance ImagingABSTRACT
Objective@#To investigate the clinical value of prothrombin time(PT) and hepatic thromboplastin test(HPT) in the diagnosis of hepatic fibrosis stage in patients with chronic hepatitis B.@*Methods@#A total of 76 patients with chronic hepatitis B in Yuncheng Central Hospital from January 2015 to January 2016 were selected.The plasma PT and HPT levels were measured in patients with different stages of liver fibrosis and healthy people.The sensitivity, specificity and accuracy were determined.The clinical value of PT and HPT indicators in liver fibrosis stages was analyzed.@*Results@#The levels of PT and HPT in patients with chronic viral hepatitis B increased significantly with the severity of hepatic fibrosis.The level of PT in stage S4 [(14.86±0.96)s] was significantly higher than that in stage S1[(13.31±0.49)s], S2[(13.43±0.52)s] and S3[(13.66±0.53)s](P<0.05). The level of HPT in stage S3[(19.33±1.14)s] was significantly higher than that in stage S1[(17.74±0.82)s] and stage S2[(18.12±0.95)s], the difference was significant (P<0.05). The level of HPT in stage S4[(20.27±1.39)s] was significantly different from that in stage S1[(17.74±0.82)s], S2[(18.12±0.95)s] and stage S3[(19.33±1.14)s](P<0.05). The sensitivity, specificity and accuracy of PT and HPT in liver fibrosis stage(>S2, S4) were higher by drawing ROC curve analysis.@*Conclusion@#The sensitivity and specificity of PT and HPT are high.They have good clinical diagnostic value in staging liver fibrosis in patients with chronic hepatitis B.
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Objective To investigate the clinical value of prothrombin time(PT) and hepatic thromboplastin test(HPT) in the diagnosis of hepatic fibrosis stage in patients with chronic hepatitis B. Methods A total of 76 patients with chronic hepatitis B in Yuncheng Central Hospital from January 2015 to January 2016 were selected. The plasma PT and HPT levels were measured in patients with different stages of liver fibrosis and healthy people.The sensitivity,specificity and accuracy were determined. The clinical value of PT and HPT indicators in liver fibrosis stages was analyzed.Results The levels of PT and HPT in patients with chronic viral hepatitis B increased signifi-cantly with the severity of hepatic fibrosis.The level of PT in stage S4 [(14.86 ± 0.96)s] was significantly higher than that in stage S1 [(13.31 ± 0.49)s],S2[(13.43 ± 0.52)s] and S3 [(13.66 ± 0.53)s](P<0.05).The level of HPT in stage S3[(19.33 ± 1.14)s] was significantly higher than that in stage S1 [(17.74 ± 0.82) s] and stage S2 [(18.12 ± 0.95)s],the difference was significant (P<0.05).The level of HPT in stage S4[(20.27 ± 1.39)s] was significantly different from that in stage S1 [(17.74 ± 0.82) s],S2 [(18.12 ± 0.95) s] and stage S3 [(19.33 ± 1.14)s](P<0.05).The sensitivity,specificity and accuracy of PT and HPT in liver fibrosis stage(>S2,S4 ) were higher by drawing ROC curve analysis.Conclusion The sensitivity and specificity of PT and HPT are high.They have good clinical diagnostic value in staging liver fibrosis in patients with chronic hepatitis B.
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Objective To investigate the correlation between tumor perfusion parameters and tumor volume and Child-Pugh classification in CT of hepatocellular carcinoma (HCC).Methods Fifty-six patients with hepatocellular carcinoma were selected to perform CT perfusion imaging.The parameters of the total tumor perfusion such as hepatic artery perfusion (HAP),portal vein perfusion (PVP)and hepatic perfusion index (HAPI)were calculated according to the degree of hepatic encephalopathy,albumin,bilirubin, clotting time,ascites for liver Child-Pugh classification.The relationship between the tumor or peritumoral perfusion parameters with tumor volume and Child-Pugh classification were analyzed.Results (1)There was no correlation between tumor or peritumoral perfusion with the tumor volume.(2)The difference of HAP,PVP and HAPI between the different Child-Pugh classification groups was statistically significant (P<0.000 1).(3)With the reduction of Child-Pugh classification,the tumor body HAP and HAPI values gradually decreased, while the PVP value increased gradually.Conclusion There is no correlation between the tumor volume of hepatocellular carcinoma with total tumor perfusion parameters.The differences in perfusion measurements between different Child-Pugh classification can intuitively and quantitatively reflect the reserve function of the liver.
