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7ème Journée de la Recherche Clinique: Accurate computed tomography-based portal pressure assessment...

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Accurate computed tomography-based portal pressure assessment in patients with hepatocellular carcinoma de P. Iranmanesh de la 7ème Journée de la Recherche Clinique

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7ème Journée de la Recherche Clinique: Accurate computed tomography-based portal pressure assessment...

  1. 1. Accurate computed tomography-based portal pressure assessment in patients with hepatocellular carcinoma P. Iranmanesh1, O. Vazquez1, S. Terraz2, P. Majno1, L. Spahr3, A. Poncet4, Ph. Morel1, G. Mentha1, C. Toso1 1Hepato-Bilio-Pancreatic Centre, University Hospitals of Geneva 2Department of Radiology, University Hospitals of Geneva 3Department of Gastroenterology, University Hospitals of Geneva 4Department of Clinical Epidemiology, University Hospitals of Geneva 7ème journée de la recherche clinique des Hôpitaux Universitaires de Genève – 8 mai 2014
  2. 2. Introduction  La transplantation et la résection hépatiques sont des traitements reconnus pour le carcinome hépatocellulaire (CHC)  La morbidité et la mortalité péri-opératoires sont corrélées au degré d’hypertension portale  La mesure invasive transjugulaire du gradient de pression veineux hépatique (HVPG) est réalisée dans de nombreux centres
  3. 3. Hypothèse  Une évaluation non-invasive du HVPG, basée sur des paramètres de tomographie computérisée (CT), peut être aussi fiable que la mesure transjugulaire.
  4. 4. Méthodes  Analyse de 75 patients avec CHC, traités soit par résection soit par transplantation hépatique  Mesure transjugulaire du HVPG et CT  Chaque CT analysé par deux investigateurs indépendants pour :  Volumes hépatique et splénique  Longueur cranio-caudale de la rate  Présence d’ascites, de varices porto-caves et d’un ligament rond perméable  Création d’un modèle prédictif de la mesure invasive du HVPG  Validation sur une autre cohorte de 70 patients
  5. 5. Données démographiques Total Patients transplantés Patients reséqués Nombre de patients 75 39 36 Age (années, moyenne ± SD) 61 ± 9 57 ± 6 64 ± 11 Sexe (M : F) 60 : 15 32 : 7 28 : 8 HVPG (mmHg, moyenne ± SD) 11 ± 6 15 ± 4 6 ± 3
  6. 6. Concordance inter-lecteurs  Variables continues
  7. 7. Concordance inter-lecteurs  Variables catégorielles Kappa P Ascite péri-hépatique 0.957 < 0.001 Ascite péri-splénique 0.945 < 0.001 Ascite médio-abdominale 1.000 < 0.001 Ascite pelvienne 0.592 < 0.001 Varices péri-gastriques 0.472 < 0.001 Varices spléno-rénales 0.302 0.008 Varices péri-rectales 0.341 0.005 Perméabilité du ligament rond 0.424 < 0.001
  8. 8. Eléments prédictifs du HVPG  Les paramètres suivants étaient corrélés de manière significative avec un HVPG>10 mmHg : Variables continues : • Rapport du volume foie/rate • Numération plaquettaire • Volume de la rate Aire sous la courbe (AUC) 0.883 (0.805 – 0.960) 0.840 (0.748 – 0.933) 0.828 (0.734 – 0.922) Variables catégorielles : • Ascite péri-hépatique • Ascite péri-splénique • Ascite médio-abdominale Valeur de P : <0.001 <0.001 0.007
  9. 9. Score HVPG = 17.37 – 4.91 * log(rapport des volumes foie/rate) + 3.8 [si présence d’ascite péri-hépatique] Création d’un modèle
  10. 10. Cohorte de validation  70 patients  Age : 57 ± 6 années  Sexe : 54 hommes and 16 femmes  Etiologies de la maladie hépatique:  Alcool (n=32)  Hépatites virales (n=20)  NASH (n=6)  Autres (n=12)
  11. 11. Performance globale
  12. 12. Conclusions  Notre modèle prédit le HVPG de manière fiable en n’utilisant que des paramètres CT non-invasifs (rapport des volumes foie/rate et présence d’ascite péri- hépatique)  Ces paramètres peuvent être mesurés par des non- spécialistes  Ce modèle est simple et peut être un outil supplémentaire intéressant dans le bilan pré-opératoire des patients avec CHC
  13. 13. Accurate computed tomography-based portal pressure assessment in patients with hepatocellular carcinoma. Iranmanesh P, Vazquez O, Terraz S, Majno P, Spahr L, Poncet A, Morel P, Mentha G, Toso C. J Hepatol. 2014 May;60(5):969-74 Merci de votre attention !

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