Bibliographies thématiques / Portal hypertension, spleen stiffness

Littérature scientifique sur le sujet « Portal hypertension, spleen stiffness »

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Publié le 10 mars 2023

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Articles de revues sur le sujet "Portal hypertension, spleen stiffness"

Yuldashev, Rustam Z., Makhmud M. Aliev, Shoilkhom I. Shokhaydarov et Dilnoza B. Tursunova. « Non-invasive diagnostics of extrahepatic portal hypertension in children ». Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care 12, n^o 1 (12 avril 2022) : 41–50. http://dx.doi.org/10.17816/psaic1011.

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BACKGROUND: The primary method for diagnosing gastroesophageal bleeding in varicose veins of the esophagus and stomach in children is fibroesophagogastroduodenoscopy. This study investigates the possibilities of 2D shear wave elastography stiffness of the spleen to determine esophageal varicose veins in children with extrahepatic portal hypertension. MATERIALS AND METHODS: A retrospective analysis of the effectiveness of the method of two-dimensional elastography by shear wave stiffness of the spleen was conducted in children with extrahepatic portal hypertension in 39 children (main group) and 11 healthy children (control group). All patients initially underwent fibroesophagogastroduodenoscopy followed by ultrasound, including 2D shear wave stiffness elastography of the spleen. Spleen stiffness was then compared with clinical symptoms, the degree of esophageal varices, and other sonographic parameters. RESULTS: According to elastography data, the spleen stiffness index in children with extrahepatic portal hypertension was 43.98 3.8 kPa, significantly higher than in the control group children (p = 0.006). Spleen stiffness measurements significantly correlated with the degree of esophageal varices in children with extrahepatic portal hypertension (r = 0.57, p = 0.0002). According to the endoscopy results in seven patients after vascular bypass surgery, esophageal varicose veins were not detected. Nevertheless, spleen stiffness in these children remained significantly higher than in the control group (27 3.9 kPa and 18 1.2 kPa, respectively, p = 0.05). CONCLUSIONS: The study results indicate that 2D stiffness shear wave elastography of the spleen effectively assesses esophageal varices in children with extrahepatic portal hypertension. This method is also convenient to monitor the reduction of varicose veins after surgical treatment and is a possible alternative to endoscopy, especially in young children.

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Binzberger, Andreas, Mark Hänle, Matthias Pfahler, Wolfgang Kratzer, Thomas Seufferlein et Eugen Zizer. « Spleen and Liver Stiffness Evaluation by ARFI Imaging : A Reliable Tool for a Short-Term Monitoring of Portal Hypertension ? » International Journal of Hepatology 2022 (9 septembre 2022) : 1–14. http://dx.doi.org/10.1155/2022/7384144.

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Background. Assessment of hepatic venous pressure gradient (HVPG) is the most reliable, though invasive method for evaluation of portal hypertension. Non-invasive, elastography-based techniques are well established in diagnosis, but not in monitoring of portal hypertension. The aim of our prospective study was to determine the value of acoustic radiation force impulse (ARFI) elastography technique of the liver and spleen in diagnosis and monitoring of portal hypertension. Methods. We prospectively assessed portal hypertension by HVPG and corresponding elastography of the liver and spleen in 31 patients with liver cirrhosis and an indication for primary prophylaxis by non-cardio selective beta-blockers. Investigations were performed at baseline and a follow-up visit after 6-8 weeks. To address the known large variability of values for spleen elastography, well-defined corresponding areas in the spleen were used for baseline and follow-up elastography. Sensitivity, specificity, and AUC-ROC values for both spleen and liver elastography monitoring of portal hypertension were calculated. Results. Liver but not spleen elastography significantly correlated with HVPG results and was suitable for initial evaluation of portal hypertension. However, changes in HVPG results did not show any correlation with alterations of ARFI values from baseline to follow-up visits both for liver and spleen elastography. Spleen stiffness results were not homogeneous across the whole organ differing significantly between the upper, hilar, and bottom placed investigation areas. Conclusions. In this prospective study ARFI-based assessment of liver elastography showed itself suitable for initial assessment but not for monitoring of portal hypertension. Spleen elastography was not appropriate for both, evaluation and monitoring of portal hypertension. A possible explanation for this new data that are in some contrast to previously published results is the degree of portal hypertension in our study, a comparatively short follow-up period, and well-defined investigation areas for spleen elastography in repetitive ARFI investigations. This trial is registered with NCT03315767.

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Franková, Soňa, et Jan Šperl. « Non-invasive methods in the assessment of portal hypertension severity ». Gastroenterologie a hepatologie 75, n^o 2 (30 avril 2021) : 125–33. http://dx.doi.org/10.48095/ccgh2021125.

