Virtual portal pressure gradient from anatomic CT angiography

By definition, portal hypertension means pathological elevation of the portal pressure gradient (PPG), the direct measurement of which is extremely invasive. This has prompted the use of the less invasive hepatic venous pressure gradient (HVPG), widely accepted as the PPG equivalent.1–3 In a recent article in Gut , HVPG was used as the only criterion to assess haemodynamic response (reduction in HVPG of ≥20% or to values <12 mm Hg) rates to carvedilol in propranolol non-responders.1 Although accurate, HVPG is still invasive, and thus not routinely performed in all centres.2 ,3 As HVPG becomes standard practice, repeated invasive measurement has stimulated the search for non-invasive techniques to measure PPG.3–5 Here, we present a virtual PPG (vPPG) based on CT angiography and Doppler ultrasound. The VIRGIN Study was a multicentre, blinded, prospective, analytical trial carried out at Tongji Hospital, Shanghai and 302 Hospital, Beijing. The study was …