Study On Risk Of Upper Gastrointestinal Bleeding Secondary To Hepatitis B-related Cirrhosis By Quantitative Morphology Of Liver,Spleen And Portal Vein System Depicted On MRI

Part one:Combinations of Liver Lobe and Spleen volumes Measured on MRI to Predict the Risk of Oesophagogastric Variceal Bleeding Secondary to Hepatitis B-related CirrhosisObjective:To investigate whether thecombinations of liver lobe and spleen volumes measured on magnetic resonance imaging(MRI)could predict oesophagogastric variceal bleeding(OVB)in the hepatitis B-related cirrhotic patients.Methods:96 hepatitis B-related cirrhotic patients,who underwent abdominal contrast-enhanced MRI,were consecutively collected.OVB occurred in 31 cases of 96 participants during the two years’ follow-up period,whereas the remained 65 patients did not suffer from OVB.Spleen volume(SV),total liver volume(TLV)and four liver lobe volumes,including right lobe volume(RV),left medial lobe volume(LMV),left lateral lobe volume(LLV)and caudate lobe volume(CV)were measured onthe axial portal venous phase images of MRI.Percentages of individual liver lobe volume in TLV(including RV/TLV,LMV/TLV,LLV/TLV and CV/TLV),ratios of SV to TLV(SV/TLV)and to individual liver lobe volume(including SV/RV,SV/LMV,SV/LLV and SV/CV)were calculated for the next statistical analyses.Results:Patients with OVB had lower RV and TLV than without OVB(P-values<0.05 for all),whereas no differences in LMV,LLVand CV were found(P-values>0.05 for all).Among the percentages of individual liver lobe volume in TLV,RV/TLV was lower whereas LMV/TLV and LLV/TLV were greater in patients with OVB than without OVB(P-values<0.05 for all),but,CV/TLV was not statistically different between the two groups of patients(P-value=0.288).SV,SV/TLV andthe ratios of SV to individual liver lobe volume in patients with OVB were larger than without OVB(P-values<0.05 for all).Among parameters with difference between patients with and without OVB,SV/RV could better predict OVB with an area under receiver operating characteristic curve of 0.84.Conclusion:SV/RV could better predict OVB in hepatitis B-related cirrhotic patients.Part two:A Novel LogisticRegression Model Based on Liver Lobe and Spleen Volumes together with Portal Vein System Diameters Measured on MRI to Predictthe Risk of Oesophagogastric Variceal Bleeding Secondary to Hepatitis B-related CirrhosisObjective:To develop and validate a novel logistic regression model based on liver lobe and spleen volumes together with portal vein system diameters measured on MRI for predicting oesophagogastric variceal bleeding(OVB)secondary to hepatitis B-related cirrhosis.Methods:One hundred and eighty-five consecutive cirrhotic patients with hepatitis B undergoing abdominal contrast-enhanced MRI were randomly divided into training cohort(n=130)and validation cohort(n=55).Spleen volume(SV),total liver volume(TLV),and four liver lobe volumes including right lobe volume(RV),left medial lobe volume(LMV),left lateral lobe volume(LLV)and caudate lobe volume(CV)were measured on the axial portal venous phase images of MRI.The ratios of SV to TLV(SV/TLV)and to individual liver lobe volume(including SV/RV,SV/LMV,SV/LLV and SV/CV)were calculated.Diameters of portal venous system composed of left gastric vein,portal vein,right portal vein,left portal vein,superior mesenteric vein and splenic vein were measured on the coronal portal venous phase images.In training cohort,Mann-Whitney U test and binary logistic regression analyses were conducted sequentially to determine independent risk factors of OVB among the above parameters.The model for predicting OVB was constructed based on independent risk factors from training cohort,performance of the model was evaluated by receiver operating characteristiccurve(ROC)analysis,and was ultimately validated by Kappa test in validation cohort.Results:OVB occurred in 42 and 18 individuals in the training and validation cohorts during the two years’ follow-up period,respectively.An OVB prediction model was constructed based on the independent risk factors including RV,left gastric vein diameter(LGVD)and portal vein diameter(PVD)(odds ratio=0.993,2.202,1.613,respectively;P-values<0.001 for all).The model equation was shown to be "-0.007×RV+0.79×LGVD+0.478×PVD-6.73".The model had excellent performance for predicting OVB with an area under the ROC curve of 0.907.An excellent performance was confirmed by the Kappa test with K-value of 0.802 in validation cohort.Conclusion:The novel logistic regression model is reliable for predicting OVBsecondary to hepatitis B-related cirrhosis.