Development and validation of a radiomics signature for clinically significant portal hypertension in cirrhosis (CHESS1701): a prospective multicenter study

Abstract

Clinically significant portal hypertension (CSPH) is associated with an incremental risk of esophageal varices and overt clinical decompensations. However, hepatic venous pressure gradient (HVPG) measurement, the gold standard for defining CSPH (HVPG≥10 mm Hg) is invasive and therefore not suitable for routine clinical practice. This study aims to develop and validate a radiomics-based model as a noninvasive method for accurate detection of CSPH in cirrhosis.The prospective multicenter diagnostic trial (CHESS1701, ClinicalTrials.gov identifier: NCT03138915) involved 385 patients with cirrhosis from five liver centers in China between August 2016 and September 2017. Patients who had both HVPG measurement and contrast-enhanced CT within 14 days prior to the catheterization were collected. The noninvasive radiomics model, termed rHVPG for CSPH was developed based on CT images in a training cohort consisted of 222 consecutive patients and the diagnostic performance was prospectively assessed in 163 consecutive patients in four external validation cohorts.rHVPG showed a good performance in detection of CSPH with a C-index of 0·849 (95%CI: 0·786–0·911). Application of rHVPG in four external prospective validation cohorts still gave excellent performance with the C-index of 0·889 (95%CI: 0·752–1·000, 0·800 (95%CI: 0·614–0·986), 0·917 (95%CI: 0·772–1·000), and 0·827 (95%CI: 0·618–1·000), respectively. Intraclass correlation coefficients for inter- and intra-observer agreement were 0·92–0·99 and 0·97–0·99, respectively.A radiomics signature was developed and prospectively validated as an accurate method for noninvasive detection of CSPH in cirrhosis. The tool of rHVPG assessment can facilitate the identification of CSPH rapidly when invasive transjugular procedure is not available.

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“…Ascites is one of the syndrome defining components and in the AARC study, about 91% patients had ascites at presentation. About one-third of the patients presenting with ACLF do require paracentesis for severe grade ascites [140]. The presence of ascites in ACLF is different in many aspects from decompensated cirrhosis or AD [141].…”

Assessment of a biofluid mechanics-based model for calculating portal pressure in canines

“…Iranmanesh and Liu also established models for detecting portal hypertensive patients, which showed good diagnostic performance with high sensitivity and specificity [ 27 , 28 ]. Although their works were able to detect patients suffering from clinically significant portal hypertension (HVPG greater than 10 mmHg) well, their models were not suitable for mild or moderate portal hypertensive patients whose HVPG were less than 10 mmHg.…”

Radiomics and Deep Learning: Hepatic Applications

“…These authors devised a model based on texture features, morphologic features, and the liver and spleen volumes with the hepatic venous pressure gradient as the reference standard. The performance of this model was significantly better than kjronline.org were those of models using liver stiffness measurements as well as other radiologic and clinical indices (12). Several exploratory studies have indicated the potential of radiomics of multiparametric ultrasound (21) and histogram features of CT images (29,30) in staging liver fibrosis and in diagnosing nonalcoholic steatohepatitis.…”

“…Radiomics features can be extracted in 2D or 3D using inhouse software (6,(9)(10)(11)(12)(13) or commercial software (14,15 (16), the analysis of high-dimensional features may lead to problems of multicollinearity and overfitting. A recent phantom study revealed that the information provided by multiple radiomics features could be summarized using only 10 features because of redundancy (16).…”

“…They demonstrated that the radiomics fibrosis index had a high diagnostic performance in staging liver fibrosis (area under the receiveroperating curve [AUROC], 0.89-0.91) and significantly outperformed the normalized liver enhancement and serum fibrosis indices. Liu et al (12) reported the feasibility of CT-based radiomics analysis for the diagnosis of clinically significant portal hypertension. These authors devised a model based on texture features, morphologic features, and the liver and spleen volumes with the hepatic venous pressure gradient as the reference standard.…”