| Research background and purposeTechnical backgroundCT three-dimensional reconstruction technology refers to the use of computer processing technology to perform feature extraction and three-dimensional reconstruction of computed tomography(CT)images.It is a tool to display,describe and interpret the three-dimensional anatomical and morphological features of organs,thereby providing an intuitive,threedimensional and accurate assessment method for clinical decision-making.CT threedimensional reconstruction technology plays an increasingly important role in the diagnosis and treatment of liver diseases.In recent years,CT three-dimensional reconstruction technology has been proved to be safe and effective in pre-hepatectomy evaluation,simulated liver resection,portal vein blood flow and velocity measurement,and liver volume measurement;At the same time,3D model combined with fluid dynamics analysis has become a new non-invasive method for the diagnosis and detection of portal hypertension.In this study,three-dimensional reconstruction was used to reconstruct the liver and spleen and intrahepatic blood vessels,and the volume was measured to explore the effect of liver and spleen volume changes before and after TIPS on liver function reserve and the outcome of portal hypertension.Research backgroundTransjugular intrahepatic portosystemic shut(TIPS)is a method of penetrating the intrahepatic portal vein through a jugular approach to establish a portal to body shunt between the hepatic vein and the portal vein in the liver parenchyma.It is a minimally invasive interventional technique for reducing portal hypertension in liver cirrhosis,treating portal hypertension complications such as esophagogastric variceal and intractable pleural effusion.The structure and function of intrahepatic vessels will change during the progression of liver cirrhosis,accompanied by varying degrees of changes in liver volume,spleen volume and reserve function.TIPS has an important influence on the hemodynamic status of portal vein system,and the relationship between the changes of liver and spleen volume and intrahepatic vascular volume before and after surgery and liver reserve function and decompensated outcome of cirrhosis after TIPS has been rarely reported.The purpose of this study was to reconstruct the liver,intrahepatic blood vessels,and spleen volume before and after TIPS by CT three-dimensional reconstruction technology,and to observe the volume variable data,To study the effect of TIPS on liver and spleen volume in patients with cirrhotic portal hypertension,and its relationship with li ver reserve function and the outcome of decompensated liver cirrhosis,In order to explore a non-invasive evaluation model for liver function reserve and decompensation outcome of liver cirrhosis in patients with liver cirrhosis after TIPS.Materials and methodsPatients who were hospitalized in the Department of Gastroenterology,East Hospital,Shandong Provincial Hospital from July 2018 to August 2021 and underwent TIPS for liver cirrhosis and portal hypertension with esophagogastric varices bleeding(or secondary prevention)were retrospectively collected,Twenty-four patients with complete preoperative and postoperative follow-up data(including abdominal contrast-enhanced CT+portal vein imaging,liver function,biochemistry,coagulation,hematological index and other test indicators)were included,Informed consent was obtained in outpatient clinic or by telephone,and follow-up was conducted.The CT of the patient before and after operation was checked by Syngo workstation,and the system software was used to reconstruct the liver,intrahepatic vessels and spleen.The total liver volume(including intrahepatic vascular volume),large-vessel-depleted liver volume(excluding d>5mm vascular volume),small-vessel-depleted liver volume(excluding d>3mm vascular volume),net liver volume(excluding intrahepatic total vascular volume),intrahepatic d>5mm vascular volume,intrahepatic d>3mm vascular volume and total intrahepatic vascular volume were measured before and after operation.The changes of total liver volume,net liver volume,total intrahepatic vascular volume and spleen volume before and after operation were calculated,The units were expressed in ’ml’ and the changes of total liver volume.The preoperative baseline data and postoperative follow-up data of all patients were collected,and the postoperative Child-Pugh score changes,MELD score changes,rebleeding rate,postoperative hepatic encephalopathy incidence,postoperative cumulative survival rate and other liver cirrhosis-related