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Shear wave elastography prior to transjugular intrahepatic portosystemic shunt may predict the decrease in hepatic vein pressure gradient

  • Dina Attia
  • Thomas Rodt
  • Steffen Marquardt
  • Jan Hinrichs
  • Bernhard C. Meyer
  • Michael Gebel
  • Frank Wacker
  • Michael P. Manns
  • Andrej Potthoff
Article
  • 22 Downloads

Abstract

Background

Transjugular intrahepatic portosystemic shunt (TIPS) is a procedure used to treat portal hypertension complications. Our aim was to evaluate liver and spleen stiffness measurement (LSM and SSM, respectively) changes using acoustic radiation force impulse imaging (ARFI) in comparison to Child–Pugh scores for predicting hepatic venous pressure gradient (HVPG) decreases after TIPS implantation.

Methods

This prospective study included 31 consecutive clinically significant portal hypertension patients with TIPS indication. All patients received LSM and SSM before TIPS, at baseline, 2 days (follow-up 1) and 6 weeks (follow-up 2) post-implantation. HVPG was performed during the TIPS procedure.

Results

The mean decrease in HVPG after TIPS was 63%. LSM and SSM decreased significantly between baseline and follow-up 2 (p < 0.001 and p < 0.001, respectively). At baseline, follow-up 1 and follow-up 2, significant correlations were detected between mean SSM and mean HVPG (p = 0.026; p = 0.018; p = 0.002, respectively). HVPG decreased to ≤ 10 mmHg in 61% of patients for which LSM, SSM, and Child–Pugh score were predictors (p = 0.033, p = 0.002 and p = 0.030, respectively). The area under the curve (AUC) for LSM, SSM, and Child–Pugh was 0.88, 0.90, and 0.84, respectively, with close sensitivity and specificity. SSM had the highest diagnostic accuracy for predicting an HVPG decrease to ≤ 10 mmHg in comparison to LSM and Child–Pugh score.

Conclusion

Spleen stiffness is superior to liver stiffness and Child–Pugh score as a non-invasive surveillance tool for evaluating patients with clinically significant portal hypertension (HVPG ≥ 10 mmHg) prior to TIPS.

Keywords

ARFI Acoustic radiation force impulse imaging elastography TIPS Transjugular intrahepatic portosystemic shunt Spleen stiffness Liver stiffness 

Abbreviations

TIPS

Transjugular intrahepatic portosystemic shunt

LSM

Liver stiffness measurement

SSM

Spleen stiffness measurement

ARFI

Acoustic radiation force impulse imaging

HVPG

Hepatic venous pressure gradient

AUC

Area under the curve

TE

Transient elastography

CSPH

Clinical significant portal hypertension

FU

Follow-up

PVV

Portal vein velocity

Tmax

Maximal flow velocity

DEGUM

Deutsche Gesellschaft für Ultraschall in der Medizin (German Association for ultrasound in medicine

ROI

Region of interest

MELD

Model of end-stage liver disease

Notes

Author contributions

Dina Attia, Andrej Potthoff, Thomas Rodt, and Michael Gebel designed the concept of the study. Dina Attia and Andrej Potthoff wrote the manuscript, analyzed, and interpreted the data. All other authors collected the data. All authors reviewed the manuscript and approved the final version to be published.

Compliance with ethical standards

Funding

No funding.

Competing interests

Andrej Potthoff and Michael Gebel received lecture fees supported by Siemens Healthineers AG (Erlangen, Germany).

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Gastroenterology, Hepatology and EndocrinologyHannover Medical SchoolHannoverGermany
  2. 2.Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of MedicineBeni-Suef UniversityBeni-SuefEgypt
  3. 3.Department of Diagnostic and Interventional RadiologyHannover Medical SchoolHannoverGermany

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