Karaciğer Sirozu Nedeniyle Takip Edilen Hastalarda Meld-Na Skoru ile Bilgisayarlı Tomografiden Elde Edilen Organometrik Ölçümler Arasındaki İlişkinin Değerlendirilmesi

Öz

Amaç: Bilgisayarlı tomografide (BT) izlenen radyolojik görüntüleme bulguları siroz tanısında önemli bir non-invaziv yöntemdir ve prognostik değerlendirmede kullanımına ilişkin çalışmalar devam etmektedir. Çalışmamızın amacı sirotik hastaların prognozunda kullanılan MELD-Na skoru ile BT elde edilen organometrik ölçümler arasındaki korelasyonu belirlemek ve bu parametrelerin siroz prognozundaki önemini saptamaktır.
Materyal ve metod: Ocak 2016 ile Aralık 2022 tarihleri arasında yürütülen retrospektif çalışmamıza trifazik abdominal BT çekilen ve güncel MELD-Na skoru olan 52 siroz hastası dahil edildi. Bu hastaların BT görüntüleri üzerinde organometrik ölçümler kaliper yöntemi kullanılarak yapıldı. Vasküler ölçümler ana portal ven (MPV) ve hepatik venlerin sağ hepatik ven, orta hepatik ven, sol hepatik ven, hepatik venlerin toplam çapı  çapları ölçülerek yapıldı. Morfolojik ölçümler 6. ve 8. karaciğer segmentleri seviyesinde perihepatik yağ kalınlığı (PHF6 ve PHF8), hiler periportal alandaki genişleme miktarı  ve safra kesesi fossasındaki genişleme miktarı  ölçülerek elde edildi. 
Bulgular: Vasküler ölçümler ve morfolojik ölçümler ile MELD-Na skoru arasında anlamlı bir korelasyon bulunmadı (p>0,05). Sonuç: BT görüntülerinden elde edilen vasküler parametreler veya morfolojik parametreler ile sirozlu hastalarda MELD-Na skoru arasında anlamlı bir korelasyon bulunmamıştır. Bu çalışmada perihepatik yağ kalınlığı ve safra kesesi çukuru genişlemesi için yeni kantitatif ölçüm yöntemleri tanıtılmıştır. Bu ölçüm yöntemlerini doğrulamak ve sirozda BT'den elde edilen organometrik parametrelerin prognostik değerini araştırmak için daha büyük örneklem boyutlarıyla daha fazla araştırmaya ihtiyaç vardır. Anahtar Kelimeler: Siroz, Bilgisayarlı Tomografi, Organometrik Ölçüm, MELD-Na

Anahtar Kelimeler

• Siroz
• Bilgisayarlı tomografi
• Organometrik ölçüm
• MELD-Na

Etik Beyan

This study was approved by the Atatürk University Faculty of Medicine Clinical Research Ethics Committee (approval no: 51, date: January 26, 2023).

The Evaluation of the Relationship Between Meld-Na Score and Organometric Measurements Obtained from Computed Tomography in Patients Followed for Liver Cirrhosis

Öz

Background: The radiological imaging findings observed on computed tomography (CT) are an important non-invasive method in the diagnosis of cirrhosis, and studies are ongoing regarding their use in prognostic evaluation. The aim of our study was to determine the correlation between the MELD-Na score, used in the prognosis of cirrhotic patients, and organometric measurements obtained from CT, and to ascertain the significance of these parameters in the prognosis of cirrhosis.
Materials and Methods: Our retrospective study, conducted between January 2016 and December 2022, included 52 cirrhosis patients who underwent triphasic abdominal CT and had current MELD-Na score. Organometric measurements on the CT images of these patients were performed using the caliper method. Vascular measurements were made by measuring the diameter of the main portal vein  and hepatic veins, right hepatic vein, middle hepatic vein, left hepatic vein, total diameter hepatic veins. Morphological measurements were obtained by measuring the perihepatic fat thickness at the level of the 6th and 8th liver segments (PHF6 and PHF8), the amount of expansion in the hilar periportal space (HPPS) and the amount of expansion in the gallbladder fossa (EGF). 
Results: No significant correlation was found between vascular measurements and morphological measurements with MELD-Na score (p>0.05).
Conclusion: No significant correlation was found between vascular parameters or morphological parameters obtained from CT images and the MELD-Na score in cirrhotic patients. Novel quantitative measurement methods for perihepatic fat thickness and gallbladder fossa expansion were introduced in this study. Further research with larger sample sizes is warranted to validate these measurement methods and to investigate the prognostic value of CT-derived organometric parameters in cirrhosis.

Anahtar Kelimeler

• Cirrhosis
• Computed tomography
• Organometric measurement
• MELD-Na

Etik Beyan

This study was approved by the Atatürk University Faculty of Medicine Clinical Research Ethics Committee (approval no: 51, date: January 26, 2023).