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Portal hypertension represents a wide spectrum of complications of chronic liver diseases and may present by ascites, oesophageal varices, splenomegaly, hypersplenism, hepatorenal and hepatopulmonary syndrome or portopulmonary hypertension. Portal hypertension and its severity predicts the patient‘s prognosis: as an invasive technique, the portosystemic gradient (HPVG – hepatic venous pressure gradient) measurement by hepatic veins catheterisation has remained the gold standard of its assessment. A reliable, non-invasive method to assess the severity of portal hypertension is of paramount importance; the patients with clinically significant portal hypertension have a high risk of variceal bleeding and higher mortality. Recently, non-invasive methods enabling the assessment of liver stiffness have been introduced into clinical practice in hepatology. Not only may these methods substitute for liver biopsy, but they may also be used to assess the degree of liver fibrosis and predict the severity of portal hypertension. Nowadays, we can use the quantitative elastography (transient elastography, point shear-wave elastrography, 2D-shear-wave elastography) or magnetic resonance imaging. We may also assess the severity of portal hypertension based on the non-invasive markers of liver fibrosis (i.e. ELF test) or estimate clinically signifi cant portal hypertension using composite scores (LSPS – liver spleen stiff ness score), based on liver stiffness value, spleen diameter and platelet count. Spleen stiffness measurement is a new method that needs further prospective studies. The review describes current possibilities of the non-invasive assessment of portal hypertension and its severity.

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Morozov, S. V., et V. А. Izranov. « Comparsion of Liver and Spleen Elastometry Features ». Journal of radiology and nuclear medicine 102, n^o 4 (15 septembre 2021) : 247–54. http://dx.doi.org/10.20862/0042-4676-2021-102-4-247-254.

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The review presents data on the comparison of the features of liver and spleen stiffness measurements and those on the impact of various conditions on the measurement results (the type of a sensor used, food intake, number of measurements, patient position, breathing phase, etc.). Literature has been sought in the PubMed and eLibrary databases. In particular, the liver and spleen stiffness values vary differently at the height of inspiration and expiration. This is due to organ engorgement with a change in intrathoracic and intraabdominal pressures, as well as to a reduction in splenic arterial flow during exhalation. The review gives published data on liver and spleen stiffness values in healthy volunteers. The spleen is a stiffer organ than the liver. The different liver and spleen stiffness is explained by the features of blood supply (the spleen receives the most blood supply from the intensive-flow artery; the liver does from the portal vein). The reasons for increasing the stiffness of these organs in both health and disease are described. Estimation of liver stiffness can be used to diagnose cirrhosis and portal hypertension. That of spleen stiffness can help in the diagnosis of portal hypertension and in the indirect diagnosis of the presence of esophageal varices and the nature of a splenic lesion.

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Robles-Medranda, Carlos, Roberto Oleas, Miguel Puga-Tejada, Manuel Valero, Raquel Del Valle, Jesenia Ospina et Hannah Pitanga-Lukashok. « Results of liver and spleen endoscopic ultrasonographic elastography predict portal hypertension secondary to chronic liver disease ». Endoscopy International Open 08, n^o 11 (22 octobre 2020) : E1623—E1632. http://dx.doi.org/10.1055/a-1233-1934.

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Abstract Background and study aims Assessment of endoscopic ultrasonography (EUS)-elastography of the liver and spleen may identify patients with portal hypertension secondary to chronic liver disease. We aimed to evaluate use of EUS-elastography of the liver and spleen in identification of portal hypertension in patients with chronic liver disease. Patients and methods This was a single-center, diagnostic cohort study. Consecutive patients with liver cirrhosis and portal hypertension underwent EUS-elastography of the liver and spleen. Patients without a history of liver disease were enrolled as controls. The primary outcome was diagnostic yield of liver and spleen stiffness measurement via EUS-elastography in prediction of portal hypertension secondary to chronic liver cirrhosis. Cutoff values were defined through Youden’s index. Overall accuracy was calculated for parameters with an area under the receiver operating characteristic (AUROC) curve ≥ 80 %. Results Among the 61 patients included, 32 had cirrhosis of the liver. Liver and spleen stiffness was measured by the strain ratio and strain histogram, with sensitivity/(1 − specificity) AUROC values ≥ 80 %. For identification of patients with cirrhosis and portal hypertension, the liver strain ratio (SR) had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 84.3 %, 82.8 %, 84.4 %, and 82.8 %, respectively; the liver strain histogram (SH) had values of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively. EUS elastography of the spleen via the SR reached a sensitivity, specificity, PPV, and NPV of 87.5 %, 69.0 %, 75.7 %, and 83.3 %, respectively, whereas the values of SH were 56.3 %, 89.7 %, 85.7 %, and 65.0 %, respectively. Conclusion Endoscopic ultrasonographic elastography of the liver and spleen is useful for diagnosis of portal hypertension in patients with cirrhosis.

