Current status and progress in noninvasive assessment of portal pressure
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摘要: 门静脉压力评估是研究门静脉高压的必要手段。肝静脉压力梯度被认为是诊断门静脉高压的金标准,但因其有创性而存在一定局限。总结了目前临床工作中常规使用的无创性门静脉压力评估方法,包括CT造影法、磁共振血管造影法、多普勒超声法、血清学指标和肝瞬时弹性成像等。此外,还介绍了基于三维血管模型提出的一种新型无创性门静脉压力测量技术,指出此方法不仅无创性地获得了门静脉的直接压力值和更加直观的血管三维模型,还可通过直接模拟的压力指标进行门静脉高压的诊断;然而,该技术目前尚处于临床验证阶段,其诊断准确性还有待于大样本量临床数据进一步证实。Abstract: Portal pressure assessment is a necessary means to diagnose portal hypertension. Currently, hepatic venous pressure gradient is considered as the diagnostic gold standard for portal hypertension. However, invasiveness is one of its most critical limitations. Therefore, a noninvasive, easy, and accurate measurement of portal pressure is of significant clinical value. The current noninvasive approaches to evaluate portal pressure, including CT portography, MR portography, Doppler ultrasonography, serum markers, and liver transient elastography, are summarized. Besides, a novel noninvasive portal pressure measurement technique based on the three- dimensional (3D) blood vessel model is introduced. It is pointed out that this method allows direct noninvasive measurement of portal pressure and establishment of 3D blood vessel model, as well as the diagnosis of portal hypertension based on directly simulated pressure indicators. However, this technique is being clinically tested, and its diagnostic accuracy needs to be further confirmed by large- sample clinical trials.
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