The parallel technique of TIPS reduction is reproducible and has a high technical success rate. A dual unilateral transjugular approach is advantageous when performing this procedure. The parallel technique allows repeat bidirectional TIPS adjustment and may be of significant clinical benefit in the management of refractory HE.
Aim: Eligibility for liver transplantation for hepatocellular carcinoma (HCC) is currently based on singledimension, diameter measurements on cross-sectional imaging, as specified by various selection criteria. This does not account for significant differences in shape, and therefore tumour volume, between patients. This study investigated whether one-dimensional selection criteria disadvantages patients by not considering volume.Methods: Patient data were collected retrospectively from a prospectively maintained database. Tumours were measured on both computer tomography (CT) and magnetic resonance imaging (MRI). Tumour volume was measured using two methods; semi-automated planimetry and the ellipsoid volume formula. Statistical analysis was performed using SPSS.Results: A total of 313 patients with HCC were assessed for liver transplantation. For this study, patients who underwent transplantation (n = 89) and those who did not based on tumour size (n = 33) were included. In total, 213 tumours were measured, showing excellent correlation between CT and MRI (R 2 = 0.83). The majority of tumour nodules (94%) were ellipsoid not spherical. Volumetric measurements of the 84 tumours that did not meet diameter-based Milan criteria confirmed that 76% would have been within a theoretical volume allowance based on Milan criteria diameters.
Conclusion:This study shows that a significant number of patients deemed outside conventional diameter-based Milan criteria have smaller tumour volumes than those considered within criteria. It appears that those with ellipsoid rather than spherical tumours may be disadvantaged by current size-based criteria. Further research using a contemporary patient cohort who have had the benefit of advancements in non-surgical treatments for HCC is required.
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