Roccarina Davide, Saffioti Francesca, Rosselli Matteo, Marshall Aileen, Pinzani Massimo, Thorburn Douglas
UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK.
JHEP Rep. 2023 Aug 6;5(11):100873. doi: 10.1016/j.jhepr.2023.100873. eCollection 2023 Nov.
BACKGROUND & AIMS: Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) have been shown to be useful tools for assessing the risk of fibrosis and portal hypertension, respectively. However, data on the accuracy of LSM and SSM measured by point-shear wave elastography (pSWE) in patients affected by primary sclerosing cholangitis (PSC) are still lacking. Thus, we aimed to prospectively assess their performance in a cohort of patients with PSC.
We determined the correlation between LSM assessed by a pSWE technique (ElastPQ) and by FibroScan-transient elastography (F-TE). Furthermore, we used receiver-operating characteristic curves and area under the curves (AUROC) to evaluate the performance of LSM by ElastPQ for the staging of fibrosis, using F-TE as a reference standard, and the performance of LSM and SSM by ElastPQ in predicting the presence of oesophageal varices (OVs).
One hundred and fifty-two patients with PSC (93 males [61.2%], mean age 46 ± 16 years) were prospectively recruited. ElastPQ and F-TE LSMs were available for all patients, while ElastPQ SSM was available in 109 (72%) patients of whom 35 underwent upper gastrointestinal endoscopy within 1 year of the ultrasound assessment. ElastPQ LSM showed an excellent correlation with F-TE ( <0.001, Spearman's 0.93; Lin's 0.86) and a good diagnostic accuracy for fibrosis staging along all stages of liver fibrosis (AUROCs 0.96, 0.97, 0.97 and 0.99 for fibrosis stages F≥1, F≥2, F≥3 and F=4, respectively), using F-TE as a surrogate of histological fibrosis. ElastPQ SSM showed a good diagnostic performance in predicting the presence of OVs at endoscopy.
LSM and SSM by ElastPQ can be used as accurate tools for liver fibrosis risk assessment and fibrosis staging, as well as for predicting the presence of OVs in the work-up of patients with PSC.
Liver and spleen stiffness measurement (LSM and SSM, respectively) by ElastPQ point-shear wave elastography in patients with primary sclerosing cholangitis represent reliable and reproducible tools for non-invasively staging the severity of liver disease and stratifying patients according to their risk of developing liver-related outcomes. In particular, LSM shows good accuracy for staging liver fibrosis and therefore detecting those patients at high risk of having compensated advanced chronic liver disease who require close monitoring. SSM seems to be promising to detect the risk of portal hypertension and therefore of oesophageal varices, enabling the triaging of patients who really need to undergo a screening endoscopy.
肝脏硬度测量（LSM）和脾脏硬度测量（SSM）已被证明分别是评估纤维化风险和门静脉高压风险的有用工具。然而，关于点剪切波弹性成像（pSWE）测量的LSM和SSM在原发性硬化性胆管炎（PSC）患者中的准确性数据仍然缺乏。因此，我们旨在前瞻性评估它们在一组PSC患者中的表现。
我们确定了通过pSWE技术（ElastPQ）评估的LSM与通过FibroScan瞬时弹性成像（F-TE）评估的LSM之间的相关性。此外，我们使用受试者操作特征曲线和曲线下面积（AUROC），以F-TE作为参考标准，评估ElastPQ测量的LSM用于纤维化分期的性能，以及ElastPQ测量的LSM和SSM预测食管静脉曲张（OVs）存在的性能。
前瞻性招募了152例PSC患者（93例男性[61.2%]，平均年龄46±16岁）。所有患者均有ElastPQ和F-TE测量的LSM数据，而109例（72%）患者有ElastPQ测量的SSM数据，其中35例在超声评估后1年内接受了上消化道内镜检查。ElastPQ测量的LSM与F-TE显示出极好的相关性（<0.001，Spearman相关系数0.93；Lin相关系数0.86），并且在所有肝纤维化阶段对纤维化分期均具有良好的诊断准确性（纤维化阶段F≥1、F≥2、F≥3和F = 4的AUROC分别为0.96、0.97、0.97和0.99），以F-TE作为组织学纤维化的替代指标。ElastPQ测量的SSM在预测内镜检查时OVs的存在方面显示出良好的诊断性能。
ElastPQ测量的LSM和SSM可作为准确工具，用于PSC患者的肝纤维化风险评估、纤维化分期以及预测OVs的存在。
在原发性硬化性胆管炎患者中，通过ElastPQ点剪切波弹性成像进行肝脏和脾脏硬度测量（分别为LSM和SSM）是用于非侵入性评估肝脏疾病严重程度和根据患者发生肝脏相关结局的风险进行分层的可靠且可重复的工具。特别是，LSM在肝纤维化分期方面具有良好的准确性，因此能够检测出那些有代偿性晚期慢性肝病高风险且需要密切监测的患者。SSM似乎有望检测出门静脉高压风险以及因此食管静脉曲张的风险，从而能够对真正需要接受筛查内镜检查的患者进行分流。
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