Diagnosis of Clinically Significant Portal Hypertension Using CT- and MRI-based Vascular Model.

Background Currently, the hepatic venous pressure gradient (HVPG) remains the reference standard for diagnosis of clinically significant portal hypertension (CSPH) but is limited by its invasiveness and availability. Purpose To investigate a vascular geometric model for noninvasive diagnosis of CSPH (HVPG ≥10 mm Hg) in patients with liver cirrhosis for both contrast-enhanced CT and MRI. Materials and Methods In this retrospective study, consecutive patients with liver cirrhosis who underwent HVPG measurement from August 2016 to April 2019 were included. Patients without hepatic diseases were included and marked as non-CSPH to balance the ratio of CSPH 1:1. A variety of vascular parameters were extracted from the portal vein, hepatic vein, aorta, and inferior vena cava and then entered into a vascular geometric model for identification of CSPH. Diagnostic performance was assessed with the area under the receiver operating characteristic curve (AUC). Results The model was developed and tested with retrospective data from 250 patients with liver cirrhosis and 273 patients without clinical evidence of hepatic disease at contrast-enhanced CT examination, including 213 patients with CSPH (mean age, 49 years ± 12 [SD]; 138 women) and 310 patients without CSPH (mean age, 50 years ± 9; 177 women). For external validation, an MRI data set with 224 patients with cirrhosis (mean age, 49 years ± 10; 158 women) and a CT data set with 106 patients with cirrhosis (mean age, 53 years ± 12; 71 women) were analyzed. Significant reductions in mean whole-vessel volumes were observed in the portal vein (ranging from 36.9 cm3 ± 16.0 to 29.6 cm3 ± 11.1; P < .05) and hepatic vein (ranging from 35.3 cm3 ± 21.5 to 22.4 cm3 ± 15.7; P < .05) when CSPH occurred. Similarly, the mean whole-vessel lengths were shorter in patients with CSPH (portal vein: 1.7 m ± 1.2 vs 3.0 m ± 2.4, P < .05; hepatic vein: 0.9 m ± 1.5 vs 1.8 m ± 1.5, P < .05) than in those without CSPH. The proposed vascular model performed well in the internal test set (mean AUC, 0.90 ± 0.02) and external test sets (mean AUCs, 0.84 ± 0.12 and 0.87 ± 0.11). Conclusion A contrast-enhanced CT- and MRI-based vascular model was proposed with good diagnostic consistency for hepatic venous pressure gradient measurement. ClinicalTrials.gov registration nos. NCT03138915 and NCT03766880 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Roldán-Alzate and Reeder in this issue.

An imaging-based artificial intelligence model for non-invasive grading of hepatic venous pressure gradient in cirrhotic portal hypertension.

The hepatic venous pressure gradient (HVPG) is the gold standard for cirrhotic portal hypertension (PHT), but it is invasive and specialized. Alternative non-invasive techniques are needed to assess the hepatic venous pressure gradient (HVPG). Here, we develop an auto-machine-learning CT radiomics HVPG quantitative model (aHVPG), and then we validate the model in internal and external test datasets by the area under the receiver operating characteristic curves (AUCs) for HVPG stages (≥10, ≥12, ≥16, and ≥20 mm Hg) and compare the model with imaging- and serum-based tools. The final aHVPG model achieves AUCs over 0.80 and outperforms other non-invasive tools for assessing HVPG. The model shows performance improvement in identifying the severity of PHT, which may help non-invasive HVPG primary prophylaxis when transjugular HVPG measurements are not available.

Dynamic Imaging Changes of COVID-19 Pneumonia at Different Stages.

