Shear-wave elastography: a noninvasive tool for monitoring changing hepatic venous pressure gradients in patients with cirrhosis.

Abstract

PURPOSE: To investigate whether liver stiffness ( LS liver stiffness ) and change

in LS liver stiffness measurements ( DeltaLS change in LS ) at shear-wave

elastography ( SWE shear-wave elastography ) correlates with the hepatic venous

pressure gradient ( HVPG hepatic venous pressure gradient ) and to assess the

feasibility of using SWE shear-wave elastography to estimate the change in HVPG

hepatic venous pressure gradient ( DeltaHVPG change in HVPG ) in patients with

portal hypertension. MATERIALS AND METHODS: Institutional review board approval

was obtained, with waiver of informed consent. Between September 2010 and October

2012, 97 consecutive patients who were given a diagnosis of portal hypertension

on the basis of HVPG hepatic venous pressure gradient measurement were included.

Among these patients, 23 who underwent follow-up HVPG hepatic venous pressure

gradient measurement to evaluate response to treatment were included in the

follow-up group. The correlation between HVPG hepatic venous pressure gradient

and LS liver stiffness was analyzed by using the Pearson correlation test. In the

follow-up group, whether DeltaHVPG change in HVPG was correlated with DeltaLS

change in LS was also evaluated. Thereafter, the areas under the receiver

operating characteristic curves ( AUC area under the ROC curve s) were calculated

to determine the diagnostic performances of DeltaLS change in LS and the second

LS liver stiffness measurement after medical treatment and to compare their

performances in association with clinical improvement and aggravation of portal

hypertension. RESULTS: LS liver stiffness was moderately correlated with HVPG

hepatic venous pressure gradient (r = 0.593) in the single-measurement group.

There was also a strong correlation between DeltaLS change in LS and DeltaHVPG

change in HVPG (r = 0.863). At comparison of the second LS liver stiffness

measurement, DeltaLS change in LS showed no significant difference in AUC area

under the ROC curve in patients with improvement (0.627 vs 0.794, P = .201) but

showed higher AUC area under the ROC curve in association with aggravation of

portal hypertension (0.925 vs 0.611, P = .026). CONCLUSION: Estimating DeltaHVPG

change in HVPG by using SWE shear-wave elastography may be useful in patients

with cirrhosis and portal hypertension.