Shear wave elastography prior to transjugular intrahepatic portosystemic shunt may predict the decrease in hepatic vein pressure gradient
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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.
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.
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.
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.
KeywordsARFI Acoustic radiation force impulse imaging elastography TIPS Transjugular intrahepatic portosystemic shunt Spleen stiffness Liver stiffness
Transjugular intrahepatic portosystemic shunt
Liver stiffness measurement
Spleen stiffness measurement
Acoustic radiation force impulse imaging
Hepatic venous pressure gradient
Area under the curve
Clinical significant portal hypertension
Portal vein velocity
Maximal flow velocity
Deutsche Gesellschaft für Ultraschall in der Medizin (German Association for ultrasound in medicine
Region of interest
Model of end-stage liver disease
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
Andrej Potthoff and Michael Gebel received lecture fees supported by Siemens Healthineers AG (Erlangen, Germany).