Application of Ultrasound Elastography in Assessing Portal Hypertension

Man Zhang, Hongyu Jin, Jiazhi Cao, Ruyu Ren, Menglu Jia, Yi Yang, Xinyi Li, Ming Chen, Shen Li, Libin Huang, Wenwu Ling, Man Zhang, Hongyu Jin, Jiazhi Cao, Ruyu Ren, Menglu Jia, Yi Yang, Xinyi Li, Ming Chen, Shen Li, Libin Huang, Wenwu Ling

Abstract

Portal hypertension is a common manifestation in late-to-end-stage liver diseases and can cause severe complications such as ascites, hepatic encephalopathy, etc. However, an early diagnosis of portal hypertension is often difficult as it can be asymptomatic. Though the gold standard to diagnose portal hypertension is hepatic vein catheterization, ultrasound elastography is regarded as a noninvasive alternative that can be used to accurately predict portal hypertension and a few further complications such as gastro-esophageal varices. Since ultrasound elastography is available in most medical centers, and is cheaper and noninvasive, studying its function in predicting portal hypertension is of paramount importance. Therefore, this review generalized the results of recently published articles in order to establish the indicators that were related to diagnostic and prediction efficiency. Our study found that various technologies of ultrasound elastography could be used to predict portal hypertension with satisfactory diagnostic sensitivity, specificity, accuracy, and AUC. Meanwhile, we also recognized similar diagnostic efficiency of ultrasound elastography in gastro-esophageal varices.

Keywords: gastro-esophageal varices; liver stiffness measurement; portal hypertension; spleen stiffness measurement; ultrasound elastography.

Conflict of interest statement

The authors declare that they have no conflict of interest.

References

    1. Sun S.H., Eche T., Dorczynski C., Otal P., Revel-Mouroz P., Zadro C., Partouche E., Fares N., Maulat C., Bureau C., et al. Predicting death or recurrence of portal hypertension symptoms after TIPS procedures. Eur. Radiol. 2022;32:3346–3357. doi: 10.1007/s00330-021-08437-0.
    1. Pons M., Augustin S., Scheiner B., Guillaume M., Rosselli M., Rodrigues S.G., Stefanescu H., Ma M.M., Mandorfer M., Mergeay-Fabre M., et al. Noninvasive Diagnosis of Portal Hypertension in Patients With Compensated Advanced Chronic Liver Disease. Am. J. Gastroenterol. 2020;116:723–732. doi: 10.14309/ajg.0000000000000994.
    1. Guixé-Muntet S., Zhu C.-P., Xie W.-F., Gracia-Sancho J. Novel therapeutics for portal hypertension and fibrosis in chronic liver disease. Pharmacol. Ther. 2020;215:107626. doi: 10.1016/j.pharmthera.2020.107626.
    1. Tripathi D., Stanley A.J., Hayes P.C., Travis S., Armstrong M.J., Tsochatzis E.A., Rowe I.A., Roslund N., Ireland H., Lomax M., et al. Transjugular intrahepatic portosystemic stent-shunt in the management of portal hypertension. Gut. 2020;69:1173–1192. doi: 10.1136/gutjnl-2019-320221.
    1. Ono Y., Inoue Y., Kato T., Matsueda K., Oba A., Sato T., Ito H., Saiura A., Takahashi Y. Sinistral Portal Hypertension after Pancreaticoduodenectomy with Splenic Vein Resection: Pathogenesis and Its Prevention. Cancers. 2021;13:5334. doi: 10.3390/cancers13215334.
    1. Boike J.R., Thornburg B.G., Asrani S.K., Fallon M.B., Fortune B.E., Izzy M.J., Verna E.C., Abraldes J.G., Allegretti A.S., Bajaj J.S., et al. North American Practice-Based Recommendations for Transjugular Intrahepatic Portosystemic Shunts in Portal Hypertension. Clin. Gastroenterol. Hepatol. 2021;20:1636–1662.e36. doi: 10.1016/j.cgh.2021.07.018.
