Evaluation of Liver and Spleen Stiffness with Acoustic Radiation Force Impulse Quantification Elastography for Diagnosing Clinically Significant Portal Hypertension

Abstract

Purpose: Hepatic vein pressure gradient (HVPG) is the gold standard for diagnosing clinically significant portal hypertension (CSPH). The aim of this study was to investigate—in comparison to HVPG—the ability to diagnose CSPH by liver and spleen stiffness measurements obtained by acoustic radiation force impulse (ARFI) imaging.

Materials and Methods: A total of 78 patients (mean age: 53 ± 13 years, 62 % male) with chronic liver disease were enrolled in this study. Each patient received liver (LSM) and spleen (SSM) stiffness measurements by ARFI, an HVPG measurement and a transjugular liver biopsy on the same day. Patients were classified according to their HVPG into three different groups: HVPG < 10 mmHg, HVPG ≥ 10–< 12 mmHg and HVPG ≥ 12 mmHg.

Results: LSM, SSM were significantly higher in patients with HVPG ≥ 10 – < 12 in comparison to HVPG < 10 mmHg (p < 0.001 and p < 0.001, respectively), and in patients with HVPG ≥ 12 mmHg in comparison to ≥ 10 – < 12 mmHg (p < 0.001 and p < 0.001, respectively). LSM and SSM were able to diagnose HVPG ≥ 10 mmHg and HVPG ≥ 12 mmHg with high diagnostic performance (AUC LSM: 0.93 and 0.87, respectively; AUC SSM: 0.97 and 0.95, respectively). The AUC of SSM in predicting esophageal varices (EVs) plus HVPG ≥ 10 mmHg and EVs plus HVPG ≥ 12 mmHg were higher compared to LSM in both groups of patients (SSM: 0.90 and 0.93 vs. LSM: 0.84 and 0.88, respectively). No significant difference between both AUCs was detected in the different HVPG groups. In the multivariate ­analysis SSM remained a factor predicting HVPG (HVPG > 10 mmHg p = 0.007; HVPG ≥ 12 mmHg p = 0.003).

Conclusion: LSM and SSM by ARFI are noninvasive diagnostic tools that may help in diagnosing CSPH. LSM and SSM could be used as a guiding noninvasive screening tool in patients with esophageal varices requiring endoscopic evaluation.

Zusammenfassung

Hintergrund: Die Lebervenenverschlussdruck-Messung (HVPG) stellt den Goldstandard für die Diagnose einer klinisch-signifikanten portalen Hypertension (CSPH) dar. Das Ziel der Studie lag darin zu evaluieren, inwiefern die Leber (LSM)- und Milz-Elastographie (SSM) mittels Acoustic Radiation Force Impulse Imaging (ARFI) geeignet ist, eine CSPH vorherzusagen.

Material und Methodik: Insgesamt wurden 78 Patienten (Alter: 53 ± 13 Jahre, 62 % männlich) mit einer chronischen Lebererkrankung in die Studie eingeschlossen. Bei allen Patienten wurden am selben Tag eine LSM und SSM mittels ARFI, eine HVPG-Messung und eine transjuguläre Leberbiopsie durchgeführt. In Abhängigkeit zu den HVPG-Ergebnissen wurden die Patienten in drei Gruppen eingeteilt: (1) HVPG < 10 mmHg, (2) HVPG ≥ 10–< 12 mmHg, (3) HVPG ≥ 12 mmHg.

Ergebnisse: Die Leber- und Milzsteife war bei Patienten mit einem HVPG ≥ 10 – < 12 signifikant höher als bei den Patienten mit einem HVPG < 10 mmHg (LSM: p < 0,001 und SSM: p < 0,001). Auch ein HVPG ≥ 12 mmHg ging im Vergleich zu einem HVPG ≥ 10 – < 12 mmHg mit signifikant höheren Werte für die LSM und SSM einher (p < 0,001 und p < 0,001). Ein HVPG ≥ 10 mmHg und ≥ 12 mmHg konnte sowohl durch die LSM, als auch durch die SSM mit einer hohen diagnostischen Genauigkeit vorhergesagt werden (AUC LSM: 0,93 und 0,87; AUC SSM: 0,97 und 0,95). Die AUC-Werte der SSM zur Vorhersage von Ösophagusvarizen + HVPG ≥ 10 mmHg und Ösophagusvarizen + HVPG ≥ 12 mmHg waren höher als die der LSM (SSM: 0,90 und 0,93 vs. LSM: 0,84 and 0,88). Innerhalb der verschiedenen HVPG-Gruppen konnte aber kein signifikanter Unterschied festgestellt werden. In der Multivarianz-Analyse war die SSM ein signifikanter Prädiktor für den HVPG (HVPG > 10mmHg, p = 0,007; HVPG ≥ 12 mmHg p = 0,003).

Schlussfolgerung: Die Leber- und Milzelastographie mittels ARFI sind hilfreiche nicht-invasive Verfahren für die Diagnose einer CSPH. Sie könnten zukünftig als Screening-Verfahren genutzt werden, um Patienten mit Ösophagusvarizen zu identifizieren, die einer endoskopischen Evaluation bedürfen.

Key words

HVPG - ARFI - portal hypertension - liver stiffness - spleen stiffness

^* These authors have contributed equally to this work.

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