Noninvasive Evaluation of Clinically Significant Portal Hypertension in Patients with Liver Cirrhosis: The Role of Contrast-Enhanced Ultrasound Perfusion Imaging and Elastography

Abstract

Background Hepatic venous pressure gradient (HVPG) is the gold standard for assessing the degree of portal hypertension (PH), but it is not suitable for routine clinical use. The recently developed ultrasonography techniques, dynamic contrast-enhanced ultrasound (D-CEUS) and liver stiffness (LS), have expanded the possibilities for noninvasive evaluation. Aims To investigate the usefulness of D-CEUS and elastographic parameters in assessing the presence and degree of PH. Methods This is a prospective monocentric study. Patients with liver cirrhosis referred for HVPG measurements underwent hepatic Doppler ultrasound, LS measurement, and D-CEUS with a second-generation contrast agent. Pearson’s correlation and a receiver operating characteristic (ROC) curve analysis were performed to assess the role of noninvasive findings in predicting clinically significant PH (CSPH) and severe PH (SPH). Results 46 consecutive patients (31 men; mean age±SD: 57±11 years) were enrolled. A significant positive correlation was noted between LS and HVPG (r = 0.809, p<0.0001) with an area under the ROC curve of 0.923. A cut-off value of 24.2 kPa best predicted CSPH with a positive predictive value of 85%. Among the D-CEUS features, the area under the ROC curves of liver parenchyma peak intensity (PI-LP) was greater than the other indices both for CSPH and SPH (1.000 and 0.981, respectively). A PI-LP under 23.3 arbitrary units indicated the presence of CSPH with a sensitivity and a specificity of 100%. Conclusion A multimodal ultrasound approach based on D-CEUS and LS might become a reliable predictor of CSPH and SPH and a useful alternative to HVPG.

Early blood pressure drop exacerbates renal function deterioration and mortality in ICU patients with liver failure

“…Our ndings suggest that an early blood pressure drop may serve as a more accessible and cost-effective predictor of prognosis than more complex measurements such as HVPG. Early peak blood pressure drop measurements are readily available in clinical practice and can provide valuable information for risk strati cation and prognostic assessment [23]. Additionally, several studies have indicated that poorer baseline renal function and acute kidney injury (AKI) are independently associated with a poorer prognosis [24,25].…”

EFSUMB Technical Review – Update 2023: Dynamic Contrast-Enhanced Ultrasound (DCE-CEUS) for the Quantification of Tumor Perfusion

“…An objective and quantitative diagnosis of perfusion characteristics is of particular relevance in the follow-up of cancer patients but can also be used for the diagnostic assessment of other pathological changes associated with alterations in tissue perfusion. This applies, for example, to the noninvasive diagnosis of the progression of parenchymal liver disease, liver cirrhosis, and portal hypertension [10,11,12,13,14,15,16] and for the noninvasive evaluation of chronic kidney disease [17,18,19] and subclinical kidney transplant rejection [17,20,21,22,23,24]. There are partially contradictory data regarding the evaluation of inflammatory activity and response to biologic therapy in inflammatory bowel disease [25,26,27,28,29,30,31,32,33,34].…”