    1. Danielsen K.V., Hove J.D., Nabilou P., Yin M., Chen J., Zhao M., Kallemose T., Teisner A.S., Siebner H.R., Ehman R.L., et al. Using MR elastography to assess portal hypertension and response to beta-blockers in patients with cirrhosis. Liver Int. 2021;41:2149–2158. doi: 10.1111/liv.14981.
    1. Hartl L., Jachs M., Desbalmes C., Schaufler D., Simbrunner B., Paternostro R., Schwabl P., Bauer D.J.M., Semmler G., Scheiner B., et al. The differential activation of cardiovascular hormones across distinct stages of portal hypertension predicts clinical outcomes. Hepatol. Int. 2021;15:1160–1173. doi: 10.1007/s12072-021-10203-9.
    1. Selicean S., Wang C., Guixé-Muntet S., Stefanescu H., Kawada N., Gracia-Sancho J. Regression of portal hypertension: Underlying mechanisms and therapeutic strategies. Hepatol. Int. 2021;15:36–50. doi: 10.1007/s12072-021-10135-4.
    1. Mohanty A., Eshein A., Kamineni P., Avissar U., Bliss C.M., Long M.T., Lowe R.C., Moore T.C., Nunes D.P., Backman V., et al. Quantification of gastric mucosal microcirculation as a surrogate marker of portal hypertension by spatially resolved subdiffuse reflectance spectroscopy in diagnosis of cirrhosis: A proof-of-concept study. Gastrointest. Endosc. 2021;94:60–67.e1. doi: 10.1016/j.gie.2020.12.037.
    1. Paternostro R., Bardach C., Hofer B.S., Scheiner B., Schwabl P., Asenbaum U., Ba-Ssalamah A., Scharitzer M., Bucscis T., Simbrunner B., et al. Prognostic impact of sarcopenia in cirrhotic patients stratified by different severity of portal hypertension. Liver Int. 2020;41:799–809. doi: 10.1111/liv.14758.
    1. Wöran K., Semmler G., Jachs M., Simbrunner B., Bauer D.J.M., Binter T., Pomej K., Stättermayer A.F., Schwabl P., Bucsics T., et al. Clinical Course of Por-to-Sinusoidal Vascular Disease Is Distinct From Idiopathic Noncirrhotic Portal Hypertension. Clin. Gastroenterol. Hepatol. 2022;20:e251–e266. doi: 10.1016/j.cgh.2020.11.039.
    1. Baffy G., Bosch J. Overlooked subclinical portal hypertension in non-cirrhotic NAFLD: Is it real and how to measure it? J. Hepatol. 2021;76:458–463. doi: 10.1016/j.jhep.2021.09.029.
    1. Lesmana C.R.A., Paramitha M.S., Gani R.A., Lesmana L.A. The role of endoscopic ultrasound for portal hypertension in liver cirrhosis. J. Med. Ultrason. 2021;49:359–370. doi: 10.1007/s10396-021-01165-4.
    1. Shao Y., Yin X., Qin T., Zhang R., Zhang Y., Wen X. Prevalence and Associated Factors of Portopulmonary Hypertension in Patients with Portal Hypertension: A Case-Control Study. BioMed Res. Int. 2021;2021:5595614. doi: 10.1155/2021/5595614.
    1. Gibiino G., Garcovich M., Ainora M.E., A Zocco M. Spleen ultrasound elastography: State of the art and future directions—A systematic review. Eur. Rev. Med. Pharmacol. Sci. 2019;23:4368–4381.
    1. Ferraioli G., Wong V.W., Castera L., Berzigotti A., Sporea I., Dietrich C.F., Choi B.I., Wilson S.R., Kudo M., Barr R.G. Liver Ultrasound Elastography: An Update to the World Federation for Ultrasound in Medicine and Biology Guidelines and Recommendations. Ultrasound Med. Biol. 2018;44:2419–2440. doi: 10.1016/j.ultrasmedbio.2018.07.008.