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Stefanescu, Horia, Bogdan Procopet, Monica Platon-Lupsor et Christophe Bureau. « Is There Any Place for Spleen Stiffness Measurement in Portal Hypertension ? » American Journal of Gastroenterology 108, n^o 10 (octobre 2013) : 1660–61. http://dx.doi.org/10.1038/ajg.2013.239.

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Thiele, M., et A. Krag. « Editorial : the portal hypertension puzzle-spleen stiffness evades validation as non-invasive marker of clinically significant portal hypertension ». Alimentary Pharmacology & ; Therapeutics 47, n^o 6 (15 février 2018) : 856–57. http://dx.doi.org/10.1111/apt.14536.

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Takuma, Yoshitaka, Kazuhiro Nouso, Youichi Morimoto, Junko Tomokuni, Akiko Sahara, Hiroyuki Takabatake, Kazuhiro Matsueda et Hiroshi Yamamoto. « Portal Hypertension in Patients with Liver Cirrhosis : Diagnostic Accuracy of Spleen Stiffness ». Radiology 279, n^o 2 (mai 2016) : 609–19. http://dx.doi.org/10.1148/radiol.2015150690.

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Goldschmidt, Imeke, Catharina Brauch, Thierry Poynard et Ulrich Baumann. « Spleen Stiffness Measurement by Transient Elastography to Diagnose Portal Hypertension in Children ». Journal of Pediatric Gastroenterology and Nutrition 59, n^o 2 (août 2014) : 197–203. http://dx.doi.org/10.1097/mpg.0000000000000400.

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Chin, Jun Liong, Grace Chan et P. Aiden McCormick. « Spleen Stiffness : The New Kid on the Block for Diagnosing Portal Hypertension ? » Gastroenterology 144, n^o 5 (mai 2013) : 1152–53. http://dx.doi.org/10.1053/j.gastro.2013.02.047.

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Thèses sur le sujet "Portal hypertension, spleen stiffness"

Borghi, Alberto <1981&gt. « Portal hypertension : a comparison between portal-venous pressure measurement and ARFI measurement of liver and spleen stiffness ». Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2012. http://amsdottorato.unibo.it/4721/1/Tesi_Alberto_Borghi.pdf.

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PURPOSE. Portal pressure is measured invasively as Hepatic Venous Pressure Gradient (HVPG) in the angiography room. Liver stiffness measured by Fibroscan was shown to correlate with HVPG values below 12 mmHg. This is not surprising, since in cirrhosis the increase of portal pressure is not directly linked with liver fibrosis and consequently to liver stiffness. We hypothesized that, given the spleen’s privileged location upstream to the whole portal system, splenic stiffness could provide relevant information about portal pressure. Aim of the study was to assess the relationship between liver and spleen stiffness measured by Virtual Touch™ (ARFI) and HVPG in cirrhotic patients. METHODS. 40 consecutive patients (30 males, mean age 62y, mean BMI=26, mean Child-Pugh A6, mean platelet count=92.000/mmc, 19 HCV+, 7 with ascites) underwent to ARFI stiffness measurement (10 valid measurements in right liver lobe both surface and centre, left lobe and 20 in the spleen) and HPVG, blindly to each other. Median ARFI values of 10 samplings on every liver area and of 20 samplings on spleen were calculated. RESULTS. Stiffness could be easily measured in all patients with ARFI, resulting a mean of 2,61±0,76, 2,5±0,62 and 2,55±0,66 m/sec in the liver areas and 3.3±0,5 m/s in the spleen. Median HPVG was 14 mmHg (range 5-27); 28 patients showed values ≥10 mmHg. A positive significant correlation was found between spleen stiffness and HPVG values (r=0.744, p<0.001). No significant correlation was found between all liver stiffness and HVPG (p>0,05). AUROC was calculated to test spleen stiffness ability in discriminating patients with HVPG ≥10. AUROC = 0.911 was obtained, with sensitivity of 69% and specificity of 91% at a cut-off of 3.26 m/s. CONCLUSION. Spleen stiffness measurement with ARFI correlates with HVPG in patients with cirrhosis, with a potential of identifying patients with clinically significant portal hypertension.

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Ramos, Danusa de Souza. « Elastografia hepatoesplênica para predizer varizes esofágicas em pacientes com hipertensão portal não cirrótica : estudo de acurácia diagnóstica ». Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5168/tde-07112018-114450/.

