Hepatology Department, Regional Institute of Gastroenterology and Hepatology, Cluj Napoca, Romania.
Liver Research Club, Cluj-Napoca, Romania.
Ultraschall Med. 2020 Oct;41(5):526-533. doi: 10.1055/a-0965-0745. Epub 2019 Sep 2.
Clinically significant portal hypertension (CSPH) is responsible for most of the complications in patients with cirrhosis. Liver stiffness (LS) measurement by vibration-controlled transient elastography (VCTE) is currently used to evaluate CSPH. Bi-dimensional shear wave elastography from General Electric (2D-SWE.GE) has not yet been validated for the diagnosis of PHT. Our aims were to test whether 2D-SWE.GE-LS is able to evaluate CSPH, to determine the reliability criteria of the method and to compare its accuracy with that of VCTE-LS in this clinical setting.
Patients with chronic liver disease referred to hepatic catheterization (HVPG) were consecutively enrolled. HVPG and LS by both VCTE and 2D-SWE.GE were performed on the same day. The diagnostic performance of each LS method was compared against HVPG and between each other.
2D-SWE.GE-LS was possible in 123/127 (96.90 %) patients. The ability to record at least 5 LS measurements by 2D-SWE.GE and IQR < 30 % were the only features associated with reliable results. 2D-SWE.GE-LS was highly correlated with HVPG (r = 0.704; p < 0.0001), especially if HVPG < 10 mmHg and was significantly higher in patients with CSPH (15.52 vs. 8.14 kPa; p < 0.0001). For a cut-off value of 11.3 kPa, the AUROC of 2D-SWE.GE-LS to detect CSPH was 0.91, which was not inferior to VCTE-LS (0.92; p = 0.79). The diagnostic accuracy of LS by 2D-SWE.GE-LS to detect CSPH was similar with the one of VCTE-LS (83.74 % vs. 85.37 %; p = 0.238). The diagnostic accuracy was not enhanced by using different cut-off values which enhanced the sensitivity or the specificity. However, in the subgroup of compensated patients with alcoholic liver disease, 2D-SWE.GE-LS classified CSPH better than VCTE-LS (93.33 % vs. 85.71 %, p = 0.039).
2D-SWE.GE-LS has good accuracy, not inferior to VCTE-LS, for the diagnosis of CSPH.
临床上显著的门静脉高压症（CSPH）是导致肝硬化患者大多数并发症的原因。目前，采用振动控制瞬态弹性成像（VCTE）来测量肝脏硬度（LS）以评估 CSPH。通用电气的二维剪切波弹性成像（2D-SWE.GE）尚未经过验证可用于诊断 PHT。我们的目的是检验 2D-SWE.GE-LS 是否能够评估 CSPH，确定该方法的可靠性标准，并在此临床环境中比较其与 VCTE-LS 的准确性。
连续招募患有慢性肝病并接受肝导管插入术（HVPG）的患者。当天对 VCTE 和 2D-SWE.GE 进行 HVPG 和 LS 测量。比较每种 LS 方法与 HVPG 的诊断性能，并比较彼此之间的诊断性能。
在 127 例患者中有 123 例（96.90％）可以进行 2D-SWE.GE-LS 测量。能够记录至少 5 次 2D-SWE.GE 的 LS 测量值且 IQR＜30％是唯一与可靠结果相关的特征。2D-SWE.GE-LS 与 HVPG 高度相关（r＝0.704；p＜0.0001），尤其是 HVPG＜10mmHg 时，并且在 CSPH 患者中明显更高（15.52 vs. 8.14kPa；p＜0.0001）。当截断值为 11.3kPa 时，2D-SWE.GE-LS 检测 CSPH 的 AUROC 为 0.91，并不劣于 VCTE-LS（0.92；p＝0.79）。2D-SWE.GE-LS 检测 CSPH 的 LS 诊断准确性与 VCTE-LS 相似（83.74％ vs. 85.37％；p＝0.238）。使用不同的截断值提高了灵敏度或特异性，但并未提高诊断准确性。但是，在酒精性肝病的代偿性患者亚组中，2D-SWE.GE-LS 比 VCTE-LS 更好地对 CSPH 进行分类（93.33％ vs. 85.71％，p＝0.039）。
2D-SWE.GE-LS 对 CSPH 的诊断准确性良好，不劣于 VCTE-LS。