INTRODUCTION: To investigate the Computed Tomography (CT) imaging characteristics and dynamic changes of COVID-19 pneumonia at different stages. METHODS: Forty-six patients infected with COVID-19 who had chest CT scans were enrolled, and CT scans were performed 4-6 times with an interval of 2-5 days. RESULTS: At the early stage (n=25), ground glass opacity was presented in 11 patients (11/25 or 44.0 %) and ground glass opacity mixed with consolidation in 13 (13/25 or 52.0 %) in the lung CT images. At the progressive stage (n=38), ground glass opacity was presented in only one patient (1/38 or 2.6 %) and ground glass opacity mixed with consolidation in 33 (33/38 or 86.8 %). In the early improvement stage (n=38), the imaging presentation was ground glass opacity alone in three patients (3/38 or 7.9 %) and ground glass opacity mixed with consolidation in 34 (34/38 or 89.5 %). In the late improvement (absorption) stage (n=33), the primary imaging presentation was ground glass presentation in eight patients (8/33 or 24.2 %) and ground glass opacity mixed with consolidation in 23 (23/33 or 69.7 %). The lesion reached the peak at 4-16 days after disease onset, and 26 (26/38 or 68.4 %) patients reached the disease peak within ten days. Starting from 6 to 20 days after onset, the disease began to be improved, with 30 (30/38 or 78.9 %) patients being improved within 15 days. CONCLUSION: COVID-19 pneumonia will progress to the peak stage at a mediate time of seven days and enter the improvement stage at twelve days. Computed tomography imaging of the pulmonary lesion has a common pattern from disease onset to improvement and recovery and provides important information for evaluation of the disease course and treatment effect.

Noncontrast-enhanced MRI-based Noninvasive Score for Portal Hypertension (CHESS1802): An International Multicenter Study.

BACKGROUND AND AIMS: This study aimed to determine the performance of the non-invasive score using noncontrast-enhanced MRI (CHESS-DIS score) for detecting portal hypertension 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 intraclass 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.

Assisting scalable diagnosis automatically via CT images in the combat against COVID-19.

The pandemic of Coronavirus Disease 2019 (COVID-19) is causing enormous loss of life globally. Prompt case identification is critical. The reference method is the real-time reverse transcription PCR (RT-PCR) assay, whose limitations may curb its prompt large-scale application. COVID-19 manifests with chest computed tomography (CT) abnormalities, some even before the onset of symptoms. We tested the hypothesis that the application of deep learning (DL) to 3D CT images could help identify COVID-19 infections. Using data from 920 COVID-19 and 1,073 non-COVID-19 pneumonia patients, we developed a modified DenseNet-264 model, COVIDNet, to classify CT images to either class. When tested on an independent set of 233 COVID-19 and 289 non-COVID-19 pneumonia patients, COVIDNet achieved an accuracy rate of 94.3% and an area under the curve of 0.98. As of March 23, 2020, the COVIDNet system had been used 11,966 times with a sensitivity of 91.12% and a specificity of 88.50% in six hospitals with PCR confirmation. Application of DL to CT images may improve both efficiency and capacity of case detection and long-term surveillance.

Diagnostic Value of Portal Vein Velocity for Portal Hypertension in Patients with Hepatitis B Virus-related Cirrhosis.

BACKGROUND: Portal vein velocity (PVV) has shown a reasonable correlation with the presence of portal hypertension in patients with cirrhosis. This study aims to evaluate the value of PVV for diagnosing clinically significant portal hypertension (CSPH) and predicting the risk of variceal hemorrhage (VH) in patients with hepatitis B virus (HBV)-related cirrhosis. MATERIALS AND METHODS: A cohort of 166 consecutive adult patients with HBV-related cirrhosis was recruited in this retrospective study from two high-volume liver centers in China between April 2015 and April 2017. The performance of PVV and other non-invasive parameters for diagnosing CSPH and predicting the risk of VH was studied. RESULTS: PVV demonstrated the best performance for diagnosing CSPH (defined as an HVPG ≥10 mmHg) in patients with HBV-related cirrhosis among the included non-invasive predictors with the area under the receiver operating characteristic curve (AUC), specificity, and sensitivity of 0.745, 50%, and 93.5%, respectively. Other non-invasive markers, including APRI, AAR, LS, FIB-4, and diameter of the portal vein, did not show sufficient performance with the AUCs of 0.565, 0.560, 0.544, 0.529, and 0.474, respectively. With regard to predicting the risk of VH (defined as an HVPG ≥12 mmHg), PPV also exhibited a moderate performance with an AUC of 0.762, which was superior to that of the aforementioned markers. By using two cutoff values of PVV to rule-out (11.65 cm/s) and rule-in (20.20 cm/s) CSPH, 30 (33.7%) patients showed definite results categories, with 23 (76.7%) patients were well classified and 7 (23.3%) were misclassified. Fifty-nine (66.3%) patients were with indeterminate results. By using PVV values of 13.10 cm/s and 21.40 cm/s to rule-out and rule-in HVPG ≥ 12mmHg, 34 (38.2%) patients has definite results, among whom 26 (76.5%) were well classified and 8 (23.5%) were misclassified. And 55 (61.8%) patients required further evaluation. CONCLUSION: PPV is insufficient to serve as a non-invasive parameter for identifying CSPH and predicting the risk of VH in patients with HBV-related cirrhosis.