    1. Piscaglia F., Marinelli S., Bota S., Serra C., Venerandi L., Leoni S., Salvatore V. The role of ultrasound elastographic techniques in chronic liver disease: Current status and future perspectives. Eur. J. Radiol. 2013;83:450–455. doi: 10.1016/j.ejrad.2013.06.009.
    1. Mulazzani L., Salvatore V., Ravaioli F., Allegretti G., Matassoni F., Granata R., Ferrarini A., Stefanescu H., Piscaglia F. Point shear wave ultrasound elastography with Esaote compared to real-time 2D shear wave elastography with supersonic imagine for the quantification of liver stiffness. J. Ultrasound. 2017;20:213–225. doi: 10.1007/s40477-017-0260-7. Erratum in J. Ultrasound 2018, 21, 169.
    1. Grgurević I., Bokun T., Mustapić S., Trkulja V., Heinzl R., Banić M., Puljiz Ž., Lukšić B., Kujundžić M. Real-time two-dimensional shear wave ultrasound elastography of the liver is a reliable predictor of clinical outcomes and the presence of esophageal varices in patients with compensated liver cirrhosis. Croat. Med. J. 2015;56:470–481. doi: 10.3325/cmj.2015.56.470.
    1. Semmler G., Lens S., Meyer E.L., Baiges A., Alvarado-Tapias E., Llop E., Tellez L., Schwabl P., Mauro E., Escudé L., et al. Non-invasive tests for clinically significant portal hypertension after HCV cure. J. Hepatol. 2022. in press .
    1. Elkrief L., Lazareth M., Chevret S., Paradis V., Magaz M., Blaise L., Rubbia-Brandt L., Moga L., Durand F., Payancé A., et al. Liver Stiffness by Transient Elastography to Detect Por-to-Sinusoidal Vascular Liver Disease with Portal Hypertension. Hepatology. 2021;74:364–378. doi: 10.1002/hep.31688.
    1. Shneider B.L., Goodrich N.P., Ye W., Sawyers C., Molleston J.P., Merion R.M., Leung D.H., Karpen S.J., Kamath B.M., Cavallo L., et al. Nonfasted Liver Stiffness Correlates with Liver Disease Parameters and Portal Hypertension in Pediatric Cholestatic Liver Disease. Hepatol. Commun. 2020;4:1694–1707. doi: 10.1002/hep4.1574.
    1. Souhami A., Sartoris R., Rautou P.E., Cauchy F., Bouattour M., Durand F., Giannelli V., Gigante E., Castera L., Valla D., et al. Similar performance of liver stiffness measurement and liver surface nodularity for the detection of portal hypertension in patients with hepatocellular carcinoma. JHEP Rep. 2020;2:100147. doi: 10.1016/j.jhepr.2020.100147.
    1. Stefanescu H., Rusu C., Lupsor-Platon M., Farcau O.N., Fischer P., Grigoras C., Horhat A., Stancu O., Ardelean A., Tantau M., et al. Liver Stiffness Assessed by Ultrasound Shear Wave Elastography from General Electric Accurately Predicts Clinically Significant Portal Hypertension in Patients with Advanced Chronic Liver Disease. Ultraschall Med. Eur. J. Ultrasound. 2019;41:526–533. doi: 10.1055/a-0965-0745.
    1. Dajti E., Ravaioli F., Colecchia A., Marasco G., Vestito A., Festi D. Liver and Spleen Stiffness Measurements for Assessment of Portal Hypertension Severity in Patients with Budd Chiari Syndrome. Can. J. Gastroenterol. Hepatol. 2019;2019:1673197. doi: 10.1155/2019/1673197.