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Introdução: elastografia ultrassônica é um método não invasivo validado e rotineiro para a determinação indireta do grau de fibrose hepática e em investigação para predizer a presença de varizes esofágicas. Entretanto, a elastografia foi validada somente em doenças que evoluem para cirrose. Na revisão de literatura que realizamos, observamos que há escassez de estudos de acurácia diagnóstica em pacientes com hipertensão portal não cirrótica. Objetivos: avaliar a acurácia diagnóstica das técnicas de elastografia hepatoesplênica (transitória por FibroScan e ARFI) para predizer a presença de varizes esofágicas e se as varizes são de risco de sangramento em pacientes com hipertensão portal não cirrótica. Avaliar a concordâncias das duas técnicas e correlacioná-las com outros índices (plaquetas/baço, APRI e FIB-4). Métodos: Foram incluídos pacientes com diagnóstico confirmado das seguintes condições: oclusão da veia porta extra-hepática, esquistossomose mansônica, hipertensão portal não cirrótica idiopática e fibrose hepática congênita. A endoscopia digestiva alta foi considerada como marcador da presença de hipertensão portal clinicamente significante. Critérios de inclusão: idade acima de um ano; diagnóstico etiológico definido; concordância do paciente ou responsável legal em participar do estudo. Critérios de exclusão: cirrose, confirmada pela combinação de critérios diagnósticos clínicos, de imagem e laboratoriais ou pela biópsia hepática quando o resultado estivesse disponível; hipertensão portal pós sinusoidal; condições que impeçam tecnicamente a realização da elastografia (ascite volumosa e insuficiência cardíaca); esplenectomia; gestação; carcinoma hepatocelular avançado. O desenho do estudo foi prospectivo, transversal, de acordo com a metodologia STARD, avaliando a acurácia, sensibilidade, especificidade, valores preditivos positivos e negativos e razões de verossimilhança positiva e negativa. Procedimentos no estudo: consulta aos dados de prontuário; ultrassonografia abdominal e elastografia hepatoesplênica com os equipamentos/métodos FibroScan e ARFI. Os pontos de corte foram determinados por curva ROC. Resultados: os valores de elastografia transitória hepática por FibroScan foram de 5,91 ± 1,87 kPa na oclusão da veia porta extra-hepática, 8,89 ± 3,96 kPa na esquistossomose, 10,60 ± 3,89 kPa na hipertensão portal não cirrótica idiopática e 10,30 ± 4,14 kPa na fibrose hepática congênita, enquanto os valores de ARFI foram de 1,27 ± 0,23 m/s; 1,35 ± 0,45 m/s; 1,43 ± 0,40 m/s; 1,55 ± 0,39 m/s; respectivamente. Os valores de elastografia transitória esplênica por FibroScan foram de 60,82 ± 20,56 kPa na oclusão da veia porta extra-hepática, 54,16 ± 22,94 kPa na esquistossomose, 52,64 kPa ± 21,97 kPa na hipertensão portal não cirrótica idiopática e 48,50 ± 24,86 kPa na fibrose hepática congênita, enquanto os valores de ARFI foram de 3,22 ± 0,62 m/s; 3,01 ± 0,74 m/s; 2,86 ± 0,53 m/s; 2,80 ± 0,55 m/s; respectivamente. A elastografia esplênica por FibroScan com ponto de corte 65,1 kPa apresentou acurácia de 0,62 (intervalo de confiança 95% 0,46-0,78; p=0,121) para presença de varizes. Para predizer varizes de alto risco de sangramento, o melhor ponto de corte foi 40,05 kPa, que apresentou acurácia de 0,63 (intervalo de confiança 95% 0,52-0,76; p=0,016). A elastografia esplênica ARFI com ponto de corte de 2,67m/s apresentou acurácia de 0,64 (intervalo de confiança 95%, 0,50-0,78; p=0,065) para presença de varizes. O melhor ponto de corte para predizer varizes de alto risco de sangramento com esse método foi de 3,17m/s, que apresentou acurácia de 0,61 (intervalo de confiança 95%, 0,51- 0,71; p=0,033). Conclusões: métodos de elastografia esplênica apresentaram uma acurácia moderada e valor preditivo positivo elevado para diagnosticar presença de varizes. A elastografia transitória esplênica por FibroScan quando associada à razão plaqueta/baço apresentou acurácia moderada com especificidade alta para predizer varizes de alto risco de sangramento. Entretanto, considerável superposição de valores foi observada entre pacientes com e sem varizes esofagianas, o que limita a aplicação a utilidade clínica do método
