Kim Tae Yeob, Jeong Woo Kyoung, Sohn Joo Hyun, Kim Jinoo, Kim Min Yeong, Kim Yongsoo
Department of Internal Medicine, Hanyang University Guri Hospital and Hanyang University College of Medicine, Seoul, Korea.
Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Liver Int. 2015 Nov;35(11):2416-24. doi: 10.1111/liv.12846. Epub 2015 May 5.
BACKGROUND & AIMS: To assess the correlation between liver stiffness measurement (LSM) by real-time shear wave elastography (SWE) and hepatic venous pressure gradient (HVPG) and to investigate the diagnostic performance of SWE for predicting clinically significant and severe portal hypertension (CSPH and SPH).
Clinical data of 115 cirrhotic patients with haemodynamic measurement were consecutively collected. Liver stiffness (LS) was measured using SWE by repeated performance five times per patient, and the median value and interquartile range of the parameters on the same day of HVPG measurement was calculated. CSPH and SPH were defined as a HVPG ≥10 mmHg and ≥12 mmHg respectively.
A total of 92 patients (male, 63; mean age, 53 ± 11.9 years) were eligible for analysis. CSPH and SPH were detected in 77 patients (83.7%) and 66 patients (71.5%) respectively. HVPG were significantly correlated with LSM in the overall, CSPH, and SPH patients (r = 0.646, 0.574 and 0.424 respectively; all P < 0.001). With ascites, the correlation coefficient did not decrease (r = 0.587). The AUROCs of LSM was 0.819 (95% CI, 0.725-0.892) for CSPH and 0.867 (95% CI, 0.780-0.928) for SPH. The cut-off values for determining CSPH and SPH were 15.2 kPa (Sensitivity, 85.7%; Specificity, 80.0%) and 21.6 kPa (Sensitivity, 83.3%; Specificity, 80.8%) respectively.
In cirrhotic patients, LSM by SWE is highly correlated with HVPG value regardless of ascites. SWE is a new reliable non-invasive diagnostic tool to predict CSPH and SPH, even in cirrhotic patients with ascites.
评估实时剪切波弹性成像（SWE）测量的肝脏硬度值（LSM）与肝静脉压力梯度（HVPG）之间的相关性，并研究SWE预测临床显著性门静脉高压和严重门静脉高压（CSPH和SPH）的诊断性能。
连续收集115例进行血流动力学测量的肝硬化患者的临床资料。每位患者通过SWE重复测量5次来测定肝脏硬度（LS），并计算HVPG测量当天参数的中位数和四分位数间距。CSPH和SPH分别定义为HVPG≥10 mmHg和≥12 mmHg。
共有92例患者（男性63例；平均年龄53±11.9岁）符合分析条件。分别在77例（83.7%）和66例（71.5%）患者中检测到CSPH和SPH。在总体、CSPH和SPH患者中，HVPG与LSM均显著相关（r分别为0.646、0.574和0.424；均P<0.001）。存在腹水时，相关系数并未降低（r=0.587）。对于CSPH，LSM的曲线下面积（AUROC）为0.819（95%CI，0.725-0.892）；对于SPH，AUROC为0.867（95%CI，0.780-0.928）。确定CSPH和SPH的截断值分别为15.2 kPa（灵敏度85.7%；特异度80.0%）和21.6 kPa（灵敏度83.3%；特异度80.8%）。
在肝硬化患者中，无论有无腹水，通过SWE测量的LSM与HVPG值高度相关。SWE是一种新型可靠的非侵入性诊断工具，可用于预测CSPH和SPH，即使在有腹水的肝硬化患者中也是如此。