Evaluating the clinical value of MRI multi-model diffusion-weighted imaging on liver fibrosis in chronic hepatitis B patients.

PURPOSE: To explore the value of various diffusion parameters obtained from monoexponential, biexponential, and stretched exponential in assessing liver fibrosis in chronic hepatitis B (CHB). METHODS: DWI and intravoxel incoherent motion (IVIM) MRI were performed prospectively on liver for 146 patients with CHB and 21 healthy volunteers. ADC values were obtained from monoexponential model imaging. Diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f) obtained by biexponential model imaging, and stretched exponential model to obtain diffusion distribution coefficient (DDC) and diffusion heterogeneity index (α). Blood draw were performed on patients to obtain AST, ALT, and PLT, and then APRI and FIB-4 index were determined based on the serological diagnostic models. The fibrosis stage was staged (S0-S4) according to the pathology of liver puncture. Independent sample t test was used to compare the parameter values between liver fibrosis group and control group. One-way ANOVA was used to compare the parameters of different liver fibrosis grades. Bonferroni test was used for correcting multiple comparisons. Spearman correlation was used to analyze the correlation between each parameter and liver fibrosis grades. ROC was used to predict the diagnostic power of each parameter for liver fibrosis stages ≥ S2 and ≥ S3. RESULTS: ADC, D, D*, f, and DDC values were significantly different between normal control group and hepatic fibrosis group (P < 0.05). There were significant differences in ADC, D*, f, and DDC value among liver fibrosis groups (P < 0.05). D* and DDC values were moderately negatively correlated with the grades of liver fibrosis (r = - 0.483, P < 0.001; r = - 0.622, P < 0.001). ADC and f values were slightly negatively correlated with the grades of liver fibrosis (r = - 0.295, P < 0.001; r = - 0.312, P < 0.001). DDC values have the highest diagnostic efficiency in liver fibrosis stages ≥ S2 and ≥ S3. The areas under ROC curve (AUC) were 0.813 and 0.832 for ≥ S2 and ≥ S3, respectively, the sensitivity is 83.72% and 73.53%, and the specificity of 83.33% and 66.04%, which were better than APRI and FIB-4. CONCLUSION: D* obtained from biexponential and DDC obtained from stretched exponential DWI have better value in evaluating the degree of liver fibrosis in CHB.

Clinical and pathological investigation of patients with severe COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory coronavirus 2 (SARS-CoV-2), has become a pandemic. This study addresses the clinical and immunopathological characteristics of severe COVID-19. METHODS: Sixty-nine patients with COVID-19 were classified into severe and nonsevere groups to analyze their clinical and laboratory characteristics. A panel of blood cytokines was quantified over time. Biopsy specimens from 2 deceased cases were obtained for immunopathological, ultrastructural, and in situ hybridization examinations. RESULTS: Circulating cytokines, including IL-8, IL-6, TNF-α, IP10, MCP1, and RANTES, were significantly elevated in patients with severe COVID-19. Dynamic IL-6 and IL-8 were associated with disease progression. SARS-CoV-2 was demonstrated to infect type II and type I pneumocytes and endothelial cells, leading to severe lung damage through cell pyroptosis and apoptosis. In severe cases, lymphopenia, neutrophilia, depletion of CD4+ and CD8+ T lymphocytes, and massive macrophage and neutrophil infiltrates were observed in both blood and lung tissues. CONCLUSIONS: A panel of circulating cytokines could be used to predict disease deterioration and inform clinical interventions. Severe pulmonary damage was predominantly attributed to both cytopathy caused by SARS-CoV-2 and immunopathologic damage. Strategies that prohibit pulmonary recruitment and overactivation of inflammatory cells by suppressing cytokine storm might improve the outcomes of patients with severe COVID-19.

Deep Convolutional Neural Network-Aided Detection of Portal Hypertension in Patients With Cirrhosis.