Background and rationale: transient elastography is a noninvasive, validated, method allowing evaluation of liver fibrosis by measurement of liver stiffness and under investigation to predict the presence of esophageal varices. However, elastography has been validated only in diseases that progress to cirrhosis. In a literature review we found few studies on diagnostic accuracy in patients with non-cirrhotic portal hypertension. Aims: to evaluate the accuracy of hepatosplenic elastography (FibroScan and ARFI) to predict the presence of esophageal varices and whether varices are at risk of bleeding in patients with non-cirrhotic portal hypertension. To evaluate the concordances of the two techniques and correlate them with other indexes such as the platelet /spleen diameter ratio, APRI and FIB-4. Methods: patients with confirmed diagnosis of the following conditions were included: extrahepatic portal vein occlusion, schistosomiasis, idiopathic non-cirrhotic portal hypertension and congenital hepatic fibrosis. Upper digestive endoscopy was considered as a marker of the presence of clinically significant portal hypertension. Inclusion criteria: age above one year; defined etiological diagnosis; agreement of the patient or legal guardian to participate in the study. Exclusion criteria: cirrhosis confirmed by combination of clinical, imaging and laboratory diagnostic criteria or by liver biopsy when the result was available; post sinusoidal portal hypertension; conditions that technically preclude the performance of elastography (massive ascites and heart failure); splenectomy; pregnancy; advanced hepatocellular carcinoma. The study design was prospective, transversal, according to the STARD methodology, evaluating the accuracy, sensitivity, specificity, positive and negative predictive values and positive and negative likelihood ratios. The procedures of the study were: review of medical records data, abdominal ultrasonography and hepatosplenic elastography with FibroScan and ARFI equipment / methods. Cut-off points for elastography were determined by ROC curves. Results: liver stiffness measurement by FibroScan were 5.91 ± 1.87 kPa in extrahepatic portal vein occlusion, 8.89 ± 3.96 kPa in schistosomiasis, 10.60 ± 3.89 kPa in portal hypertension non-cirrhotic idiopathic and 10.30 ± 4.14 kPa in congenital hepatic fibrosis, whereas by ARFI were 1.27 ± 0.23 m/s; 1.35 ± 0.45 m/s; 1.43 ± 0.40 m/s; 1.55 ± 0.39 m/s; respectively. Spleen stiffness measurement by FibroScan were 60.82 ± 20.56 kPa in extrahepatic portal vein occlusion, 54.16 ± 22.94 kPa in schistosomiasis, 52.64 ± 21.97 kPa in idiopathic non-cirrhotic portal hypertension, and 48.50 ± 24.86 kPa in congenital hepatic fibrosis, while by ARFI were 3.22 ± 0.62 m/s; 3.01 ± 0.74 m/s; 2.86 ± 0.53 m/s; 2.80 ± 0.55 m/s; respectively. Liver stiffness measurement by FibroScan with a cut-off of 65.1 kPa had an accuracy of 0.62 (95%confidence interval, 0.46-0.78, p=0.121) for the presence of esophageal varices. The best cut-off point for predicting the presence of varices at high risk of bleeding was 40.05 kPa (accuracy, 0.63, 95% confidence interval, 0.52-0.76, p = 0.016). The spleen stiffness measurement by ARFI with a cut-off of 2.67 m/s showed (accuracy, 0.64, 95% confidence interval, 0.50-0.78, p=0.065) for the presence of esophageal varices. The best cut-off point for predicting the presence of varices at high risk of bleeding was 3.17 m/s (accuracy, 0.61, 95% confidence interval, 0.51-0.71, p=0.033) for varices at high risk of bleeding. Conclusions: spleen stiffness measurement by transient elastography (FibroScan and ARFI) presented a moderate accuracy and a high positive predictive value to diagnose the presence of esophageal varices. Spleen stifness by FibroScan when associated with platelet/spleen diameter ratio, there is a moderate accuracy with a high specificity to predict varices at high risk of bleeding. However, overlapping values between patients with or without varices was high and this precludes the clinical applicability of these methods