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Objective To evaluate the ability of Gd-EOB-DTPA enhanced MRI in the evaluation of liver reserve function in patients with hepatitis B cirrhosis.Methods Patients with hepatitis B cirrhosis and controls with normal liver function and free of chronic liver disease were collected prospectively.Signal intensity(SI)of each hepatic segments(S1-S8)were measured of all cases before injection and after bolus administration of Gd-EOB-DTPA,and the whole liver signal intensity was assessed as the average signal intensity.The whole liver relative enhancement degree(relative enhancement RE)was calculated.The one way A NOVA was used to compare SI and RE among four groups at different time and the Friedman test was used to compare SI and RE within each group at different time.The Spearman rank correlation analysis was used to do correlation analysis.ROC curve was used to analyze the efficacy of Gd-EOB-DTPA enhanced MRI in the diagnosis of liver dysfunction and was used to compare the diagnostic performance of SI and RE in discriminating normal liver function group-Child A from Child B-C.Results Patients enrolled with normal liver function,Child-Pugh A,B and C was 21, 40,48 and 11.SI and RE between different groups were statistically significant at each time(P<0.05);and was statistically significant at different time within the same group.Correlation analysis of SI and RE with liver function classification at different time points showed:in addition to SI20 s(r= -0.190,P= 0.038),RE20 s(r=0.081,P=0.382),SI and RE at each time point were highly negatively related with liver function classification(P<0.01).SI10 minand RE10 minwere higher significantly negatively related with liver function classification.T he area under the ROC curve was 0.839,0.707,0.779 and 0.547,respectively.Conclusion Gd-EOB-DTPA enhanced MRI can assess liver reserve function in patients with hepatitis B cirrhosis,SI and RE can reflect the degree of liver function reserve in a certain extent.It has some value in predicting the normal or mild injury of liver function with moderate or severe injury of liver function.
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Objective To observe the clinical value of indocyanine green retention rate at 15 minutes (ICGR15) in the evaluation of hepatic functional reserve. Methods A total of 185 patients with liver disease, including 45 cases of liver failure, 90 cases of cirrhosis (child A, B and C, respectively), 20 cases of acute hepatitis, 30 cases of chronic hepatitis (mild, moderate). Expression levels of ICGR15 were compared between groups. Values of ICGR15, total bilirubin (TBIL), albumin (ALB), blood coagulation time (PT) were compared before treatment and one month after treatment in hepatic failure group. Levels of alanine aminotransferase (ALT), aspertate aminotransferase (AST), TBIL and ICGR15 were compared before treatment and 1 month after treatment in acute hepatitis group. Results Levels of ICGR15 (%) were 56.3±14.7, 28.9±9.6, 22.4±6.8 and 13.7±2.3 in liver failure group, liver cirrhosis group, acute hepatitis group and chronic hepatitis group, which showed a gradual downward trend (F=125.317, P<0.05). Among them, the levels of ICGR15 (%) were 17.3±5.4, 25.7±7.5 and 34.5±7.3 in Child A, B and C groups of liver cirrhosis group, which showed a gradual upward trend (P<0.05). After one month treatment, levels of TBIL, PT and ICGR15 were significantly lower than T helper 17 cells; intima-media thickness before the treatment in liver failure group. The levels of ALT, AST, TBIL and ICGR15 were significantly lower after treatment than those before treatment in acute hepatitis group (P<0.05). Conclusion ICGR15 can reflect hepatic reserved function, which is not affected by the application of albumin and fresh plasma, and makes up the deficiency of PT and ALB detection.