BACKGROUND & AIMS: Noninvasive and accurate methods are needed to identify patients with clinically significant portal hypertension (CSPH). We investigated the ability of deep convolutional neural network (CNN) analysis of computed tomography (CT) or magnetic resonance (MR) to identify patients with CSPH. METHODS: We collected liver and spleen images from patients who underwent contrast-enhanced CT or MR analysis within 14 days of transjugular catheterization for hepatic venous pressure gradient measurement. The CT cohort comprised participants with cirrhosis in the CHESS1701 study, performed at 4 university hospitals in China from August 2016 through September 2017. The MR cohort comprised participants with cirrhosis in the CHESS1802 study, performed at 8 university hospitals in China and 1 in Turkey from December 2018 through April 2019. Patients with CSPH were identified as those with a hepatic venous pressure gradient of 10 mm Hg or higher. In total, we analyzed 10,014 liver images and 899 spleen images collected from 679 participants who underwent CT analysis, and 45,554 liver and spleen images from 271 participants who underwent MR analysis. For each cohort, participants were shuffled and then sampled randomly and equiprobably for 6 times into training, validation, and test data sets (ratio, 3:1:1). Therefore, a total of 6 deep CNN models for each cohort were developed for identification of CSPH. RESULTS: The CT-based CNN analysis identified patients with CSPH with an area under the receiver operating characteristic curve (AUC) value of 0.998 in the training set (95% CI, 0.996-1.000), an AUC of 0.912 in the validation set (95% CI, 0.854-0.971), and an AUC of 0.933 (95% CI, 0.883-0.984) in the test data sets. The MR-based CNN analysis identified patients with CSPH with an AUC of 1.000 in the training set (95% CI, 0.999-1.000), an AUC of 0.924 in the validation set (95% CI, 0.833-1.000), and an AUC of 0.940 in the test data set (95% CI, 0.880-0.999). When the model development procedures were repeated 6 times, AUC values for all CNN analyses were 0.888 or greater, with no significant differences between rounds (P > .05). CONCLUSIONS: We developed a deep CNN to analyze CT or MR images of liver and spleen from patients with cirrhosis that identifies patients with CSPH with an AUC value of 0.9. This provides a noninvasive and rapid method for detection of CSPH (ClincialTrials.gov numbers: NCT03138915 and NCT03766880).

Clinical and computed tomographic imaging features of novel coronavirus pneumonia caused by SARS-CoV-2.

PURPOSE: To investigate the clinical and imaging characteristics of computed tomography (CT) in novel coronavirus pneumonia (NCP) caused by SARS-CoV-2. MATERIALS AND METHODS: A retrospective analysis was performed on the imaging findings of patients confirmed with COVID-19 pneumonia who had chest CT scanning and treatment after disease onset. The clinical and imaging data were analyzed. RESULTS: Fifty patients were enrolled, including mild type in nine, common in 28, severe in 10 and critically severe in the rest three. Mild patients (29 years) were significantly (P<0.03) younger than either common (44.5 years) or severe (54.7) and critically severe (65.7 years) patients, and common patients were also significantly (P<0.03) younger than severe and critically severe patients. Mild patients had low to moderate fever (<39.1 °C), 49 (98%) patients had normal or slightly reduced leukocyte count, 14 (28%) had decreased counts of lymphocytes, and 26 (52%) patients had increased C-reactive protein. Nine mild patients were negative in CT imaging. For all the other types of NCP, the lesion was in the right upper lobe in 30 cases, right middle lobe in 22, right lower lobe in 39, left upper lobe in 33 and left lower lobe in 36. The lesion was primarily located in the peripheral area under the pleura with possible extension towards the pulmonary hilum. Symmetrical lesions were seen in 26 cases and asymmetrical in 15. The density of lesion was mostly uneven with ground glass opacity as the primary presentation accompanied by partial consolidation and fibrosis. CONCLUSION: CT imaging presentations of NCP are mostly patchy ground glass opacities in the peripheral areas under the pleura with partial consolidation which will be absorbed with formation of fibrotic stripes if improved. CT scanning provides important bases for early diagnosis and treatment of NCP.

Noninvasive evaluation of esophageal varices in cirrhotic patients based on spleen hemodynamics: a dual-energy CT study.

