Liver Stiffness Assessed by Ultrasound Shear Wave Elastography from General Electric Accurately Predicts Clinically Significant Portal Hypertension in Patients with Advanced Chronic Liver Disease

Abstract

Purpose Clinically significant portal hypertension (CSPH) is responsible for most of the complications in patients with cirrhosis. Liver stiffness (LS) measurement by vibration-controlled transient elastography (VCTE) is currently used to evaluate CSPH. Bi-dimensional shear wave elastography from General Electric (2D-SWE.GE) has not yet been validated for the diagnosis of PHT. Our aims were to test whether 2D-SWE.GE-LS is able to evaluate CSPH, to determine the reliability criteria of the method and to compare its accuracy with that of VCTE-LS in this clinical setting. Materials and Methods Patients with chronic liver disease referred to hepatic catheterization (HVPG) were consecutively enrolled. HVPG and LS by both VCTE and 2D-SWE.GE were performed on the same day. The diagnostic performance of each LS method was compared against HVPG and between each other. Results 2D-SWE.GE-LS was possible in 123/127 (96.90 %) patients. The ability to record at least 5 LS measurements by 2D-SWE.GE and IQR < 30 % were the only features associated with reliable results. 2D-SWE.GE-LS was highly correlated with HVPG (r = 0.704; p < 0.0001), especially if HVPG < 10 mmHg and was significantly higher in patients with CSPH (15.52 vs. 8.14 kPa; p < 0.0001). For a cut-off value of 11.3 kPa, the AUROC of 2D-SWE.GE-LS to detect CSPH was 0.91, which was not inferior to VCTE-LS (0.92; p = 0.79). The diagnostic accuracy of LS by 2D-SWE.GE-LS to detect CSPH was similar with the one of VCTE-LS (83.74 % vs. 85.37 %; p = 0.238). The diagnostic accuracy was not enhanced by using different cut-off values which enhanced the sensitivity or the specificity. However, in the subgroup of compensated patients with alcoholic liver disease, 2D-SWE.GE-LS classified CSPH better than VCTE-LS (93.33 % vs. 85.71 %, p = 0.039). Conclusion 2D-SWE.GE-LS has good accuracy, not inferior to VCTE-LS, for the diagnosis of CSPH.

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

“…(81,82) Transient elastography provides point-of-care information regarding liver stiffness and can reliably distinguish patients with a high versus low likelihood of cirrhosis. (83)(84)(85) Screening for HBV with an FDA-approved hepatitis B surface antigen (HBsAg) assay and HIV with an FDA-approved HIV-antigen/antibody test is recommended because these coinfections are associated with a poorer HCV prognosis. (86)(87)(88)(89)(90) Persons who test positive for HBsAg require additional monitoring during HCV treatment due to HBV reactivation risk.…”

“…Cirrhosis with portal hypertension portends a greater likelihood of developing future hepatic complications in untreated patients . Transient elastography provides point‐of‐care information regarding liver stiffness and can reliably distinguish patients with a high versus low likelihood of cirrhosis …”

Spleen Stiffness for Predicting Varices Needing Treatment: Comparison between Two Different Elastography Techniques (Point vs. 2D-SWE)

“…LS using Transient Elastography (TE) is an easily reproducible, noninvasive method that has been extensively studied and was found to have a good correlation with HVPG and the presence of EV [7][8][9]. A very good correlation between LS measurements (LSM) performed by 2D-shear wave elastography (2D-SWE) techniques and the presence of CSPH was also demonstrated in published studies [10][11][12][13][14][15].…”

New frontiers in liver resection for hepatocellular carcinoma

“…Other elastography methods, measuring liver and spleen stiffnesses, have shown promising results for CSPH assessment but require further investigation in larger cohorts. [70][71][72][73][74][75] More recently, liver surface nodularity was found to be an accurate tool for CSPH assessment, with a high positive predictive value. 76 Even if its accuracy needs to be confirmed, it could be an attractive, noninvasive, and easily accessible method for CSPH assessment.…”