Non‐invasive evaluation of portal hypertension using shear‐wave elastography: analysis of two algorithms combining liver and spleen stiffness in 191 patients with cirrhosis

Summary Background Two algorithms based on sequential measurements of liver and spleen stiffness using two‐dimensional shearwave elastography (2D‐SWE) have been recently proposed to estimate clinically significant portal hypertension (hepatic venous pressure gradient [HVPG] ≥10 mm Hg) in patients wi...

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Published in:Alimentary pharmacology & therapeutics 2018-03, Vol.47 (5), p.621-630
Main Authors: Elkrief, L., Ronot, M., Andrade, F., Dioguardi Burgio, M., Issoufaly, T., Zappa, M., Roux, O., Bissonnette, J., Payancé, A., Lebrec, D., Francoz, C., Soubrane, O., Valla, D., Durand, F., Vilgrain, V., Castera, L., Rautou, P.‐E.
Format: Article
Language:English
Subjects:
Aged
Algorithms
Cirrhosis
Elasticity Imaging Techniques - methods
Female
Hardness - physiology
Hemorrhage
Humans
Hypertension
Hypertension, Portal - complications
Hypertension, Portal - diagnosis
Liver
Liver - diagnostic imaging
Liver - pathology
Liver cirrhosis
Liver Cirrhosis - complications
Liver Cirrhosis - diagnosis
Male
Mercury
Middle Aged
Portal Pressure
Reproducibility of Results
Sensitivity
Sensitivity and Specificity
Spleen
Spleen - diagnostic imaging
Spleen - pathology
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Summary:Summary Background Two algorithms based on sequential measurements of liver and spleen stiffness using two‐dimensional shearwave elastography (2D‐SWE) have been recently proposed to estimate clinically significant portal hypertension (hepatic venous pressure gradient [HVPG] ≥10 mm Hg) in patients with cirrhosis, with excellent diagnostic accuracy. Aim To validate externally these algorithms in a large cohort of patients with cirrhosis. Methods One hundred and ninety‐one patients with stable cirrhosis (Child‐Pugh class A 39%, B 29% and C 31%) who underwent liver and spleen stiffness measurements using 2D‐SWE at the time of HVPG measurement were included. Diagnostic accuracy of the 2 algorithms was assessed by calculating sensitivity, specificity, positive and negative predictive values. Results The first algorithm, using liver stiffness 27.9 kPa, was used to rule‐in HVPG ≥10 mm Hg. In our population, its specificity and positive predictive value were 52% and 83% respectively. Restricting the analyses to the 74 patients without any history of decompensation of cirrhosis or to the 65 patients with highly reliable liver stiffness measurement did not improve the results. Conclusion In our population, diagnostic accuracies of non‐invasive algorithms based on sequential measurements of liver and spleen stiffness using 2D‐SWE were acceptable, but not good enough to replace HVPG measurement or to base clinical decisions. Linked ContentThis article is linked to Thiele and Krag paper. To view this article visit https://doi.org/10.1111/apt.14536.
ISSN:0269-2813
1365-2036
DOI:10.1111/apt.14488