Department of Gastroenterology, Nizam's Institute of Medical Sciences, 4th Floor, Specialty Block, Panjagutta, Hyderabad, Telangana, 500082, India.
Department of Gastroenterology, Seth GS Medical College and KEM Hospital, Mumbai, India.
Abdom Radiol (NY). 2023 Jul;48(7):2340-2348. doi: 10.1007/s00261-023-03927-9. Epub 2023 Apr 29.
Porto-sinusoidal vascular disorder (PSVD) is one of the common causes of portal hypertension and has overlapping features with early cirrhosis. The differentiation of PSVD from cirrhosis requires a liver biopsy, which is invasive and has potential complications. This systematic review aimed at summarizing the current evidence on the performance of noninvasive modalities for differentiating PSVD from cirrhosis.
A comprehensive search of electronic databases of MEDLINE, Embase, and Scopus was conducted from 2000 to October 2022 for the studies comparing the elastographic and radiological features of PSVD and cirrhosis, using liver biopsy as the gold standard.
A total of 12 studies were included in the systematic review. Transient elastography (TE) as a modality was studied in five studies, MR elastography (MRE) in two, contrast CT in two, Contrast CT and MRI in two, and ARFI in only one. Both TE and MRE showed a significantly lower liver stiffness measurement and a higher splenic stiffness measurement with a higher SSM/LSM ratio with PSVD, compared to cirrhosis. Among the radiological features, focal nodular hyperplasia-like lesions, portal vein abnormalities (intrahepatic and extrahepatic), and a larger spleen size favored a diagnosis of PSVD. In contrast, surface nodularity and atrophy of segment IV with a segment I hypertrophy favored a diagnosis of cirrhosis.
Elastography and cross-sectional imaging can help differentiate PSVD from early cirrhosis with good accuracy. Further studies are required to assess the diagnostic role of a combination of both modalities.
门脉高压症的常见病因之一是门-体静脉血管病变（PSVD），其与早期肝硬化有重叠特征。PSVD 与肝硬化的鉴别需要进行肝活检，这是一种有创且有潜在并发症的方法。本系统评价旨在总结目前关于非侵入性方法鉴别 PSVD 与肝硬化的证据。
对 2000 年至 2022 年 10 月期间 MEDLINE、Embase 和 Scopus 电子数据库进行全面检索，纳入比较 PSVD 和肝硬化的弹性成像和影像学特征的研究，以肝活检为金标准。
本系统评价共纳入 12 项研究。有 5 项研究研究了瞬时弹性成像（TE）作为一种方法，2 项研究了磁共振弹性成像（MRE），2 项研究了对比 CT，2 项研究了对比 CT 和 MRI，仅有 1 项研究了声辐射力脉冲成像（ARFI）。与肝硬化相比，PSVD 的肝脏硬度测量值明显较低，脾脏硬度测量值较高，且 SSM/LSM 比值较高。在影像学特征方面，局灶性结节样增生样病变、门静脉异常（肝内和肝外）和较大的脾脏大小有利于 PSVD 的诊断。相反，表面结节和 IV 段萎缩伴 I 段肥大则有利于肝硬化的诊断。
弹性成像和横断面成像可以帮助准确地区分 PSVD 和早期肝硬化。需要进一步研究来评估两种方法联合的诊断作用。
