Splenic-hepatic elastography index is useful in differentiating between porto-sinusoidal vascular disease and cirrhosis in patients with portal hypertension

Ferreira‐Silva, Joel; Gaspar, Rui; Liberal, Rodrigo; Cardoso, Hélder; Macedo, Guilherme

doi:10.1016/j.dld.2022.09.018

Cited by 18 publications

(7 citation statements)

References 27 publications

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Section: Discussionsupporting

confidence: 94%

“…These results are in accordance with several published works: the median TE-LSM values of PSVD are 6.2-7.9 kPa, 9,15,16 which is similar to our results that the median TE-LSM value was 10.0 kPa. Ferreira-Silva et al reported that the optimal cut-off value was 12.5 kPa with a sensitivity of 91.7%, a specificity of 65.9% and a diagnostic accuracy of 77.9% for PSVD, 16 which is in parallel to our work. Furthermore, our results suggested that a TE-LSM value of 10.0 kPa was the rule-in cut-off with a specificity of 95% and a positive likelihood ratio of >10, suggesting more confidence in the diagnosis of PSVD.…”

Section: Discussionsupporting

confidence: 94%

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Diagnostic performance of transient elastography in differentiation between porto‐sinusoidal vascular liver disease and compensated cirrhosis

Zhang,

Ma,

et al. 2023

Liver International

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Background and AimsThe efficacy of transient elastography (TE) in the differential diagnosis between porto‐sinusoidal vascular disease (PSVD) and compensated cirrhosis has not been sufficiently studied. We aimed to investigate the diagnostic performance of TE and identify histological lesions associated with liver stiffness.MethodsWe conducted a retrospective cohort study including patients with PSVD and cirrhosis (Child‐Turcotte‐Pugh class A) and healthy subjects. Both the PSVD and cirrhotic patients had at least one sign of PH. The area under the receiver operating characteristic curve (AUROC) was used for differentiation.ResultsNinety‐two patients with PSVD (median age: 53 years, 33% male), 100 patients with compensated cirrhosis and 101 healthy subjects were included. The median TE‐LSM in the PSVD patients (10.0 [7.0–13.0] kPa) was significantly lower than that in the cirrhotic patients (21.0 [15.0–28.0] kPa, p < .001) but was significantly higher than that in the healthy subjects (5.1 [4.6–6.0] kPa, p < .001). The AUROCs of TE‐LSM for the discrimination of PSVD from the cirrhosis and healthy subjects were 0.886 (95% CI: 0.833–0.928) and 0.913 (95% CI: 0.864–0.949), respectively. The sensitivity and specificity to discriminate PSVD from compensated cirrhosis were 78.3% and 82.0%, respectively, at a cut‐off of 13.6 kPa. Furthermore, portal fibrosis and aberrant cytokeratin 7 expression of centrilobular hepatocytes were significantly associated with higher TE‐LSM (≥10.0 kPa).ConclusionTE‐LSM can be used to differentiate PSVD from compensated cirrhosis. Pathological features in association with increased liver stiffness are identified.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 94%

Diagnostic performance of transient elastography in differentiation between porto‐sinusoidal vascular liver disease and compensated cirrhosis

Zhang,

Ma,

et al. 2023

Liver International

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“…Spleen stiffness measurements, although not performed in this study protocol, may be useful in the diagnosis of NCPH, alone or in combination with LSM. [21][22][23] The cutoffs of APRI ≥0.73 and Fibrosis-4 index ≥2.72 have been validated…”

Section: Discussionmentioning

confidence: 99%

“…HVPG and LSM may be helpful to raise suspicion of PH in patients who are at risk for NCPH; however, they may underestimate the degree of PH when compared to patients with cirrhosis. Spleen stiffness measurements, although not performed in this study protocol, may be useful in the diagnosis of NCPH, alone or in combination with LSM 21–23 . The cut‐offs of APRI ≥0.73 and Fibrosis‐4 index ≥2.72 have been validated to predict clinically significant PH in patients with cirrhosis 24 .…”

Section: Discussionmentioning

confidence: 99%

Prospective evaluation of patients with non‐cirrhotic portal hypertension: A single centre study