OBJECTIVE: To evaluate noninvasively the severity of esophageal varices (EV) in cirrhotic patients using splenic hemodynamics obtained with dual-energy CT. METHODS: We retrospectively analyzed 72 cirrhotic patients with EV between December 2018 and June 2019. Patients were divided into three groups: mild (EV1), medium (EV2), or severe (EV3) EV groups based on severity of EV assessed by endoscopy. An additional control group included 20 patients with normal liver CT. All patients underwent contrast-enhanced dual-energy CT. The iodine weight in spleen (IW-S) was calculated as IW-S = IC-S (iodine concentration in spleen) × V-S (spleen volume). Differences between EV and control groups were analyzed using one-way analysis of variance with Welch's correction. Games-Howell test made further pairwise comparison. The diagnostic value of IW-S on high-risk EV (EV2, EV3, or EV1 with red color sign) was evaluated using the ROC curve. p < 0.05 indicated statistical significance. RESULTS: The overall difference of IW-S between the control and EV groups was statistically significant (p < 0.001). Patients with more severe EV had higher IW-S values. Pairwise comparisons showed that except for control vs. EV1 groups, the IW-S between any other two groups was significantly different (p < 0.05). With a cutoff value at 1087 mg, the AUC for using IW-S for the detection of high-risk EV was 0.87 (95% CI 0.77~0.94). Sensitivity and specificity were 84.9% and 84.2%, respectively. CONCLUSION: IW-S obtained with dual-energy CT can noninvasively predict EV severity. KEY POINTS: • A higher iodine weight in spleen (IW-S) was observed in case of severe esophageal varices. • Cirrhotic patients have significantly higher IW-S than normal-liver patients. • IW-S in dual-energy CT maybe used to evaluate the severity of EV.

Accuracy of liver stiffness-based model by different imaging modalities in compensated advanced chronic liver disease.

OBJECTIVES: A liver stiffness × spleen size/platelet count score (LSPS) model which can rule out high-risk varices and identify high likelihood of clinically significant portal hypertension in patients with compensated cirrhosis has been endorsed by American Association for the Study of Liver Diseases in the 2016 practice guidance on portal hypertension bleeding. This study aims to evaluate the accuracy of LSPS model assessed by ultrasound in well characterized patients with compensated advanced chronic liver disease. METHODS: Eligible patients with compensated advanced chronic liver disease were retrospectively enrolled between January 2017 and March 2018, who had undergone routine clinical and laboratory tests, liver stiffness measurement, ultrasound examination, and computed tomography scanning. Spleen sizes were evaluated by ultrasound and computed tomography reconstructed model, respectively. The correlation and agreement of spleen size and LSPS derived from ultrasound and computed tomography imaging modality were compared. RESULTS: A total of 158 patients were included and analyzed. Spleen size showed a moderate correlation (R = 0.649, P < 0.001) according to ultrasound and computed tomography imaging. Also, the correlation between the two LSPS models based on ultrasound and computed tomography was excellent (R = 0.985, P < 0.001). The Bland-Altman plots demonstrated a superior agreement of LSPS model values evaluated by ultrasound and computed tomography, respectively. CONCLUSION: This study demonstrated the accuracy of LSPS model based on ultrasound in a well characterized cohort of fully compensated patients with advanced chronic liver disease.

Nuclear magnetic resonance evaluation of inflammatory activity from chronic viral Hepatitis B.

OBJECTIVES: To discuss the value of applying magnetic resonance diffusion-weighted imaging (DWI) to evaluate inflammatory activity from chronic viral hepatitis B. METHODS: One hundred forty-two patients with chronic viral hepatitis B who received treatment at The Fifth Medical Center of Chinese PLA General Hospital from January 2014 to December 2015 and 20 healthy persons in the control group who were scheduled to undergo nuclear magnetic resonance scanning and DWI examinations (b value = 0, 800 s/mm2), and the apparent diffusion coefficients (ADCs) were measured and compared with the biopsy results of hepatic tissue. RESULTS: The ADC value of the group with hepatitis B was lower than that of the healthy group (P<0.05), and the ADC value of the group with mild inflammation (G1) significantly differed from that of the group with moderate inflammation (G2) and that of the group with severe inflammation (G3-G4) (P<0.05). CONCLUSIONS: Magnetic resonance diffusion-weighted imaging technology has high clinical value for evaluating the inflammatory activity from chronic hepatitis B, and the measured ADC value corresponds to the pathological grade well, so this method is worth clinical promotion and application.

Virtual Hepatic Venous Pressure Gradient with CT Angiography (CHESS 1601): A Prospective Multicenter Study for the Noninvasive Diagnosis of Portal Hypertension.