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Rajakannu, Muthukumarassamy. « Impact de l'utilisation du Fibroscan dans la prise en charge des tumeurs du foie ». Thesis, Université Paris-Saclay (ComUE), 2017. http://www.theses.fr/2017SACLS365/document.

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Contexte: Les limites du traitement chirurgical des tumeurs du foie sont définies par la réserve hépatique fonctionnelle qui est déterminée par le volume et la qualité du foie non tumoral restant. L’hépatopathie sous-jacente détermine non seulement la place de la chirurgie mais aussi le risque de récidive pour les tumeurs hépatiques primitives. Dans les cas des métastases hépatiques, la chimiothérapie précède très souvent la chirurgie et l’hépatotoxicité de cette chimiothérapie est un risque important des complications post opératoires. Dans le contexte particulier de la transplantation hépatique (TH) pour le carcinome hépatocellulaire (CHC), l’hypertension portale est un risque de progression tumorale pendant la période d’attente et la sortie de la liste. Le foie non tumoral est donc est un facteur important dans la prise en charge des patients avec des tumeurs du foie. FibroScan® qui mesure l'élasticité du foie pourrait être utilisé pour évaluer le foie et prédire les suites post opératoires et la risque de progression de CHC dans la liste de TH. Méthodes: Les patients consécutifs qui ont été programmés pour subir une hépatectomie ou une transplantation ont été inclus dans l'étude après un consentement éclairé. L'élastométrie (LS) et le paramètre d'atténuation contrôlée (CAP) du foie non tumorale ont été estimés en pré opératoire par l’élastographie transitoire avec le dispositif FibroScan® 502 Touch en utilisant des sondes M ou XL. Résultats: Les nomogrammes basés sur LS qui ont été développés et validés dans cette étude ont pu hépatectomie pour les maladies hépatobiliaires. Chez les patients atteints de CHC, LS a joué un rôle plus important car il prédit non seulement les résultats de 90 jours, mais aussi la décompensation hépatique persistante au-delà de la période post-opératoire. En plus, LS ≥30 kPa et CAP <240 dB/m ont été associés à un mauvais pronostic oncologique après l’hépatectomie et peuvent ainsi être un marqueur de substitution pour la nature agressive du CHC. La performance de LS pour diagnostiquer la fibrose hépatique avancée (AUROC: 0.95) et la cirrhose (AUROC: 0.97) a été validée dans cette recherche et CAP a eu une performance satisfaisante pour détecter la stéatose hépatique significatif (AUROC: 0.70). Un modèle à base de LS appelé score HVPG10 a été développé et validé pour diagnostiquer une hypertension portale significative chez les patients atteints d'une maladie chronique du foie. Avec un seuil de 15, le score HVPG10 était précis pour exclure une hypertension portale importante dans >95% des patients et éviter des investigations supplémentaires et inutiles. Conclusion: L'exploration des patients prévus pour l'hépatectomie permet d'prévoir des complications sévères et la mortalité après l’hépatectomie. LS ≥30 kPa élevé est un facteur de risque important la récidive après la résection et de progression de CHC en attente de TH. Par conséquent, TH devrait être le traitement en première intention avec les patients avec LS ≥30 kPa
Background: The major determinant of the results of surgical resection for liver tumors is the volume and quality of the future liver remnant. The hepatopathy of the non-tumoral liver not only limits the type of surgery but also the risk of recurrence in primary liver tumors. With respect to liver metastasis, pre-operative chemotherapy is the usual treatment strategy and the hepatotoxicity of prolonged chemotherapy is an important risk factor for post-operative morbi-mortality. In patients with hepatocellular carcinoma (HCC) waiting for liver transplantation (LT), clinically significant portal hypertension (CSPH) is a risk for tumor progression and dropout of the waiting list for LT. Overall, degree of liver fibrosis and portal hypertension in the non-tumoral liver are important factors in the management of patients with liver tumors as they determine the prognosis of patients after hepatectomy. FibroScan®, which estimate the degree of liver fibrosis and steatosis, could utilized to evaluate the non-tumoral liver and predict the post-operative outcomes and the risk of dropout from the list of LT in HCC patients waiting for LT. Methods: Consecutive patients programmed to undergo hepatectomy or LT were included in the present study prospectively after an informed consent. Liver stiffness (LS) and controlled attenuation parameter (CAP) were measured pre-operatively by transient elastography using FibroScan® 502 Touch Standard device with M or XL probes. Results: LS-based nomograms that were developed and valided in this study were accurate to predict 90-day severe morbidity and 90-day mortality after hepatectomy for various hepatobiliary diseases. In patients with HCC undergoing hepatectomy, elevated LS ≥22 kPa was a risk factor for persistent hepatic decompensation beyond the 90-day post-operative period. Moreover, LS ≥30 kPa and CAP <240 dB/m were associated with poor oncological outcomes after resection and thus could be a surrogate biomarker of more aggressive HCC. The discriminatory ability of LS to diagnose advanced liver fibrosis (AUROC: 0.95) and cirrhosis (AUROC: 0.97) was validated in the present study. Further, CAP had a satisfactory performance to screen significant hepatic steatosis (S≥2) with AUROC of 0.70. A new LS-based model called HVPG10 score was developed and validated to diagnose CSPH. With a cut-off of 15, it was capable of accurately ruling out CSPH in >95% of the patients with chronic liver disease and would avoid further unnecessary investigations. Conclusion: Pre-operative evaluation of patients with transient elastography would enable surgeons to predict major complications and mortality after hepatectomy with LS-based nomograms. In patients with HCC, LS ≥30 kPa was an important risk factor of incomplete surgical resection, early recurrence after hepatectomy and for tumor progression and dropout while waiting for LT. Therefore, LT must be the primary treatment in HCC patients with LS ≥30 kPa

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ROSSELLI, MATTEO. « Prospective evaluation of liver and spleen stiffness by transient and point shear wave elastography : surrogate markers of fibrosis and clinically significant portal hypertension in cirrhosis ». Doctoral thesis, 2017. http://hdl.handle.net/2158/1078164.

