While hepatic vein pressure gradient measurement is the gold standard, it is invasive and often technically difficult. The Barcelona group Caspase cleavage published a non-invasive Portal Hypertension Risk score with a NPV 80.6% for the exclusion of clinically significant portal hypertension (p = 0.0001)1.

Indocyanine green clearance testing assesses hepatic blood flow in addition to hepatocellular function. Goals: To assess whether Indocyanine Green clearance study (ICGR15), alone or in combination with other markers of portal hypertension, is a reliable non-invasive marker for clinically significant portal hypertension. Study: A retrospective analysis of 26 patients, who underwent invasive portal pressure measurements and indocyanine green clearance testing between

2008 and 2014. All patients were being investigated for hepatic mass lesions suspicious for hepatocellular carcinoma (HCC). The data collected included age, sex, etiology of liver disease, platelet count, spleen size, platelet count to spleen size ratio and MELD score in addition to ICGR15 percentage and hepatic vein pressure gradient (HVPG). Results: Of the 26 patients, 23 were male, with a mean age of 62.5 LDK378 mw years. The most common etiology was Hepatitis B virus (35%), followed by Hepatitis C virus (30%). 10 patients had HVPG ≥ 10 mmHg and 11 patients had ICGR15 ≥ 10%. Prediction of Portal Hypertension compared to Hepatic Vein Pressure Gradients ≥10 Sensitivity Specificity Negative Predictive Value P Value ICGR15 ≥ 10% 80% (44.43–96.89) 81.25% (54.34–95.73) 87.5% (61.62–98.08) P = 0.0048 Platelet Count <130 50% (18.89–81.11) 62.5% (35.47–84.71) 66.67% (38.48–88.05) P = 0.4116 Platelet Count/Spleen size ratio <909 40% (12.4–73.63) 上海皓元 71.43% (41.92–91.43) 62.5% (35.47–84.71) P = 0.6734 MELD ≥ 8 100% (66.21–100)

37.5% (15.29–64.53) 100% (54.05–100) P = 0.0571 MELD ≥ 8 + ICGR15 ≥ 10% 88.89% (51.74–98.16) 82.35% (56.55–95.99) 93.33% (67.98–98.89) P = 0.0008 Conclusion: Indocyanine green retention of ≥10% at 15 minutes compares favourably with currently available non-invasive markers of clinically significant portal hypertension. When combined with MELD scores of ≥8, ICGR15 ≥ 10% has a negative predictive value of 93.33% for the exclusion of clinically significant portal hypertension. ICGR15 may be a useful non-invasive method for assessing portal hypertension in patients with HCC prior to surgery and warrants further prospective study. 1. Barcelona Group 2013 Berzigotti et al; Gastroenterology 2013;144:102–111.