Maja Thiele1,2, Mie B Hugger1,2, Yongsoo Kim3, Pierre-Emmanuel Rautou4,5,6, Laure Elkrief4,5,6, Christian Jansen7, Wim Verlinden8, Giulia Allegretti9, Mads Israelsen1,2, Horia Stefanescu10, Fabio Piscaglia9, Juan C García-Pagán11, Sven Franque8, Annalisa Berzigotti12, Laurent Castera4,13, Woo K Jeong14, Jonel Trebicka1,7,12,15, Aleksander Krag1,2. 1. Department of Gastroenterology and Hepatology and OPEN Patient Data Explorative Network, Odense University Hospital, Odense, Denmark. 2. Department of Clinical Research, University of Southern Denmark, Odense, Denmark. 3. Department of Radiology, College of Medicine, Hanyang University Guri Hospital, Gyeonggi-do, Korea. 4. Centre de recherche sur l'inflammation, Inserm, Université de Paris, Paris, France. 5. Service d'Hépatologie, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France. 6. Centre de Référence des Maladies Vasculaires du Foie, French Network for Rare Liver Diseases (FILFOIE), European Reference Network (ERN) 'Rare-Liver', Paris, France. 7. Department of Internal Medicine I, University of Bonn, Bonn, Germany. 8. Department of Gastroenterology Hepatology, University Hospital Antwerp & Translational Sciences in Inflammation and Immunology TWI2N, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium. 9. Unit of Internal Medicine, Hospital S.Orsola-Malpighi, University of Bologna, Bologna, Italy. 10. Liver Unit, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. 11. Barcelona Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clínic, Institut de Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and CIBEREHD, University of Barcelona, Barcelona, Spain. 12. Hepatology, UVCM, Inselspital, University of Bern, Bern, Switzerland. 13. Hepatogastroenterology Unit, CHU de Tours, Tours, France. 14. Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 15. Translational Hepatology, Medical Department I, Goethe University Clinic, Frankfurt, Germany.
Abstract
BACKGROUND & AIMS: Liver stiffness measured with 2-dimensional shear wave elastography by Supersonic Imagine (2DSWE-SSI) is well-established for fibrosis diagnostics, but non-conclusive for portal hypertension. METHODS: We performed an individual patient data meta-analysis of 2DSWE-SSI to identify clinically significant portal hypertension (CSPH), severe portal hypertension and large varices in cirrhosis patients, using hepatic venous pressure gradient and upper endoscopy as reference. We used meta-analytical integration of diagnostic accuracies with optimized rule-out (sensitivity-90%) and rule-in (specificity-90%) cut-offs. RESULTS: Five studies from seven centres shared data on 519 patients. After exclusion, we included 328 patients. Eighty-nine (27%) were compensated and 286 (87%) had CSPH. 2DSWE-SSI < 14 kPa ruled out CSPH with a summary AUROC (sROC), sensitivity and specificity of 0.88, 91% and 37%, and correctly classified 85% of patients, with minimal between-study heterogeneity. The false negative rate was 60%, of which decompensated patients accounted for 78%. 2DSWE-SSI ≥ 32 kPa ruled in CSPH with sROC, sensitivity, specificity and correct classifications of 0.83, 47%, 89% and 55%. In a subgroup analysis, the 14 kPa cut-off showed consistent sensitivity and higher specificity for patients with compensated cirrhosis, without ascites, viral aetiology or BMI < 25 kg/m2 . 2DSWE-SSI ruled out severe portal hypertension and large varices with fewer correctly classified and lower sROC, and with minimal benefit for ruling in. CONCLUSION: Liver stiffness using 2-dimensional shear wave elastography below 14 kPa may be used to rule out clinically significant portal hypertension in cirrhosis patients, but this would need validation in populations of compensated liver disease. 2DSWE-SSI cannot predict varices needing treatment.
BACKGROUND & AIMS:Liver stiffness measured with 2-dimensional shear wave elastography by Supersonic Imagine (2DSWE-SSI) is well-established for fibrosis diagnostics, but non-conclusive for portal hypertension. METHODS: We performed an individual patient data meta-analysis of 2DSWE-SSI to identify clinically significant portal hypertension (CSPH), severe portal hypertension and large varices in cirrhosispatients, using hepatic venous pressure gradient and upper endoscopy as reference. We used meta-analytical integration of diagnostic accuracies with optimized rule-out (sensitivity-90%) and rule-in (specificity-90%) cut-offs. RESULTS: Five studies from seven centres shared data on 519 patients. After exclusion, we included 328 patients. Eighty-nine (27%) were compensated and 286 (87%) had CSPH. 2DSWE-SSI < 14 kPa ruled out CSPH with a summary AUROC (sROC), sensitivity and specificity of 0.88, 91% and 37%, and correctly classified 85% of patients, with minimal between-study heterogeneity. The false negative rate was 60%, of which decompensated patients accounted for 78%. 2DSWE-SSI ≥ 32 kPa ruled in CSPH with sROC, sensitivity, specificity and correct classifications of 0.83, 47%, 89% and 55%. In a subgroup analysis, the 14 kPa cut-off showed consistent sensitivity and higher specificity for patients with compensated cirrhosis, without ascites, viral aetiology or BMI < 25 kg/m2 . 2DSWE-SSI ruled out severe portal hypertension and large varices with fewer correctly classified and lower sROC, and with minimal benefit for ruling in. CONCLUSION:Liver stiffness using 2-dimensional shear wave elastography below 14 kPa may be used to rule out clinically significant portal hypertension in cirrhosispatients, but this would need validation in populations of compensated liver disease. 2DSWE-SSI cannot predict varices needing treatment.
Authors: M Lunova; S Frankova; H Gottfriedova; R Senkerikova; M Neroldova; J Kovac; E Kieslichova; V Lanska; E Sticova; J Spicak; M Jirsa; J Sperl Journal: Physiol Res Date: 2021-06-01 Impact factor: 1.881
Authors: Oyekoya T Ayonrinde; Marilyn Zelesco; Christopher J Welman; Steven Abbott; Niwansa Adris Journal: Intern Med J Date: 2022-03-10 Impact factor: 2.611
Authors: Jonel Trebicka; Wenyi Gu; Victor de Ledinghen; Christophe Aubé; Aleksander Krag; Michael Praktiknjo; Laurent Castera; Jerome Dumortier; David Josef Maria Bauer; Mireen Friedrich-Rust; Stanislas Pol; Ivica Grgurevic; Rongqin Zheng; Sven Francque; Halima Gottfriedovà; Sanda Mustapic; Ioan Sporea; Annalisa Berzigotti; Frank Erhard Uschner; Benedikt Simbrunner; Maxime Ronot; Christophe Cassinotto; Maria Kjaergaard; Filipe Andrade; Martin Schulz; Georg Semmler; Ida Tjesic Drinkovic; Johannes Chang; Maximilian Joseph Brol; Pierre Emmanuel Rautou; Thomas Vanwolleghem; Christian P Strassburg; Jerome Boursier; Philip Georg Ferstl; Ditlev Nytoft Rasmussen; Thomas Reiberger; Valerie Vilgrain; Aymeric Guibal; Olivier Guillaud; Stefan Zeuzem; Camille Vassord; Xue Lu; Luisa Vonghia; Renata Senkerikova; Alina Popescu; Cristina Margini; Wenping Wang; Maja Thiele; Chrisitan Jansen Journal: Gut Date: 2021-01-21 Impact factor: 23.059