Purpose To develop and validate a computational model for estimating hepatic venous pressure gradient (HVPG) based on CT angiographic images, termed virtual HVPG, to enable the noninvasive diagnosis of portal hypertension in patients with cirrhosis. Materials and Methods In this prospective multicenter diagnostic trial (ClinicalTrials.gov identifier: NCT02842697), 102 consecutive eligible participants (mean age, 47 years [range, 21-75 years]; 68 men with a mean age of 44 years [range, 21-73 years] and 34 women with a mean age of 52 years [range, 24-75 years]) were recruited from three high-volume liver centers between August 2016 and April 2017. All participants with cirrhosis of various causes underwent transjugular HVPG measurement, Doppler US, and CT angiography. Virtual HVPG was developed with a three-dimensional reconstructed model and computational fluid dynamics. Results In the training cohort (n = 29), the area under the receiver operating characteristic curve (AUC) of virtual HVPG in the prediction of clinically significant portal hypertension (CSPH) was 0.83 (95% confidence interval [CI]: 0.58, 1.00). The diagnostic performance was prospectively confirmed in the validation cohort (n = 73), with an AUC of 0.89 (95% CI: 0.81, 0.96). Inter- and intraobserver agreement was 0.88 and 0.96, respectively, suggesting the good reproducibility of virtual HVPG measurements. There was good correlation between virtual HVPG and invasive HVPG (R = 0.61, P < .001), with a satisfactory performance to rule out (7.3 mm Hg) and rule in (13.0 mm Hg) CSPH. Conclusion The accuracy of a computational model of virtual hepatic venous pressure gradient (HVPG) shows significant correlation with invasive HVPG. The virtual HVPG also showed a good performance in the noninvasive diagnosis of clinically significant portal hypertension in cirrhosis. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Malayeri in this issue.

Development and validation of a radiomics signature for clinically significant portal hypertension in cirrhosis (CHESS1701): a prospective multicenter study.

Clinically significant portal hypertension (CSPH) is associated with an incremental risk of esophageal varices and overt clinical decompensations. However, hepatic venous pressure gradient (HVPG) measurement, the gold standard for defining CSPH (HVPG≥10 mm Hg) is invasive and therefore not suitable for routine clinical practice. This study aims to develop and validate a radiomics-based model as a noninvasive method for accurate detection of CSPH in cirrhosis. The prospective multicenter diagnostic trial (CHESS1701, ClinicalTrials.gov identifier: NCT03138915) involved 385 patients with cirrhosis from five liver centers in China between August 2016 and September 2017. Patients who had both HVPG measurement and contrast-enhanced CT within 14 days prior to the catheterization were collected. The noninvasive radiomics model, termed rHVPG for CSPH was developed based on CT images in a training cohort consisted of 222 consecutive patients and the diagnostic performance was prospectively assessed in 163 consecutive patients in four external validation cohorts. rHVPG showed a good performance in detection of CSPH with a C-index of 0·849 (95%CI: 0·786-0·911). Application of rHVPG in four external prospective validation cohorts still gave excellent performance with the C-index of 0·889 (95%CI: 0·752-1·000, 0·800 (95%CI: 0·614-0·986), 0·917 (95%CI: 0·772-1·000), and 0·827 (95%CI: 0·618-1·000), respectively. Intraclass correlation coefficients for inter- and intra-observer agreement were 0·92-0·99 and 0·97-0·99, respectively. A radiomics signature was developed and prospectively validated as an accurate method for noninvasive detection of CSPH in cirrhosis. The tool of rHVPG assessment can facilitate the identification of CSPH rapidly when invasive transjugular procedure is not available.

Diagnostic value evaluation of trefoil factors family 3 for the early detection of colorectal cancer.

AIM: The purpose of this study was to evaluate the diagnostic value of trefoil factor family 3 (TFF3) for the early detection of colorectal cancer (CC). METHODS: Serum TFF3 and carcino-embryonic antigen (CEA) were detected in 527 individuals, including 115 healthy control (HC), 198 colorectal adenoma (CA), and 214 CC individuals in the training group. RESULTS: Serum TFF3 showed no significant correlation with age, gender, or tumor location but showed significant correlation with the tumor stage. Serum TFF3 in the CC group was significantly higher than in the HC or CA group. The AUC values of TFF3 for discriminating between HC and CC and between CA and CC were 0.930 (0.903, 0.958) and 0.834 (0.796, 0.873). A multivariate model combining TFF3 and CEA was built. Compared to TFF3 or CEA alone, the multivariate model showed significant improvement (P < 0.001). For discriminating between HC and CC, HC and early stage CC, HC and advanced stage CC, CA and CC, CA and early stage CC, and CA and advanced stage CC in the training group, the sensitivities were 92.99%, 91.46%, 93.18%, 73.83%, 76.83%, and 81.82%, and the specificities were 91.30%, 91.30%, 93.91%, 88.38%, 77.27%, and 88.38%, respectively. After validation, the sensitivities were 89.39%, 85.71%, 90.79%, 72.73%, 71.43%, and 78.95%, and the specificities were 87.85%, 87.85%, 2.52%, 87.85%, 80.77%, and 87.50%, respectively. CONCLUSION: The multivariate diagnostic model that included TFF3 and CEA showed significant improvement over the conventional biomarker CEA and might provide a potential method for the early detection of CC.