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Objective To determine the perioperative risks of partial hepatectomy by determining the preoperative liver functional reserve in patients with hepatocellular carcinoma (HCC),and to compare the model for end-stage liver disease (MELD) score with the Child-Pugh classification in predicting prognosis.Methods We reviewed the clinical data of 202 patients with HCC who underwent partial hepatectomy.The MELD score and the Child-Pugh classification were determined preoperatively.Results The incidence of postoperative liver dysfunction happened in 44.0％ of Child A patients,50％ in Child B patients,41.6％in patients with a MELD score below 14,and 91.7％ in patients with a MELD score of ＞ 14.The difference between the rates of postoperative liver dysfunction in patients with a preoperative MELD score above 14 and below 14 was significant (P ＜ 0.05),while that between patients with Child-Pugh A and B was insignificant (P ＞ 0.05).The incidences of postoperative liver dysfunction in patient with a MELD ＜ 8,8 ≤ MELD ≤ 14,MELD ＞ 14 were 38.2％,57.6％ and 91.7％,respectively,indicating that there was a positive co-relationship between the MELD score and the incidences of liver dysfunction.The Spearman rank correlation test showed the MELD score was significant correlated with the Child-Pugh score (r =0.404 ; P ＜ 0.05).The areas under the ROC curves of the MELD score and the Child-Pugh score were 0.703 and 0.587 (P ＜ 0.05).Conclusions The MELD score predicted postoperative liver dysfunction more accurately than the Child-Pugh classification.HCC patients undergoing partial hepatectomy with a preoperative MELD score ＞ 14 had a high perioperative risk.To ensure the safety of partial hepatectomy,HCC patients with a preoperative MELD score ＞ 14 requires active preoperative preparation,bringing the score near to or less than 14.
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Hepatic hemangioma is a common benign tumor of liver,while hepatic hemangioma with a diameter ＞ 3 cm is rarely seen in clinical practice.A female patient with a giant hepatic hemangioma (diameter =48 cm) received tumor resection via chest and abdomen joint incision at the Peking Union Medical College Hospital on April 10,2012.The patient received exploratory laparotomy for hepatic tumor via chest and abdomen joint incision 22 years ago,while the operation was failed due to intraoperative bleeding.The success of the operation benefited from comprehensive application of computed tomography angiography reconstruction technique,three-dimensional liver reserve function assessment,intraoperative controlled low central venous pressure,total hepatic vascular exclusion and precise hepatectomy technique.
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Liver resection is one of the important treatments of liver diseases,especially hepatocellular carcinoma.In China,the vast majority of liver cancer patients suffer from generalized damage of the liver parenchyma such as cirrhosis,lead to liver reserve function reducing in various degrees.Liver dysfunction or even liver failure after liver resection becomes an important reason of perioperative death and influences the patients' long-term survival.Therefore,accurate preoperative evaluation of liver reserve function is very important.Though there are seveal kinds of assessment of liver reserve function in recent years,it still lack of a clinically recognized,comprehensive assessment method.This paper reviewed the clinical commonly used preoperative liver reserve function evaluation methods,summarizes and analyzes the value and the insufficiency of several important methods,and prospects the development of evaluation methods about preoperative liver reserve function.
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Objective To investigate the value of retention rate of indocyanine green at fifteen minutes(ICGR15)during hemihepatectomy for evaluation of residual liver reserve function in patients with primary liver carcinoma.Methods During hemihepatectomy,ICGR15 was tested in 44 patients after the hepatic artery and portal vein of resected side were ligated.Child-Pugh score,Child-Pugh classification,and MELD score before operation were tested.After operation,the liver function condition was estimated.Results The incidence of liver dysfunction was significantly lower in ICGR150.05).ICGR15 and MELD score in normal liver function group were statistical lower than those in mild insufficiency of liver function group and severe insufficiency of liver function group(P