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.

Zusammenfassung

Ziel Klinisch signifikante portale Hypertonie (CSPH) ist für die meisten Komplikationen bei Patienten mit Zirrhose verantwortlich. Die Messung der Lebersteifigkeit (LS) mittels vibrationsgesteuerter transienter Elastografie (VCTE) wird derzeit zur Abschätzung einer CSPH verwendet. Die 2-dimensionale Scherwellenelastografie von General Electric (2D-SWE.GE) wurde für die Diagnose der PHT noch nicht validiert. Unser Ziel war es zu untersuchen, ob die LS mittels 2D-SWE.GE in der Lage ist, eine CSPH abzuschätzen, die Zuverlässigkeitskriterien der Methode zu bestimmen und ihre Treffsicherheit in diesem klinischen Anwendungsbereich mit der VCTE-LS zu vergleichen.

Material und Methoden Patienten mit chronischer Lebererkrankung, die für einen Lebervenendruckgradienten (HVPG) mittels Lebervenenkatheter vorgesehen wurden, wurden nacheinander eingeschlossen. HVPG und LS wurden sowohl mittels VCTE als auch 2D-SWE.GE am selben Tag durchgeführt. Die diagnostische Leistung jeder LS-Methode wurde mit dem HVPG sowie untereinander verglichen.

Ergebnisse 2D-SWE.GE-LS war bei 123/127 (96,90 %) Patienten durchführbar. Die Fähigkeit, mindestens 5 LS-Messungen mit 2D-SWE.GE und einer IQR < 30 % aufzuzeichnen, waren die einzigen Parameter, die zu zuverlässigen Ergebnissen führten. Die 2D-SWE.GE-LS korrelierte stark mit dem HVPG (r = 0,704; p < 0,0001), insbesondere bei HVPG < 1 mmHg, und war bei Patienten mit CSPH signifikant höher (15,52 vs. 8,14 kPa; p < 0,0001). Bei einen Cut-off von 11,3 kPa betrug die AUROC der 2D-SWE.GE-LS zum Nachweis einer CSPH 0,91, was der VCTE-LS nicht unterlegen war (0,92; p = 0,79). Die diagnostische Genauigkeit der LS mittels 2D-SWE.GE-LS zur Erkennung von einer CSPH war ähnlich wie bei VCTE-LS (83,74 % gegenüber 85,37 %; p = 0,238). Die diagnostische Genauigkeit wurde durch den Einsatz unterschiedlicher Cut-offs, die die Sensitivität oder Spezifität erhöhten, nicht verbessert. In der Untergruppe der kompensierten Patienten mit alkoholbedingter Lebererkrankung klassifizierte die 2D-SWE.GE-LS eine CSPH jedoch besser als die VCTE-LS (93,33 % gegenüber 85,71 %, p = 0,039).

Schlussfolgerung Für die Diagnose der CSPH zeigt die 2D-SWE.GE-LS eine gute Treffsicherheit – diese ist nicht schlechter als die der VCTE-LS.

Key words

liver stiffness - ultrasound elastography - portal hypertension - noninvasive

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