    1. Song J., Ma Z., Huang J., Luo Y., Zykus R., Kumar A., Kitson M., Lu Q. Reliability of Transient Elastography-Based Liver Stiffness for Diagnosing Portal Hypertension in Patients with Alcoholic Liver Disease: A Diagnostic Meta-Analysis with Specific Cut-Off Values. Ultraschall Med. Eur. J. Ultrasound. 2019;41:60–68. doi: 10.1055/a-0731-0178.
    1. Zhu Y.L., Ding H., Fu T.T., Peng S.Y., Chen S.Y., Luo J.J., Wang W.P. Portal hypertension in hepatitis B-related cirrhosis: Diagnostic accuracy of liver and spleen stiffness by 2-D shear-wave elastography. Hepatol. Res. 2019;49:540–549. doi: 10.1111/hepr.13306.
    1. Tseng Y., Li F., Wang J., Chen S., Jiang W., Shen X., Wu S. Spleen and liver stiffness for noninvasive assessment of portal hypertension in cirrhotic patients with large esophageal varices. J. Clin. Ultrasound. 2018;46:442–449. doi: 10.1002/jcu.22635.
    1. Song J., Ma Z., Huang J., Liu S., Luo Y., Lu Q., Schwabl P., Zykus R., Kumar A., Kitson M. Comparison of three cut-offs to diagnose clinically significant portal hypertension by liver stiffness in chronic viral liver diseases: A meta-analysis. Eur. Radiol. 2018;28:5221–5230. doi: 10.1007/s00330-018-5478-z.
    1. Elkrief L., Ronot M., Andrade F., Dioguardi Burgio M., Issoufaly T., Zappa M., Roux O., Bissonnette J., Payancé A., Lebrec D., et al. Non-invasive evaluation of portal hypertension using shear-wave elastography: Analysis of two algorithms combining liver and spleen stiffness in 191 patients with cirrhosis. Aliment. Pharmacol. Ther. 2018;47:621–630. doi: 10.1111/apt.14488.
    1. Yoon H.M., Kim S.Y., Kim K.M., Oh S.H., Ko G.-Y., Park Y., Lee J.S., Jung A.Y., Cho Y.A. Liver Stiffness Measured by Shear-wave Elastography for Evaluating Intrahepatic Portal Hypertension in Children. J. Pediatr. Gastroenterol. Nutr. 2017;64:892–897. doi: 10.1097/MPG.0000000000001517.
    1. Zykus R., Jonaitis L., Petrenkienė V., Pranculis A., Kupčinskas L. Liver and spleen transient elastography predicts portal hypertension in patients with chronic liver disease: A prospective cohort study. BMC Gastroenterol. 2015;15:183. doi: 10.1186/s12876-016-0467-7. Erratum in BMC Gastroenterol. 2016, 16, 53.
    1. Colecchia A., Montrone L., Scaioli E., Reggiani M.L.B., Colli A., Casazza G., Schiumerini R., Turco L., Di Biase A.R., Mazzella G., et al. Measurement of Spleen Stiffness to Evaluate Portal Hypertension and the Presence of Esophageal Varices in Patients With HCV-Related Cirrhosis. Gastroenterology. 2012;143:646–654. doi: 10.1053/j.gastro.2012.05.035.
    1. Attia D., Schoenemeier B., Rodt T., Negm A.A., Lenzen H., Lankisch T.O., Manns M., Gebel M., Potthoff A. Evaluation of Liver and Spleen Stiffness with Acoustic Radiation Force Impulse Quantification Elastography for Diagnosing Clinically Significant Portal Hypertension. Ultraschall Med. 2015;36:603–610. doi: 10.1055/s-0041-107971.
    1. Procopet B., Berzigotti A., Abraldes J.G., Turon F., Hernandez-Gea V., Gárcia-Pagán J.C., Bosch J. Real-time shear-wave elastography: Applicability, reliability and accuracy for clinically significant portal hypertension. J. Hepatol. 2015;62:1068–1075. doi: 10.1016/j.jhep.2014.12.007.
