Post-doctoral research fellow, Department of Radiology, Thomas Jefferson University, Philadelphia, PA 19107, USA; School of Biomedical Engineering, Sciences and Health Systems, Drexel University, Philadelphia, PA 19104, USA.
Associate Professor, Department of Medicine, Division of Gastroenterology and Hepatology, Thomas Jefferson University, Philadelphia, PA 19107, USA.
Acad Radiol. 2021 Nov;28 Suppl 1(Suppl 1):S128-S137. doi: 10.1016/j.acra.2020.11.023. Epub 2020 Dec 17.
Subharmonic aided pressure estimation (SHAPE) is based on the inverse relationship between the subharmonic amplitude of ultrasound contrast microbubbles and ambient pressure. The aim of this study was to verify if SHAPE can accurately monitor disease progression in patients identified with portal hypertension.
MATERIALS & METHODS: A modified Logiq 9 scanner with a 4C curvi-linear probe (GE, Waukesha, WI) was used to acquire SHAPE data (transmitting and receiving at 2.5 and 1.25 MHz, respectively) using Sonazoid (GE Healthcare, Oslo, Norway; FDA IND 124,465). Twenty-one (median age 59 years; 12 Males) of the 178 patients enrolled in this institutional review board approved study (14F.113) were identified as having clinically significant portal hypertension based on their hepatic venous pressure gradient results ≥ 10 mmHg. Repeat SHAPE examinations were done every 6.2 months. Liver function tests and clinical indicators were used to establish treatment response.
Of the 21 portal hypertensive subjects, 11 had successful follow up scans with an average follow up time of 6.2 months. There was a significantly larger SHAPE signal reduction in the group who were classified as treatment responders (n = 10; -4.01±3.61 dB) compared to the single nonresponder (2.33 dB; p < 0.001). Results for responders matched the corresponding clinical outcomes of improved model for end stage liver disease (MELD) scores, improvement in underlying cause of portal hypertension, improved liver function tests and reduced ascites.
SHAPE can potentially monitor disease progression in portal hypertensive patients and hence, may help clinicians in patient management. A larger study would further validate this claim.
次谐波辅助压力估计（SHAPE）基于超声对比微泡的次谐波幅度与环境压力之间的反比关系。本研究的目的是验证 SHAPE 是否可以准确监测已确诊为门静脉高压症患者的疾病进展。
使用经过修改的 Logiq 9 扫描仪和 4C 曲线线性探头（GE，威斯康星州沃基肖），以分别在 2.5 和 1.25 MHz 下发射和接收，使用 SonoVue（GE Healthcare，挪威奥斯陆；FDA IND 124,465）获取 SHAPE 数据。在这项机构审查委员会批准的研究（14F.113）中，共有 178 名患者中的 21 名（中位年龄 59 岁；12 名男性）被确定为患有临床显著门静脉高压症，依据是他们的肝静脉压力梯度结果≥10mmHg。重复的 SHAPE 检查每 6.2 个月进行一次。肝功能测试和临床指标用于确定治疗反应。
在 21 名门静脉高压患者中，有 11 名患者成功进行了后续扫描，平均随访时间为 6.2 个月。在被归类为治疗反应者（n=10）中，SHAPE 信号减少明显更大（-4.01±3.61dB），与唯一的无反应者（2.33dB；p<0.001）相比。反应者的结果与终末期肝病模型（MELD）评分的相应临床结果、门静脉高压病因的改善、肝功能测试的改善和腹水的减少相匹配。
SHAPE 可能有潜力监测门静脉高压患者的疾病进展，从而帮助临床医生进行患者管理。更大规模的研究将进一步验证这一说法。