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Non-invasive assessment of liver disease has become a sub-speciality able to predict with high accuracy the presence and the severity of liver disease. The objective of this work was to evaluate the accuracy of point shear wave elastography in detecting fibrosis and portal hypertension as well as being able to distinguish cirrhotic from non-cirrhotic portal hypertension.

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Hamza, Shereen M. « Splenic neurohormonal modulation of renal and mesenteric hemodynamics in portal hypertension ». Phd thesis, 2009. http://hdl.handle.net/10048/497.

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Thesis (Ph.D.)--University of Alberta, 2009.
A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Department of Physiology. Title from pdf file main screen (viewed on August 16, 2009). Includes bibliographical references.

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Livres sur le sujet "Portal hypertension, spleen stiffness"

Beattie, R. Mark, Anil Dhawan et John W.L. Puntis. Portal hypertension. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569862.003.0064.

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Definition 488Pathophysiology 488Clinical features 489Causes 490Investigations 491Management 492Portal hypertension is increased blood pressure within the portal venous system and defined as an increase in the pressure gradient between the portal veins and the hepatic veins (>5 mmHg).The portal vein carries nutrient-rich blood to the liver from the GI tract and spleen. At the hilum of the liver it divides into the major right and left portal veins. Within the liver these veins undergo further divisions to supply each segment, and terminate in small branches, which pierce the limiting plate of the portal tract and enter the hepatic sinusoids through small channels (...

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Shackelford, Richard T., George D. Zuidema et Jeremiah G. Turcotte. Shackelford's Surgery of the Alimentary Tract : Pancreas, Biliary Tract, Liver and Portal Hypertension, Spleen (Surgery of the Alimentary Tract). 3^e éd. W.B. Saunders Company, 1991.

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Sengupta, Sankar P. System of Operative Surgery Abdominial Herniae, General Technique of Laparotomy, Gastroduodenal Surgery, Surgery of Spleen and Portal Hypertension, Hepatobiliary and Pancreatic Surgery. Academic Publishers, 1988.

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Chapitres de livres sur le sujet "Portal hypertension, spleen stiffness"

Colecchia, Antonio, Élise Vuille-Lessard et Annalisa Berzigotti. « Spleen Stiffness ». Dans Portal Hypertension VII, 121–33. Cham : Springer International Publishing, 2022. http://dx.doi.org/10.1007/978-3-031-08552-9_12.

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Furuichi, Yoshihiro, et Fuminori Moriyasu. « Liver and Spleen Stiffness Measurement ». Dans Clinical Investigation of Portal Hypertension, 127–35. Singapore : Springer Singapore, 2019. http://dx.doi.org/10.1007/978-981-10-7425-7_11.

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Colecchia, Antonio, Federico Ravaioli, Giovanni Marasco et Davide Festi. « Spleen Stiffness by Ultrasound Elastography ». Dans Diagnostic Methods for Cirrhosis and Portal Hypertension, 113–37. Cham : Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-72628-1_8.

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Mendoza, Yuly P., Giuseppe Murgia, Susana G. Rodrigues, Maria G. Delgado et Annalisa Berzigotti. « Liver and Spleen Stiffness to Predict Portal Hypertension and Its Complications ». Dans Liver Elastography, 325–59. Cham : Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-40542-7_31.

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Kage, Masayoshi, Reiichirou Kondou et Toshirou Ogata. « Anatomy of the Spleen and Pathology of Hypersplenism ». Dans Clinical Investigation of Portal Hypertension, 25–34. Singapore : Springer Singapore, 2019. http://dx.doi.org/10.1007/978-981-10-7425-7_3.

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Busuttil, R. W., et W. Arnaout. « Portal Hypertension and Disorders of the Splenic Circulation ». Dans Surgical Diseases of the Spleen, 175–93. Berlin, Heidelberg : Springer Berlin Heidelberg, 1997. http://dx.doi.org/10.1007/978-3-642-60574-1_11.

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Castera, Laurent. « Liver Stiffness by Ultrasound Elastography ». Dans Diagnostic Methods for Cirrhosis and Portal Hypertension, 95–111. Cham : Springer International Publishing, 2018. http://dx.doi.org/10.1007/978-3-319-72628-1_7.

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Sharma, Praveen. « Liver and Spleen Stiffness in Patients with Portal Vein Thrombosis ». Dans Liver Elastography, 177–80. Cham : Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-40542-7_15.

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Helmy, Ahmed. « The Spleen in Patients with Portal Hypertension ». Dans The Spleen, 134–52. BENTHAM SCIENCE PUBLISHERS, 2012. http://dx.doi.org/10.2174/978160805273811101010134.

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Chatelin, Simon, Raoul Pop, Céline Giraudeau, Khalid Ambarki, Ning Jin, François Severac, Elodie Breton et Jonathan Vappou. « Magnetic Resonance Elastography and Portal Hypertension : Influence of the Portal Venous Flow on the Liver Stiffness ». Dans Stem Cells and Regenerative Medicine. IOS Press, 2021. http://dx.doi.org/10.3233/bhr210022.