    1. Lee C.-M., Jeong W.K., Lim S., Kim Y., Kim J., Kim T.Y., Sohn J.H. Diagnosis of Clinically Significant Portal Hypertension in Patients with Cirrhosis: Splenic Arterial Resistive Index versus Liver Stiffness Measurement. Ultrasound Med. Biol. 2016;42:1312–1320. doi: 10.1016/j.ultrasmedbio.2016.01.026.
    1. Schwabl P., Bota S., Salzl P., Mandorfer M., Payer B.A., Ferlitsch A., Stift J., Wrba F., Trauner M., Peck-Radosavljevic M., et al. New reliability criteria for transient elastography increase the number of accurate measurements for screening of cirrhosis and portal hypertension. Liver Int. 2014;35:381–390. doi: 10.1111/liv.12623.
    1. Llop E., Lopez M., De La Revilla J., Fernandez N., Trapero M., Hernandez M., Fernández-Carrillo C., Pons F., Martinez J.L., Calleja J.L. Validation of noninvasive methods to predict the presence of gastroesophageal varices in a cohort of patients with compensated advanced chronic liver disease. J. Gastroenterol. Hepatol. 2017;32:1867–1872. doi: 10.1111/jgh.13781.
    1. Lemoine M., Katsahian S., Ziol M., Nahon P., Ganne-Carrie N., Kazemi F., Grando-Lemaire V., Trinchet J.-C., Beaugrand M. Liver stiffness measurement as a predictive tool of clinically significant portal hypertension in patients with compensated hepatitis C virus or alcohol-related cirrhosis. Aliment. Pharmacol. Ther. 2008;28:1102–1110. doi: 10.1111/j.1365-2036.2008.03825.x.
    1. Vizzutti F., Arena U., Romanelli R.G., Rega L., Foschi M., Colagrande S., Petrarca A., Moscarella S., Belli G., Zignego A.L., et al. Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatology. 2007;45:1290–1297. doi: 10.1002/hep.21665.
    1. Sánchez-Conde M., Miralles P., Bellón J.M., Rincón D., Ramírez M., Gutiérrez I., Ripoll C., López J.C., Cosín J., Clemente G., et al. Use of transient elastography (FibroScan®) for the noninvasive assessment of portal hypertension in HIV/HCV-coinfected patients. J. Viral Hepat. 2011;18:685–691. doi: 10.1111/j.1365-2893.2010.01371.x.
    1. Reiberger T., Ferlitsch A., Payer B.A., Pinter M., Schwabl P., Stift J., Trauner M., Peck-Radosavljevic M. Noninvasive screening for liver fibrosis and portal hypertension by transient elastography—A large single center experience. Wien. Klin. Wochenschr. 2012;124:395–402. doi: 10.1007/s00508-012-0190-5.
    1. Sharma P., Kirnake V., Tyagi P., Bansal N., Singla V., Kumar A., Arora A. Spleen stiffness in patients with cirrhosis in predicting esophageal varices. Am. J. Gastroenterol. 2013;108:1101–1107. doi: 10.1038/ajg.2013.119.
    1. Friedrich-Rust M., Poynard T., Castera L. Critical comparison of elastography methods to assess chronic liver disease. Nat. Rev. Gastroenterol. Hepatol. 2016;13:402–411. doi: 10.1038/nrgastro.2016.86.
    1. European Association for Study of Liver. Asociacion Latinoamericana para el Estudio del Higado EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J. Hepatol. 2015;63:237–264. doi: 10.1016/j.jhep.2015.04.006.
    1. Ferraioli G., Filice C., Castera L., Choi B.I., Sporea I., Wilson S.R., Cosgrove D., Dietrich C.F., Amy D., Bamber J.C., et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: Liver. Ultrasound Med. Biol. 2015;41:1161–1179. doi: 10.1016/j.ultrasmedbio.2015.03.007.
