S4208 Hepatic Pressure Mapping: Novel Utility of VExUS Scoring System
Bibliographic record
Abstract
Introduction: Hepatic venous pressure gradient (HVPG) is the gold standard for diagnosing and measuring the severity of portal hypertension. Recent diagnostic developments demonstrate the feasibility and accuracy of EUS-guided portal pressure gradient (EUS-PPG). However, both methods are invasive and can involve radiation. The venous excess ultrasound (VExUS) scoring system quantifies systemic venous congestion based on Doppler interrogations and can be applied for hepatic pressure mapping in both acute and chronic conditions. Case Description/Methods: The aim of the study was to present a novel use of the VExUS scoring system in diagnosing portal vein (PV) and hepatic vein (HV) congestion and to evaluate the severity of venous pathology through 2 scenarios. Patient 1: A 39-year-old woman with a recent diagnosis of hepatic epithelioid hemangioendothelioma presented with epistaxis and petechiae on her body for 2 days. Mental status was at baseline. Total bilirubin was 31.8, direct bilirubin >15, AST 504, ALT 116, ALP 1479, albumin 2.4, INR 2.5, and creatinine 3.1. Calculated MELDNa score was 41. CT triple phase showed evidence of left and mid HV, and left PV thrombosis. Abdominal doppler showed IVC of 4cm, severe decrease in HV phasicity and increase in pulsatility index >60% of the PV. VExUS grade 3. Patient 2: A 72-year-old woman with untreated chronic Hep C presented with acute onset RUQ pain. CT abdomen showed a hepatic lesion with left PV thrombosis. Liver enzymes were slightly elevated AST 75, ALT 85; otherwise, the blood profile was normal. Doppler US revealed a mildly enlarged liver with a smooth contour, 5.5cm mass in the left lobe of the liver, an IVC diameter of 1.5 cm, a well-circumscribed hypoechoic heterogeneous mass with internal vascularity in the left side of the porta hepatis representing a tumor thrombus PV. Main PV remained patent with normal hepatopetal flow. VExUS grade 0 (Figure 1). Discussion: The presence of PV/HV thrombus isn’t sufficient for hepatic malfunction; however, the degree of congestion in the HV/PV greatly contributes to hepatic insult and malfunction. VExUS scoring quantifies congestion noninvasively and radiation-free while providing significant details not readily available in other imaging modalities (ex. CT,MRI). While VEsUS is relatively new, the physiology behind it is well-validated. It can be potentially used as a dynamic marker to prognosticate individuals in isolation or with other noninvasive markers for PV hypertension and to optimize liver pressures while on treatment.Figure 1.: Ultrasound doppler's utility in quantifying liver pressures (Portal and Hepatic) through VExUS Scoring System.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".