engleski

Diagnosis of clinically significant portal hypertension in patients with compensated liver disease by two-dimensional shear wave and transient elastography of liver and spleen

Introduction: Portal hypertension is key prognostic factor in patients with compensated advanced chronic liver disease (cACLD), with major complications starting to occur at the threshold of 10 mmHg as measured invasively by hepatic venous pressure gradient (HVPG), representing clinically significant portal hypertension (CSPH). Aims & Methods: We aimed to investigate diagnostic performance of two dimensional shear wave elastography by Supersonic imagine (2DSWEAixplorer®) and transient elastography (TE- Fibroscan®) to noninvasively diagnose CSPH in patients with cACLD by liver and spleen stiffness measurements (LSM and SSM). Patients with cACLD undergoing HVPG measurements were prospectively included. cACLD was considered in patients with history of liver disease lasting >6 months, without previous decompensation and either LSM by TE ≥10 kPa or presence of morphological features by liver imaging studies suggestive of cACLD. All patients underwent LSM and SSM by TE and 2DSWE in fasting condition, followed by HVPG measurements and transjugular liver biopsy (TJB). Patients with congestive liver, cholestasis, infiltrative liver conditions or ALT>5x ULN were not included. Results: We included 76 patients (78.9% males, average age 62 years, 36.8% with alcoholic liver disease, 30.3% with non-alcoholic fatty liver, 14.5% with viral hepatitis B/C). Cirrhosis was histologically confirmed in 67.9% patients, mean HVPG was 10 mmHg, and esophageal varices present in 42.9%. Correlation between HVPG and LSM by 2DSWE (Pearson r=0.82) or TE (r=0.73) was better as compared to SSM (Pearson r= 0.655 for TE and r= 0.596 for 2DSWE). Cut-off value of LSM for CSPH by 2DSWE was 20.1 kPa (sens. 80.5% ; spec. 94.3% ; AUROC 0.926), whereas for TE it was 20.2 kPa (sens. 77.5% ; spec. 86.1% ; AUROC 0.866). Cut-off value of SSM for CSPH by 2DSWE was 34.8 kPa (sens. 83.3% ; spec. 81.5% ; AUROC 0.877), and by TE was 43.5 kPa (sens. 89.3% ; spec. 69.7% ; AUROC 0.857). Conclusion: Among patients with cACLD LSM was highly reliable for noninvasive diagnosis of CSPH, better than SSM, and with better diagnostic performance obtained by 2DSWE as compared to TE.

portal hypertension ; compensated liver disease ; two-dimensional shear wave and transient elastography

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