Kaynakça

1. 1. Pinzani M, Rosselli M, Zuckermann M. Liver cirrhosis. Best Pract Res Clin Gastroenterol 2011;25(2):281-90.
2. 2. García-Criado A, Gilabert R, Bargalló X, Brú C. Radiology in liver transplantation. Semin Ultrasound CT MR 2002;23(1):114-29.
3. 3. Mazumder NR, Atiemo K, Kappus M, Giuseppe C, Matthew H, Daniela L,et al. A Comprehensive Review of Outcome Predictors in Low MELD Patients. Transplantation 2020;104(2):242-50.
4. 4. Kamath PS, Kim WR. The model for end-stage liver disease (MELD). Hepatology 2007;45(3):797-805.
5. 5. Huber A, Ebner L, Heverhagen JT, Christe A. State-of-the-art imaging of liver fibrosis and cirrhosis: A comprehensive review of current applications and future perspectives. Eur J Radiol Open 2015;2:90-100.
6. 6. Numminen K, Tervahartiala P, Halavaara J, Isoniemi H, Höckerstedt K. Non-invasive diagnosis of liver cirrhosis: magnetic resonance imaging presents special features. Scand J Gastroenterol 2005;40(1):76-82.
7. 7. Akhan O, Akpinar E, Karcaaltincaba M, Haliloglu M,Akata D,Karaosmanoglu AD,et al. Imaging findings of liver involvement of Wilson's disease. Eur J Radiol 2009;69(1):147-55.
8. 8. Lirussi F, Vitturi N, Azzalini L,Orando S, Orlando R, Plebanet M, et al. Perihepatic adipose tissue thickness: a new non-invasive marker of NAFLD? J Gastrointestin Liver Dis 2009;18(1):61-6.

9. 9. Stamm ER, Meier JM, Pokharel SS,Clark T, Glueck DH, Lind KE,et al. Normal main portal vein diameter measured on CT is larger than the widely referenced upper limit of 13 mm. Abdom Radiol (NY) 2016;41(10):1931-6.
10. 10. Huber A, Ebner L, Montani M,Nasser S,Choudhury R, Johannes H, et al. Computed tomography findings in liver fibrosis and cirrhosis. Swiss Med Wkly 2014;144:w13923.
11. 11. Mamone G, Miraglia R. The "enlarged hilar periportal space sign" in liver cirrhosis. Abdom Radiol (NY) 2019;44(5):1936-7.
12. 12. Mitchell DG, Navarro VJ, Herrine SK, Bergin D, Parker L, Frangos A,et al. Compensated hepatitis C: unenhanced MR imaging correlated with pathologic grading and staging. Abdom Imaging 2008;33(1):58-64.
13. 13. Geleto G, Getnet W, Tewelde T. Mean Normal Portal Vein Diameter Using Sonography among Clients Coming to Radiology Department of Jimma University Hospital, Southwest Ethiopia. Ethiop J Health Sci 2016;26(3):237-42.
14. 14. Rani S, Sudarsi B, Siddeswari R, Manohar S. Correlation of portal vein size with esophageal varices severity in patients with cirrhosis of liver with portal hypertension. Int J Sci Res Publ, 2015. 5(1): p. 1-5.
15. 15. Dong G, Huang XQ, Zhu YL,Ding H, Li F, Chen SY. Increased portal vein diameter is predictive of portal vein thrombosis development in patients with liver cirrhosis. Ann Transl Med 2021;9(4):289.
16. 16. Garg A, Singh K, Bhardwaj N, Kaur N. Correlation of Portal Vein Diameter as a Reflection of Portal Hypertension With Clinical and Laboratory Parameters in Chronic Liver Disease. J Assoc Physicians India 2022;70(4):11-2.
17. 17. Xu X, Zhang C, Shi C, Hu N, Sun B, Kong D,et al. Antiviral therapy effectively improves liver hemodynamics as evidenced by serum biomarker and contrast-enhanced ultrasound examinations in patients with hepatitis B cirrhosis. PeerJ, 2018. 6: p. e5484.
18. 18. Sinkala E, Vinikoor M, Zyambo K, Besa E, Nsokolo B,Kell P. Propranolol Reduces Portal Vein Diameter in Schistosomal Liver Disease with Portal Hypertension: A Prospective Cohort Study. Am J Trop Med Hyg 2020;102(4):832-7.
19. 19. Zhang Y, Zhang XM, Prowda JC, Zhang HL, Henry CS,Shih G,et al. Changes in hepatic venous morphology with cirrhosis on MRI. J Magn Reson Imaging 2009;29(5):1085-92.
20. 20. Mihai F, Trifan A, Stanciu C, Singeap AM, Cucuteanu B,Ursulescu CL,et al. Liver Remodeling on CT Examination in Patients with HCV Compensated Cirrhosis Who Achieved Sustained Virological Response after Direct-Acting Antivirals Treatment. Medicina (Kaunas) 2020;56(4).
21. 21. Ito K, Mitchell DG, Gabata T. Enlargement of hilar periportal space: a sign of early cirrhosis at MR imaging. J Magn Reson Imaging 2000;11(2):136-40.
22. 22. Ludwig DR, Fraum TJ, Ballard DH, Narra VR, Shetty AS. Imaging Biomarkers of Hepatic Fibrosis: Reliability and Accuracy of Hepatic Periportal Space Widening and Other Morphologic Features on MRI. AJR Am J Roentgenol 2021;216(5):1229-39.
23. 23. Rao C, Chen J, Wang W, Xue C, Wu L, Huang X, et al. Computed tomography imaging features to evaluate the severity of portal hypertension and predict the rebleeding risk after endoscopic treatment in cirrhotic patients with variceal hemorrhage. Eur J Radiol 2023;163:110841.
24. 24. Yu JS, Shim JH, Chung JJ, Kim JH, Kim KW. Double contrast-enhanced MRI of viral hepatitis-induced cirrhosis: correlation of gross morphological signs with hepatic fibrosis. Br J Radiol 2010;83(987):212-7.
25. 25. Ito K, Mitchell DG, Gabata T, Hussain SM. Expanded gallbladder fossa: simple MR imaging sign of cirrhosis. Radiology 1999;211(3):723-6.
26. 26. Zhang K, Zhang J, Kan C, Tian H, Ma Y, Huang N, et al. Role of dysfunctional peri-organ adipose tissue in metabolic disease. Biochimie 2023;212:12-20.