The "Vessel through Strait" Sign is a Signature Radiological Sign for the Diagnosis of Left Hepatic Artery Variation.

An aberrant artery (AA) can frequently be observed coursing through the fissure for the ligamentum venosum (FLV) which was termed the "vessel through strait" sign (VTSS) by us. Fundamental data including the incidence, anatomical composition and clinical significance of VTSS and the AAs composing VTSS are still lacking. We sought to give a systematic demonstration on this issue in the present study. VTSS was respectively analyzed in 2,275 patients and was observed in 357 of them. Interestingly, 319 (89.4%) out of the 357 patients exhibiting VTSS were proved to have left hepatic artery variation (LHAV) (247 with replaced left hepatic artery, 64 with accessory left hepatic artery and 8 with variant common hepatic artery). We therefore hypothesized that VTSS could be a sign that strongly associated with LHAV and could be used for its diagnosis. In the following validating analysis, VTSS gained a sensitivity of 96.3% and a specificity of 98.3% for the diagnosis of LHAV in another bicenter cohort consisted of 1,329 patients. In conclusion, VTSS is a signature radiological sign of LHAV which could be used as an easy and specific method for the diagnosis of LHAV.

Primary hepatic malignant fibrous histiocytoma mimicking hepatocellular carcinoma: A report of two cases.

Malignant fibrous histiocytoma (MFH) is a tumor that occurs throughout the body as a relatively uncommon entity. The current study presents two cases of primary malignant fibrous histiocytoma of the liver. The first case was of a 67-year-old male who exhibited no symptoms or abnormal physical signs, and in whom the lesion was found by ultrasound examination during a routine physical examination. The second case was of a 35-year-old male who presented with persistent malaise, weight loss and intermittent right upper quadrant pain. The presence of liver cirrhosis due to hepatitis B virus, which was identified 10 years previously, and the clinical appearance caused MFH to appear as hepatocellular carcinoma at the time of the initial diagnosis. Abdominal magnetic resonance imaging scans were the main tools of diagnosis, but the MFH mimicked hepatocellular carcinoma due to the similar morphological characteristics, the rare occurrence of MFH and the underlying diseases of the liver. The first patient underwent a complete resection and recovered well, while the second patient underwent palliative treatment due to the large size of the tumor and the obstructive emboli in the portal vein. The diagnoses of the tumors were confirmed as MFH by histopathology and immunohistochemistry.

The efficacy of radiofrequency ablation combined with transcatheter arterial chemoembolization for primary hepatocellular carcinoma in a cohort of 487 patients.

Although diagnostic methods, surgical techniques, and perioperative care have undergone significant advancement over the past decades, the prognosis of primary hepatocellular carcinoma (HCC) remains discouraged because of the high postoperative recurrence rate and high cancer mortality. Radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) is a recently developed means for the treatment of HCC. In this study, we analyzed the efficacy of RFA plus TACE in 487 cases of HCC in our institution. We observed that the 1-, 2-, 3-, 4- and 5-year rates of overall survival rates after RFA and TACE treatment were 97.5% (475/487), 89.4% (277/310), 84.2% (181/215), 80.4% (150/186) and 78.7% (141/177), respectively. We did not find that age or tumor location (the caudate group or non-caudate group) plays a role in this cohort. However, we have identified that tumor recurrent status, the number of tumors, albumin (ALB), prothrombin time (PT) and platelet count (PLT) were significantly associated with poor overall survival in HCC patients receiving RFA combined with TACE. Interestingly, tumor size did not significantly impact overall survival, indicating that RFA combined with TACE for HCC treatment has the same efficiency for different sizes of tumors. Our results provide evidence for the rationale for using combined RFA and TACE in the treatment of primary HCC.