Non-invasive prediction of portal pressures using CT and MRI in chronic liver disease.

Purpose: To assess the diagnostic value of a fast scoring system based on non-invasive cross-sectional imaging to predict portal hypertension (PH) in patients with liver disease.

Methods: In this retrospective study, we included patients who underwent contrast-enhanced CT or MRI within 3 months of hepatic venous pressure gradient (HVPG) measurements. Two independent observers provided an imaging-based scoring system (max of 9): number of variceal sites, volume of ascites, and spleen size. ROC analysis was performed to predict the presence of PH (HVPG ≥ 5 mmHg) and clinically significant PH (HVPG ≥ 10 mmHg).

Results: Our cohort consists of 143 patients with mean HVPG of 13.1 ± 2.0 mmHg. Mean PH scores from the two observers were 3.9 ± 2.7 and 3.2 ± 2.5. There was a significant correlation between PH score and HVPG (r = 0.58, p < 0.001 for both observers) with high inter-observer agreement (kappa 0.71). AUCs of 0.78-0.76 and 0.83-0.81 were observed for diagnosing HVPG ≥ 5 mmHg and HVPG ≥ 10 mmHg, respectively, for observers 1 and 2.

Conclusions: We have developed a fast PH imaging-based composite score, which could be used for non-invasive detection of clinically significant PH.