    1. Cosgrove D., Piscaglia F., Bamber J., Bojunga J., Correas J.M., Gilja O.H., Klauser A.S., Sporea I., Calliada F., Cantisani V., et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall Med. 2013;34:238–253. doi: 10.1055/s-0033-1335375.
    1. Mejias M., Garcia-Pras E., Gallego J., Mendez R., Bosch J., Fernandez M. Relevance of the mTOR signaling pathway in the pathophysiology of splenomegaly in rats with chronic portal hypertension. J. Hepatol. 2010;52:529–539. doi: 10.1016/j.jhep.2010.01.004.
    1. Piscaglia F., Donati G., Cecilioni L., Celli N., Stagni B., Pini P., Gaiani S., Gherlinzoni F., Bolondi L. Influence of the spleen on portal haemodynamics: A non-invasive study with Doppler ultrasound in chronic liver disease and haematological disorders. Scand. J. Gastroenterol. 2002;37:1220–1227. doi: 10.1080/003655202760373452.
    1. Reiberger T. The Value of Liver and Spleen Stiffness for Evaluation of Portal Hypertension in Compensated Cirrhosis. Hepatol. Commun. 2021;6:950–964. doi: 10.1002/hep4.1855.
    1. Dajti E., Marasco G., Ravaioli F., Colecchia L., Ferrarese A., Festi D., Colecchia A. Risk of hepatocellular carcinoma after HCV eradication: Determining the role of portal hypertension by measuring spleen stiffness. JHEP Rep. 2021;3:100289. doi: 10.1016/j.jhepr.2021.100289.
    1. Hu X., Huang X., Hou J., Ding L., Su C., Meng F. Diagnostic accuracy of spleen stiffness to evaluate portal hypertension and esophageal varices in chronic liver disease: A systematic review and meta-analysis. Eur. Radiol. 2021;31:2392–2404. doi: 10.1007/s00330-020-07223-8. Erratum in Eur. Radiol. 2021, 31, 4396–4399.
    1. Giuffrè M., Bedogni G., Abazia C., Masutti F., Tiribelli C., Crocè L.S. Spleen stiffness can be employed to assess the efficacy of spontaneous portosystemic shunts in relieving portal hypertension. Ann. Hepatol. 2020;19:691–693. doi: 10.1016/j.aohep.2020.07.004.
    1. Yuldashev R.Z., Aliev M.M., Shokhaydarov S.I., Tursunova D.B. Spleen stiffness measurement as a non-invasive test to evaluate and monitor portal hypertension in children with extrahepatic portal vein obstruction. Pediatr. Surg. Int. 2020;36:637–641. doi: 10.1007/s00383-020-04648-6.
    1. Ahmad A.K., Atzori S., Taylor-Robinson S.D., Maurice J.B., Cooke G.S., Garvey L. Spleen stiffness measurements using point shear wave elastography detects noncirrhotic portal hypertension in human immunodeficiency virus. Medicine. 2019;98:e17961. doi: 10.1097/MD.0000000000017961.
    1. Ravaioli F., Colecchia A., Dajti E., Marasco G., Alemanni L.V., Tamè M., Azzaroli F., Brillanti S., Mazzella G., Festi D. Spleen stiffness mirrors changes in portal hypertension after successful interferon-free therapy in chronic-hepatitis C virus patients. World J. Hepatol. 2018;10:731–742. doi: 10.4254/wjh.v10.i10.731.
    1. Song J., Huang J., Huang H., Liu S., Luo Y. Performance of spleen stiffness measurement in prediction of clinical significant portal hypertension: A meta-analysis. Clin. Res. Hepatol. Gastroenterol. 2018;42:216–226. doi: 10.1016/j.clinre.2017.11.002.