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The invasive measurement of the hepatic venous pressure gradient is still considered as the reference method to assess the severity of portal hypertension. Even though previous studies have shown that the liver stiffness measured by elastography could predict portal hypertension in patients with chronic liver disease, the mechanisms behind remain today poorly understood. The main reason is that the liver stiffness is not specific to portal hypertension and is also influenced by concomitant pathologies, such as cirrhosis. Portal hypertension is also source of a vascular incidence, with a substantial diversion of portal venous blood to the systemic circulation, bypassing the liver. This study focuses on this vascular effect of portal hypertension. We propose to generate and control the portal venous flow (to isolate the modifications in the portal venous flow as single effect of portal hypertension) in an anesthetized pig and then to quantify its implications on liver stiffness by an original combination of MRE and 4D-Flow Magnetic Resonance Imaging (MRI). A catheter balloon is progressively inflated in the portal vein and the peak flow, peak velocity magnitude and liver stiffness are quantified in a 1.5T MRI scanner (AREA, Siemens Healthcare, Erlangen, Germany). A strong correlation is observed between the portal peak velocity magnitude, the portal peak flow or the liver stiffness and the portal vein intraluminal obstruction. Moreover, the comparison of mechanical and flow parameters highlights a correlation with the possibility of identifying linear relationships. These results give preliminary indications about how liver stiffness can be affected by portal venous flow and, by extension, by hypertension.

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Actes de conférences sur le sujet "Portal hypertension, spleen stiffness"

Roccarina, Davide, Francesca Saffioti, Matteo Rosselli, Anna Mantovani, Roberta Stupia, Aileen Marshall, Massimo Pinzani et Douglas Thorburn. « OTU-12 Spleen stiffness has a good performance in predicting clinically significant portal hypertension in PSC ». Dans British Society of Gastroenterology Annual Meeting, 17–20 June 2019, Abstracts. BMJ Publishing Group Ltd and British Society of Gastroenterology, 2019. http://dx.doi.org/10.1136/gutjnl-2019-bsgabstracts.203.

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Atzori, Sebastiana, Lucy Garvey, Tim Hoogenboom, James Maurice, Graham Cooke et Simon Taylor-Robinson. « PWE-073 Spleen stiffness via acoustic radiation force impulse in HIV patients with non cirrhotic portal hypertension ». Dans British Society of Gastroenterology, Annual General Meeting, 4–7 June 2018, Abstracts. BMJ Publishing Group Ltd and British Society of Gastroenterology, 2018. http://dx.doi.org/10.1136/gutjnl-2018-bsgabstracts.215.

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Saffioti, Francesca, Davide Roccarina, Matteo Rosselli, Roberta Stupia, Aileen Marshall, Massimo Pinzani et Douglas Thorburn. « PTU-034 Spleen stiffness by elastPQ point shear wave elastography predicts clinically significant portal hypertension in PBC ». Dans British Society of Gastroenterology Annual Meeting, 17–20 June 2019, Abstracts. BMJ Publishing Group Ltd and British Society of Gastroenterology, 2019. http://dx.doi.org/10.1136/gutjnl-2019-bsgabstracts.243.

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Retoriano, Katherine, Shirley Christine Margarett Velasco, Odessa Bayani et Emaluz Parian-De Los Angeles. « IDDF2022-ABS-0037 Spleen stiffness measurement by elastography in the diagnosis of portal hypertension in children : a systematic review and meta-analysis ». Dans Abstracts of the International Digestive Disease Forum (IDDF), Hong Kong, 2–4 September 2022. BMJ Publishing Group Ltd and British Society of Gastroenterology, 2022. http://dx.doi.org/10.1136/gutjnl-2022-iddf.90.

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Elshaarawy, O., S. Alquzi, V. Rausch, J. Mueller, I. Silva, T. Peccerella, HK Seitz et S. Mueller. « Response of spleen stiffness to portal pressure lowering drugs in a rat model of cirrhosis ». Dans 35. Jahrestagung der Deutschen Arbeitsgemeinschaft zum Studium der Leber. Georg Thieme Verlag KG, 2019. http://dx.doi.org/10.1055/s-0038-1677069.

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Büchter, M., A. Kahraman, P. Manka, G. Gerken, A. Dechêne, A. Canbay, A. Wetter, L. Umutlu et J. Theysohn. « Partial spleen embolization reduces the risk of portal hypertension-induced upper gastrointestinal bleeding in patients not eligible for TIPS implantation ». Dans Viszeralmedizin 2017. Georg Thieme Verlag KG, 2017. http://dx.doi.org/10.1055/s-0037-1605110.

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