Department of Radiology, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA.
Department of Surgery, Lankenau Medical Center, Wynnewood, PA, 19096, USA.
Dig Dis Sci. 2021 Dec;66(12):4354-4360. doi: 10.1007/s10620-020-06790-6. Epub 2021 Jan 4.
Portal hypertension is the underlying cause of most complications associated with cirrhosis, with the hepatic venous pressure gradient (HVPG) used for diagnosis and disease progression. Subharmonic imaging (SHI) is a contrast-specific imaging technique receiving at half the transmit frequency resulting in better tissue suppression.
To determine whether the presence of optimized SHI signals inside the hepatic vein can be used as a screening test for portal hypertension.
This prospective trial had 131 patients undergoing SHI examination of portal and hepatic veins using a modified Logiq 9 scanner (GE, Waukesha, WI). Images acquired after infusion of the ultrasound contrast agent Sonazoid (GE Healthcare, Oslo, Norway) were assessed for the presence of optimized SHI signals in the hepatic vein and compared to the HVPG values obtained as standard of care.
Of 131 cases, 64 had increased HVPG values corresponding to subclinical (n = 31) and clinical (n = 33) portal hypertension (> 5 and > 10 mmHg, respectively), and 67 had normal HVPG values (< 5 mmHg). Two readers performed independent, binary qualitative assessments of the acquired digital clips. Reader one (experienced radiologist) achieved for the subclinical subgroup sensitivity of 98%, specificity of 88%, and ROC area of 0.93 and for the clinical subgroup sensitivity of 100% and specificity of 61%, with an ROC area of 0.74. Reader two (less experienced radiologist) achieved for the subclinical subgroup sensitivity of 77%, specificity of 76%, and ROC area of 0.76 and for the clinical subgroup sensitivity of 88% and specificity of 63%, with an ROC area of 0.70. Readers agreement was of 83% with kappa value of 0.66.
The presence of optimized SHI signals inside the hepatic vein can be a qualitative screening test for portal hypertension, which could reduce the need for invasive diagnostic procedures.
门静脉高压是大多数与肝硬化相关并发症的根本原因，肝静脉压力梯度（HVPG）用于诊断和疾病进展。亚谐波成像（SHI）是一种对比特异性成像技术，以半发射频率接收，从而实现更好的组织抑制。
确定肝静脉内存在优化的 SHI 信号是否可作为门静脉高压的筛查试验。
本前瞻性试验使用改良的 Logiq 9 扫描仪（GE，威斯康星州沃基肖）对门静脉和肝静脉进行 SHI 检查，共纳入 131 例患者。在注射超声造影剂 Sonazoid（挪威 GE Healthcare）后获取的图像评估肝静脉中存在优化的 SHI 信号，并与作为标准护理获得的 HVPG 值进行比较。
在 131 例患者中，64 例 HVPG 值升高，对应亚临床（n = 31）和临床（n = 33）门静脉高压（分别为> 5 和 > 10mmHg），67 例 HVPG 值正常（< 5mmHg）。两位读者对获得的数字剪辑进行了独立的、二进制定性评估。经验丰富的放射科医生读者 1 实现了亚临床亚组的敏感性为 98%、特异性为 88%、ROC 曲线下面积为 0.93，临床亚组的敏感性为 100%、特异性为 61%、ROC 曲线下面积为 0.74。经验较少的放射科医生读者 2 实现了亚临床亚组的敏感性为 77%、特异性为 76%、ROC 曲线下面积为 0.76，临床亚组的敏感性为 88%、特异性为 63%、ROC 曲线下面积为 0.70。读者间的一致性为 83%，kappa 值为 0.66。
肝静脉内存在优化的 SHI 信号可能是门静脉高压的定性筛查试验，可以减少对有创诊断程序的需求。
