Real-time two-dimensional shear wave ultrasound elastography of the liver is a reliable predictor of clinical outcomes and the presence of esophageal varices in patients with compensated liver cirrhosis

Abstract

AimPrimary: to evaluate predictivity of liver stiffness (LS), spleen stiffness (SS), and their ratio assessed by real-time 2D shear wave elastography (RT-2D-SWE) for adverse outcomes (hepatic decompensation, hepatocellular carcinoma or death; “event”) in compensated liver cirrhosis (LC) patients. Secondary: to evaluate ability of these measures to discriminate between cirrhotic patients with/without esophageal varices (EV).MethodsPredictivity of LS, SS, and LS/SS was assessed in a retrospectively analyzed cohort of compensated LC patients (follow-up cohort) and through comparison with incident patients with decompensated cirrhosis (DC) (cross-sectional cohort). Both cohorts were used to evaluate diagnostic properties regarding EV.ResultsIn the follow-up cohort (n = 44) 18 patients (40.9%) experienced an “event” over a median period of 28 months. LS≥21.5 kPa at baseline was independently associated with 3.4-fold (95% confidence interval [CI] 1.16-10.4, P = 0.026) higher risk of event. Association between SS and outcomes was weaker (P = 0.056), while there was no association between LS/SS ratio and outcomes. Patients with DC (n = 43) had higher LS (35.3 vs 18.3 kPa, adjusted difference 65%, 95% CI 43%-90%; P < 0.001) than compensated patients at baseline. Adjusted odds of EV increased by 13% (95% CI 7.0%-20.0%; P < 0.001) with 1 kPa increase in LS. At cut-offs of 19.7 and 30.3 kPa, LS and SS had 90% and 86.6% negative predictive value, respectively, to exclude EV in compensated patients.ConclusionThis is the first evaluation of RT-2D-SWE as a prognostic tool in LC. Although preliminary and gathered in a limited sample, our data emphasize the potential of LS to be a reliable predictor of clinical outcomes and the presence of EV in LC patients.

Spleen Stiffness Is Superior to Liver Stiffness for Predicting Esophageal Varices in Chronic Liver Disease: A Meta-Analysis

“…As the most commonly used technique, transient elastography (TE) was used in 10 studies for liver and spleen stiffness measurement [8,14,18,24,25,27,29,30,32,36]. Another 4 techniques, acoustic radiation force impulse (ARFI) [26,34], virtual touch tissue quantification (VTTQ) [33], share wave elastography (SWE) and magnetic resonance elastography (MRE) [28,35,31] were used in other included studies. According to the QUADAS-2 scale, overall, studies were felt to be at low risk of bias and had good applicability (S1 Table).…”

“…The diagnostic accuracy of liver and spleen stiffness measurement for prediction of the presence of EV was evaluated in 13 studies [8,14,18,24–27,28–33]. For LS measurement, the summary sensitivity was 0.83 (95% CI: 0.78–0.87), the summary specificity was 0.66 (95% CI: 0.60–0.72) (Fig 2A), the summary positive likelihood ratio (LR+) was 2.44 (95% CI: 1.99–2.99), the summary negative likelihood ratio (LR-) was 0.26 (95% CI: 0.19–0.35), the summary DOR was 9.54 (95% CI: 5.85–15.56), and the area under SROC curve was 0.81 (95% CI: 0.77–0.84) (Fig 3A).…”

Liver Stiffness Measured by 2‐Dimensional Shear Wave Elastography: Prospective Evaluation of Healthy Volunteers and Patients With Liver Cirrhosis

“…The elastograms were only considered representative and valid if they fulfilled the following quality criteria as previously described: (1) more than two‐thirds of the elastographic map had to be homogeneously colored or have a gradual color transition; (2) artifacts (spots, pixelization, and lack of a signal) had to occupy less than one‐third of the elastographic map; and (3) no sharp transition from soft (blue) to hard (red) elastographic areas was permitted. Patients without 12 valid measurements according to these criteria were excluded because of technical failure.…”

Assessing Baveno VI criteria with liver stiffness measured using a new point‐shear wave elastography technique (BAVElastPQ study)

“…7,8 On the other hand, only few studies have evaluated the ability of these new elastographic devices in predicting the presence of VNT by measuring the LS and/ or SS using p-SWE or 2D-SWE techniques. [9][10][11][12][13][14] More specifically, no study has explored the potential role of ElastPQ technique in the assessment of clinically significant portal hypertension. Therefore, the primary aim of our study was to determine the correlation between LS values measured by ElastPQ and the presence of VNT in cACLD patients.…”