    1. Calvaruso V., Bronte F., Conte E., Simone F., Craxì A., Di Marco V. Modified spleen stiffness measurement by transient elastography is associated with presence of large oesophageal varices in patients with compensated hepatitis C virus cirrhosis. J. Viral Hepat. 2013;20:867–874. doi: 10.1111/jvh.12114.
    1. Takuma Y., Nouso K., Morimoto Y., Tomokuni J., Sahara A., Takabatake H., Matsueda K., Yamamoto H. Portal Hypertension in Patients with Liver Cirrhosis: Diagnostic Accuracy of Spleen Stiffness. Radiology. 2016;279:609–619. doi: 10.1148/radiol.2015150690.
    1. Jansen C., Bogs C., Verlinden W., Thiele M., Möller P., Görtzen J., Lehmann J., Vanwolleghem T., Vonghia L., Praktiknjo M., et al. Shear-wave elastography of the liver and spleen identifies clinically significant portal hypertension: A prospective multicentre study. Liver Int. 2016;37:396–405. doi: 10.1111/liv.13243.
    1. Wong G.L., Kwok R., Chan H.L., Tang S.P., Lee E., Lam T.C., Lau T.W., Ma T.M., Wong B.C., Wong V.W. Measuring spleen stiff-ness to predict varices in chronic hepatitis B cirrhotic patients with or without receiving non-selective beta-blockers. J. Dig. Dis. 2016;17:538–546. doi: 10.1111/1751-2980.12359.
    1. Hirooka M., Ochi H., Koizumi Y., Kisaka Y., Abe M., Ikeda Y., Matsuura B., Hiasa Y., Onji M. Splenic Elasticity Measured with Real-time Tissue Elastography Is a Marker of Portal Hypertension. Radiology. 2011;261:960–968. doi: 10.1148/radiol.11110156.
    1. Vermehren J., Polta A., Zimmermann O., Herrmann E., Poynard T., Hofmann W.-P., Bojunga J., Sarrazin C., Zeuzem S., Friedrich-Rust M. Comparison of acoustic radiation force impulse imaging with transient elastography for the detection of complications in patients with cirrhosis. Liver Int. 2011;32:852–858. doi: 10.1111/j.1478-3231.2011.02736.x.
    1. Rizzo L., Attanasio M., Pinzone M.R., Berretta M., Malaguarnera M., Morra A., L’Abbate L., Balestreri L., Nunnari G., Cacopardo B. A new sampling method for spleen stiffness measurement based on quantitative acoustic radiation force impulse elastography for noninvasive assessment of esophageal varices in newly diagnosed HCV-related cirrhosis. BioMed Res. Int. 2014;2014:365982. doi: 10.1155/2014/365982.
    1. Cassinotto C., Charrie A., Mouries A., Lapuyade B., Hiriart J.-B., Vergniol J., Gaye D., Hocquelet A., Charbonnier M., Foucher J., et al. Liver and spleen elastography using supersonic shear imaging for the non-invasive diagnosis of cirrhosis severity and oesophageal varices. Dig. Liver Dis. 2015;47:695–701. doi: 10.1016/j.dld.2015.04.008.
    1. Elkrief L., Rautou P.-E., Ronot M., Lambert S., Burgio M.D., Francoz C., Plessier A., Durand F., Valla D., Lebrec D., et al. Prospective Comparison of Spleen and Liver Stiffness by Using Shear-Wave and Transient Elastography for Detection of Portal Hypertension in Cirrhosis. Radiology. 2015;275:589–598. doi: 10.1148/radiol.14141210.
    1. Bota S., Sporea I., Sirli R., Focsa M., Popescu A., Danila M., Strain M. Can ARFI elastography predict the presence of significant esophageal varices in newly diagnosed cirrhotic patients? Ann. Hepatol. 2012;11:519–525. doi: 10.1016/S1665-2681(19)31466-8.