prognostic indicators were observed.Statistical analysis was carried out by using SPSS26.0 software.The significant level was statistically significant P<0.05.ResultA total of 24 patients who underwent TIPS treatment in our hospital were included in this study,and the preoperative and postoperative CT examination and hematological index data were included in the analysis.1.Through paired comparison of preoperative and postoperative test indicators(WBC,HGB,PLT,AST,ALT,ALB,BUN,creatinine,Na+,PT,INR),it was found that there were differences in the overall distribution of paired data in 4 groups,Postoperative AST,ALT,TBIL,and INR were higher than preoperative AST,ALT,TBIL,and INR(z values were:1.867,-1.940,-2.412,-1.867,P were 0.008,0.010,0.001,0.001,respectively,P<0.05),That is,the liver function damage will be further aggravated after TIPS,and the coagulation function will be deteriorated.There was no significant difference in WBC,PLT,ALB,BUN,creatinine,Na+,and PT before and after surgery,suggesting that WBC,PLT,ALB,BUN,creatinine,Na+,and PT did not change significantly after TIPS.2.Changes in score,outcome events,and volume changes after TIPS:Child-pugh score increased in 13 patients(54.17%)and decreased in 11 patients(45.83%);MELD score increased in 22 patients(91.67%)and decreased in 2 patients(8.3%);1 patient(4.17%)died,and the cause of death was upper gastrointestinal bleeding;2 cases(8.33%)had postoperative rebleeding;4 cases(16.67%)had postoperative hepatic encephalopathy,which improved after conservative treatment;The median change of the total intrahepatic vascular volume of the patients after operation was-9ml,a total of 4 patients(16.7%)had an increase in the total intrahepatic vascular volume,and 20(83.3%)patients had a decrease in the total intrahepatic vascular volume;The median postoperative change in total liver volume was-102.5ml,and the mean postoperative change in net liver volume was-83.46±207.32ml.The change direction of total liver volume and net liver volume was consistent.A total of 8 patients(33.3%)had increased postoperative liver volume,and 16 patients(66.7%)had decreased postoperative liver volume.The mean value of postoperative splenic volume change was-57.39±157.34mL,5 patients(20.83%)had postoperative splenic volume increase,and 19 patients(79.17%)had postoperative splenic volume decrease.3.Paired t/rank-sum test was performed on preoperative and postoperative volume variables(actual liver volume to theoretical liver volume ratio,total liver volume,net liver volume,intrahepatic total vessel volume,spleen volume,liver and spleen ratio).The data showed differences in the overall mean or distribution of the three groups of data:The preoperative ratio of actual liver volume to theoretical liver volume was 0.77±0.21,the postoperative ratio of actual liver volume to theoretical liver volume was 0.70±0.17,the difference was-0.07,the postoperative ratio decreased significantly(t=2.121 P=0.045),suggesting that the actual liver volume decreased after surgery.The preoperative total liver volume was 996.5±31 1.67ml,and the postoperative total liver volume was 897.92±235.54mL,with a difference of-98.58mL(t=2.231P=0.036).The postoperative total liver volume was significantly lower than the preoperative total liver volume,suggesting that the postoperative total liver volume had a downward trend;Compared with postoperative total hepatic vessel volume(Z=-3.394 P=0.001,P<0.05),postoperative total hepatic vessel volume was significantly lower than preoperative total hepatic vessel volume,suggesting that postoperative total hepatic vessel volume showed a decreasing trend;The preoperative spleen volume was 813.20±8.91ml,and the postoperative spleen volume was 751.18±293.86ml,with a difference of-62.02ml.Although the postoperative spleen volume showed a decreasing trend,the data analysis showed no statistical significance,which may be related to the small sample size(P=0.071).4.Correlation analysis between preoperative three-dimensional CT volume variables of TIPS and liver function and other indicators:4.1 Correlation analysis between preoperative volume variables and preoperative liver function score:The correlation analysis between preoperative total liver volume,excluding liver volume of blood vessels with intrahepatic d>5mm,excluding liver volume of blood vessels with intrahepatic d>3mm,net liver volume,blood vessel volume with intrahepatic d>5mm,blood vessel volume with intrahepatic d>3mm,all blood vessel volume that can be recognized,spleen volume,liver and spleen ratio and Child-Pugh score and MELD score