Real-time shear-wave elastography: applicability, reliability and accuracy for clinically significant portal hypertension.

Abstract

BACKGROUND & AIMS:

Real-time shear wave elastography (RT-SWE) might be useful to assess the severity of portal hypertension; reliability criteria for measurement are needed.

METHODS:

We prospectively included 88 consecutive patients undergoing hepatic venous pressure gradient measurement (HVPG, reference standard) for portal hypertension. Liver stiffness (LS) was measured by RT-SWE and by transient elastography (TE). Spleen stiffness (SS) was measured by RT-SWE. Reliability criteria for RT-SWE were searched, and the accuracy of these techniques to identify HVPG ⩾10mmHg (clinically significant portal hypertension, CSPH) was tested and internally validated by bootstrapping analysis.

RESULTS:

LS and SS by RT-SWE were feasible respectively in 87 (99%) and 58 (66%) patients. Both correlated with HVPG (LS: R=0.611, p<0.0001 and SS: R=0.514, p<0.0001). LS performed well for diagnosing CSPH (optimism corrected AUROC=0.858). Reliability of measurements was influenced by standard deviation (SD)/median ratio and depth. SD/median ⩽0.10 and depth of measurement <5.6cm were associated to 96.3% well classified for CSPH, while when one or none of the criteria were fulfilled the rates were 76.4% and 44.4%, respectively. Measurements fulfilling at least one criterion were considered acceptable; in these patients, RT-SWE performance to detect CSPH was excellent (AUROC=0.939; 95% CI: 0.865-1.000; p<0.0001; best cut-off: 15.4kPa). LS by RT-SWE and by TE were strongly correlated (R=0.795, p<0.0001) and performed similarly both in "per protocol" and in "intention-to-diagnose" analysis after applying reliability criteria.

CONCLUSIONS:

LS by RT-SWE is an accurate method to diagnose CSPH if reliability criteria (SD/median ⩽0.10 and/or depth <5.6cm) are fulfilled.

• Authors: Bogdan Procopet, Annalisa Berzigotti, Juan G Abraldes, Fanny Turon, Virginia Hernandez-Gea, Juan Carlos García-Pagán, Jaime Bosch
• Journal: Journal of hepatology (J Hepatol) Vol. 62 Issue 5 Pg. 1068-75 (May 2015) ISSN: 1600-0641 [Electronic] Netherlands
• PMID: 25514554 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Topics

• Aged
• Dimensional Measurement Accuracy
• Elasticity Imaging Techniques (methods)
• Female
• Humans
• Hypertension, Portal (diagnosis, physiopathology)
• Liver (pathology, physiopathology)
• Male
• Middle Aged
• Portal Pressure
• Portal System (diagnostic imaging, physiopathology)
• Reproducibility of Results
• Severity of Illness Index
• Spleen (pathology, physiopathology)