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CNAA / Theses / 2017 / June /

Diagnostic in portal hypertension by hepatic cirrhosis using medical imaging


Author: Țâmbală Carolina
Degree:doctor of medicine
Speciality: 14.00.19 - Medical Imagistics
Year:2018
Scientific adviser: Vasile Ţurcan
doctor, associate professor (docent)
Scientific consultant: Cazacov Vladimir
doctor, associate professor (docent)
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 7 June, 2017
Approved by NCAA on the 11 May, 2018

Abstract

Adobe PDF document – 1.07 Mb / in romanian

Thesis

CZU 616.149-008.341.1:616.36-004-073

Adobe PDF document 7.41 Mb / in romanian
156 pages

Keywords

hepatic cirrhosis (HC), Doppler ultrasound, portal hypertension (PHT) imaging

Summary

Thesis structure:It contains the following sections: introduction, four chapters, general conclusions, practical recommendations, bibliography of 157 sources, it is exposed on 126 pages. The thesis contains 32 charts, 46 figures and 11 appendices. The obtained results are published in 21 scientific papers.

Field of study: medical imaging.

The purpose of work: The comparative research of imaging methods for current strategy diagnostic imaging optimization of portal hypertension in liver cirrhosis in order to improve monitoring and enforcement of adjusted treatment.

Study objectives: Comparative analysis of noninvasive imaging methods used in the evaluation of portal hypertension in liver cirrhosis, determining the discriminate values of Doppler ultrasound parameters in predicting portal hypertension in hepatic cirrhosis, correlation of echo- Doppler parameters with stages of liver cirrhosis and its complications in assessing the dynamics of portal hypertension, creating echo-Doppler score to quantify the severity of hemodynamic disturbances in liver cirrhosis, using a complex mathematical model, developing an optimized algorithm of imaging strategy diagnostic of portal hypertension in liver cirrhosis.

Scientific novelty of the obtained results. The research is original realizing the comparative analysis of imaging methods assessing portal hypertension in hepatic cirrhosis, in order to improve dynamic evaluation and adjust the applied treatment based on a group of 222 patients. Following the analysis made it was determined the predictive value of Doppler ultrasound in diagnosis as being similar to CT angiography and were established echo-Doppler parameters with diagnostic value and important discriminator, with the demonstrated utility in specification of PHT changes in patients with PHT in HC. Innovative contributions of the thesis are: algorithms ways were developed of a gradual diagnostic approach of patients with chronic liver diseases; the conduct scheme in PHT imaging diagnosis and prediction of complications of this disease; the echo-Doppler hemodynamic score of PHT assessment which allows a differentiated approach of the patient's condition with liver cirrhosis; optimized PHT diagnostic imaging algorithm in liver cirrhosis therapy.

Solved scientific issue was to optimize current strategy diagnostic imaging of PHT and HC and its complications, achieved by developing an algorithm adjusted by imaging assistance based on echo-Doppler created score, resulting in effective monitoring in order to select the best therapeutic strategy in case of a cirrhotic patient.

Theoretical significance and practical value of the research. It was determined the sensitivity, specificity of color Doppler duplex ultrasonography parameters in predicting PHT in liver cirrhosis by identifying changes of portal hemodynamics indicators that correlate with disease stage. It was proposed an algorithm of imaging evaluation based on the echo- Doppler score developed, useful in assessing the development of the analyzed cases under treatment.

Implementation of scientific results. The obtained results are implemented in everyday work of specialists in the field of hepatology and liver surgery from the Clinical Republican Hospital, of the National Scientific and Practical Center of Pediatric Surgery "Natalia Gheorghiu", PMSI Clinical Hospital of Infectious Diseases "Toma Ciorba", medical Center "Ana-Maria ", PMSI Municipal Clinical Hospital ”Sfânta Treime” to optimize the monitoring of patients with chronic liver disease, and used in the training of specialist doctors, residents, students. There are 6 registered documents of practical implementation of research results.