    1. Yan Y., Xing X., Wang X., Yang L. Liver stiffness by two-dimensional shear wave elastography for screening high-risk varices in patients with compensated advanced chronic liver disease. Eur. Radiol. 2021;32:2078–2088. doi: 10.1007/s00330-021-08280-3.
    1. Fofiu R., Bende F., Lupuşoru R., Roxana Şirli Popescu A., Sporea I. Spleen Stiffness for Predicting Varices Needing Treatment: Comparison between Two Different Elastography Techniques (Point vs. 2D-SWE) Can. J. Gastroenterol. Hepatol. 2021;2021:6622726. doi: 10.1155/2021/6622726.
    1. Zhou H., Zhang Z., Zhang J., Sang L., Liu L., Lv Y., Gong X., Yin Z., Sun Y., Han G., et al. Spleen Stiffness Performance in the Noninvasive Assessment of Gastroesophageal Varices after Transjugular Intrahepatic Portosystemic Shunts. BioMed Res. Int. 2021;2021:5530004. doi: 10.1155/2021/5530004.
    1. Vadlapudi S.S., Jagadisan B., Ananthkrishnan R., Narayanaswamy S. Splenic stiffness and platelet count to predict varices needing treatment in pediatric extrahepatic portal vein obstruction. Indian J. Gastroenterol. 2020;39:576–583. doi: 10.1007/s12664-020-01099-8.
    1. Muñoz-Codoceo C., Amo M., Martín A., Martín-Arriscado Arroba C., Cuevas Del Campo L., Manzano M.L., Muñoz R., Cas-tellano G., Fernández I. Diagnostic accuracy of liver and spleen stiffness measured by fibroscan® in the prediction of esoph-ageal varices in HCV-related cirrhosis patients treated with oral antivirals. Gastroenterol. Hepatol. 2021;44:269–276. doi: 10.1016/j.gastrohep.2020.09.001.
    1. Fofiu R., Bende F., Popescu A., Şirli R., Lupușoru R., Ghiuchici A.-M., Sporea I. Spleen and Liver Stiffness for Predicting High-Risk Varices in Patients with Compensated Liver Cirrhosis. Ultrasound Med. Biol. 2020;47:76–83. doi: 10.1016/j.ultrasmedbio.2020.09.004.
    1. Liu Y., Tang T., Örmeci N., Huang Y., Wang J., Li X., Li Z., An W., Liu D., Zhang C., et al. Noncontrast-enhanced MRI-based Noninvasive Score for Portal Hypertension (CHESS1802): An International Multicenter Study. J. Clin. Transl. Hepatol. 2021;9:818–827. doi: 10.14218/JCTH.2021.00177.
    1. Catucci D., Obmann V.C., Berzigotti A., Gräni C., Guensch D.P., Fischer K., Ebner L., Heverhagen J.T., Christe A., Huber A.T. Noninvasive assessment of clinically significant portal hypertension using ΔT1 of the liver and spleen and ECV of the spleen on routine Gd-EOB-DTPA liver MRI. Eur. J. Radiol. 2021;144:109958. doi: 10.1016/j.ejrad.2021.109958.
    1. Machado P., Gupta I., Gummadi S., Stanczak M., Wessner C.E., Fenkel J.M., Shaw C.M., Shamini-Noori S., Schultz S., Soulen M.C., et al. Hepatic Vein Contrast-Enhanced Ultrasound Subharmonic Imaging Signal as a Screening Test for Portal Hypertension. Am. J. Dig. Dis. 2021;66:4354–4360. doi: 10.1007/s10620-020-06790-6.
    1. Gupta I., Eisenbrey J.R., Machado P., Stanczak M., Wessner C.E., Shaw C.M., Gummadi S., Fenkel J.M., Tan A., Miller C., et al. Diagnosing Portal Hypertension with Noninvasive Subharmonic Pressure Estimates from a US Contrast Agent. Radiology. 2021;298:104–111. doi: 10.1148/radiol.2020202677.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