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Computed Tomography

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Diagnostic Methods for Cirrhosis and Portal Hypertension

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Abstract

Cirrhosis is a heterogeneous and dynamic condition, associated with the progressive deposition of hepatic fibrosis that leads to increased vascular resistance at the level of the hepatic sinusoids, and to portal hypertension. Cirrhosis accounts for 90% of the causes of portal hypertension (PHT) in adults. Increased portal pressure is the main factor determining the clinical course of cirrhosis. An accurate estimation of the severity of fibrosis and PHT is essential to evaluate the disease state and prognosis, and is often the first step towards the optimization of treatment. Liver biopsy and invasive measurement of hepatic venous pressure gradient (HVPG) are the gold standard techniques for the estimation of hepatic fibrosis and PHT, respectively. However, both are invasive and, as such, cannot be used repeatedly in clinical practice. As a consequence, the need for non-invasive diagnosis tests for cirrhosis and PHT is major. Computed Tomography (CT) is a fast, standardized, and cheap cross-sectional imaging technique based on 3D X-ray technology that provides an anatomical exploration of organs. In the field of hepatology it is routinely used for the exploration of patients with chronic liver disease and portal hypertension, but also for the characterization of focal liver lesions. This chapter aims to review the role of CT in the diagnosis, grading, and prognosis of hepatic fibrosis and portal hypertension.

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Abbreviations

CT:

Computed tomography

DE-CT:

Dual-energy computed tomography

fEES:

Fractional extravascular extracellular space

HCC:

Hepatocellular carcinoma

HH:

Hepatic hydrothorax

HPS:

Hepatopulmonary syndrome

HVPG:

Hepatic venous pressure gradient

LSN:

Liver surface nodularity

MRI:

Magnetic resonance imaging

PCT:

Perfusion tomography perfusion

PHT:

Portal hypertension

TIPS:

Transjugular intrahepatic portosystemic shunt

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Authors and Affiliations

  1. Department of Radiology, Hôpitaux Universitaires Paris Nord Val de Seine, Beaujon, Clichy, Hauts-de-Seine, France

    Maxime Ronot M.D., Ph.D., Romain Pommier M.D., Paul Calame M.D., Yvonne Purcell & Valérie Vilgrain M.D., Ph.D.

  2. University Paris Diderot, Sorbonne Paris Cité, Paris, France

    Maxime Ronot M.D., Ph.D., Romain Pommier M.D., Paul Calame M.D. & Valérie Vilgrain M.D., Ph.D.

  3. INSERM U1149, Centre de Recherche Biomédicale Bichat-Beaujon, CRB3, Paris, France

    Maxime Ronot M.D., Ph.D. & Valérie Vilgrain M.D., Ph.D.

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  1. Maxime Ronot M.D., Ph.D.
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  2. Romain Pommier M.D.
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  3. Paul Calame M.D.
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  4. Yvonne Purcell
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  5. Valérie Vilgrain M.D., Ph.D.
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Correspondence to Maxime Ronot M.D., Ph.D. .

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  1. Inselspital, University of Bern, UVCM, DMLL, Hepatology Inselspital, University of Bern, Berne, Switzerland

    Annalisa Berzigotti

  2. Hospital Clinic, Hepatic Hemodynamic Laboratory Hospital Clinic, Barcelona, Spain

    Jaime Bosch

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Ronot, M., Pommier, R., Calame, P., Purcell, Y., Vilgrain, V. (2018). Computed Tomography. In: Berzigotti, A., Bosch, J. (eds) Diagnostic Methods for Cirrhosis and Portal Hypertension. Springer, Cham. https://doi.org/10.1007/978-3-319-72628-1_13

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