Mironova,

Gopalakrishna,

Viana Rodriguez

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundNon‐cirrhotic portal hypertension (NCPH) is a spectrum of liver diseases, including porto‐sinusoidal vascular disorder, with portal hypertension (PH) in the absence of cirrhosis. The natural history and diagnostic approach to NCPH are not well understood.AimWe aimed to evaluate disease progression and outcomes in NCPH.MethodsPatients with or at risk for NCPH were enrolled in a single centre prospective study; two groups were formed based on the presence of specific features of PH, such as varices, collaterals, portal hypertensive gastropathy or portal hypertensive bleeding. All participants underwent a baseline liver biopsy. Liver stiffness measurement (LSM), and imaging were repeated every 6–12 months.ResultsFifteen patients without specific features of PH (Group I), and 35 patients with specific features (Group II) were enrolled. The median follow‐up time was 50 months. Group II had higher hepatic venous pressure gradients, non‐invasive measures of PH and a lower platelet count (PLT) when compared to Group I. Rates of survival and decompensation were similar in both groups. Patients with PLT ≤100 K/mcL had lower survival compared to those with PLT >100 K/mcL. Patients with LSM ≥10 kPa had lower survival and survival without decompensation when compared to patients with LSM <10 kPa.ConclusionsPatients irrespective of specific features of PH had similar survival or survival without decompensation. Patients without specific features are at risk for disease progression and should be monitored closely. Thrombocytopenia and increased LSM are associated with severe forms of liver disease, which are strongly associated with outcomes.

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“…Tis is a major limit, not only because it could have shown how liver disease (i.e., fbrosis staging) would have been underestimated by ultrasound only, but also because signs of portal hypertension (i.e., splenomegaly, dilated portal vein, and collaterals) could have been detected and correlated with the absence/presence of liver cirrhosis at TE. In addition, the application of spleen stifness would have been useful to address more specifcally the severity of portal hypertension, as is complementary to LSM [61], and the spleen stifness measurement (SSM)/LSM ratio could be informative in these cases [62].…”

Section: Discussionmentioning

confidence: 99%

Liver Assessment in Patients with Ataxia-Telangiectasia: Transient Elastography Detects Early Stages of Steatosis and Fibrosis

Donath

Wölke

Knop

et al. 2023

Canadian Journal of Gastroenterology and Hepatology

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Background. Ataxia-telangiectasia (A-T) is a rare autosomal-recessive multisystem disorder characterized by pronounced cerebellar ataxia, telangiectasia, cancer predisposition, and altered body composition. Liver diseases with steatosis, fibrosis, and hepatocellular carcinoma are frequent findings in older patients but sensitive noninvasive diagnostic tools are lacking. Objectives. To determine the sensitivity of transient elastography (TE) as a screening tool for early hepatic tissue changes and serum biomarkers for liver disease. Methods. Thirty-one A-T patients aged 2 to 25 years were examined prospectively from 2016–2018 by TE. In addition, we evaluated the diagnostic performance of liver biomarkers for steatosis and necroinflammatory activity (SteatoTest and ActiTest, Biopredictive, Paris) compared to TE. For calculation and comparison, patients were divided into two groups (<12, >12 years of age). Results. TE revealed steatosis in 2/21 (10%) younger patients compared to 9/10 (90%) older patients. Fibrosis was present in 3/10 (30%) older patients as assessed by TE. We found a significant correlation of steatosis with SteatoTest, alpha-fetoprotein (AFP), HbA1c, and triglycerides. Liver stiffness correlated significantly with SteatoTest, ActiTest, HbA1c, and triglycerides. Conclusion. Liver disease is a common finding in older A-T patients. TE is an objective measure to detect early stages of steatosis and fibrosis. SteatoTest and ActiTest are a good diagnostic assessment for steatosis and necroinflammatory activity in patients with A-T and confirmed the TE results.

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Splenic-hepatic elastography index is useful in differentiating between porto-sinusoidal vascular disease and cirrhosis in patients with portal hypertension

Cited by 18 publications

References 27 publications

Diagnostic performance of transient elastography in differentiation between porto‐sinusoidal vascular liver disease and compensated cirrhosis

Diagnostic performance of transient elastography in differentiation between porto‐sinusoidal vascular liver disease and compensated cirrhosis

Prospective evaluation of patients with non‐cirrhotic portal hypertension: A single centre study

Liver Assessment in Patients with Ataxia-Telangiectasia: Transient Elastography Detects Early Stages of Steatosis and Fibrosis

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