was conducted,The results showed that preoperative spleen volume was positively correlated with MELD score(R=0.527;P=0.008).There was no significant correlation between other volume variables and Child-Pugh score or MELD score.The results of data analysis showed that there was no significant correlation between the changes of postoperative total vascular volume,postoperative total liver volume,postoperative net liver volume,postoperative spleen volume and the changes of Child Pugh score and MELD score.4.2 Correlation between preoperative spleen volume and preoperative blood routine indexes.Preoperative spleen volume was negatively correlated with WBC,and the difference was statistically significant(r=-0.476 P=0.019);There was no significant correlation between preoperative spleen volume and HGB and PLT.5.Postoperative child-Pugh score was used to evaluate the outcome of liver function:the incidence of improved liver function was 45.83%,univariate and multivariate analysis showed a certain correlation with the increase of postoperative spleen volume,with statistical significance(OR=1.012,95%CI 1.001-1.024,P=0.037).The results suggest that spleen volume change after TIPS is an independent factor influencing the improvement of child-Pugh score liver function,which has potential application value in predicting the improvement of liver function in patients.6.Correlation analysis of postoperative volume change and postoperative MELD score change in TIPS.The changes of postoperative total intrahepatic vessel volume,postoperative total liver volume,postoperative net liver volume,postoperative spleen volume,actual liver volume and theoretical liver volume ratio and MELD score were compared and analyzed.The results showed that:The change of postoperative hepatic total vessel volume was positively correlated with the change of postoperative splenic volume,that is,the increase of vascular volume was consistent with the increase of splenic volume(r=0.445 P=0.029);The change of postoperative total liver volume was positively correlated with the change of postoperative spleen volume(r=0.504 P=0.012),suggesting that if the spleen volume increases,the liver volume will increase accordingly;The ratio of actual liver volume to theoretical liver volume was also positively correlated with the change of postoperative spleen volume(r=0.503 P=0.012);There was no significant correlation between postoperative total volume of intrahepatic vessels,postoperative total liver volume,postoperative net liver volume,postoperative spleen volume,postoperative actual liver volume to theoretical liver volume ratio and MELD score.7.Follow-up analysis of patients:the incidence of death,rebleeding and hepatic encephalopathy(HE)in TIPS group was 4.2%,8.3%and 16.7%,respectively,Correlation analysis of volume variables,related changes in liver function and follow-up outcomes showed that:The changes of AST and ALT were correlated with the occurrence of postoperative hepatic encephalopathy(R=0.436,0.549,P=0.033,0.005);There was no statistically significant correlation between other three-dimensional CT volume variables and postoperative events.Conclusion1.This study showed that 66.7%of patients had decreased liver volume after TIPS,while 33.3%had increased liver volume.The mean value of the change in total liver volume after TIPS decreased by 98.58ml,suggesting that the volume of patients after TIPS was smaller than before;The postoperative intrahepatic vascular volume decreased by 83.3%and increased by 16.7%,and the postoperative intrahepatic vascular volume decreased by 6.96ml,suggesting decreased hepatic blood perfusion after TIPS;In addition,AST,ALT,TBIL and INR of patients after TIPS showed an increasing trend;The decrease in liver volume and hepatic vessel volume on CT after TIPS provides a basis for imaging evaluation of further decompensation of liver function after TIPS.2.Data analysis showed that the changes of liver volume and intrahepatic total vessel volume were correlated with the changes of spleen volume,suggesting that the relationship between liver and spleen volume and hepatic blood perfusion was inseparable in the progression of cirrhosis.3.Spleen volume increased in 20.83%of patients after TIPS,and decreased in 79.17%of patients,The mean change of splenic volume decreased by 57.39ml after surgery,and the spleen volume showed a downward trend.Although the difference was not statistically significant,it suggested that TIPS had a potential improvement effect on splenomegaly and hypersplenism.. |
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