Role of splenic hepatic elastography ratio in differentiating non-cirrhotic portal fibrosis and chronic liver disease in children and adolescents.

IF 5.9 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Hepatology International Pub Date : 2025-02-01 Epub Date: 2024-07-29 DOI:10.1007/s12072-024-10713-2

Piyush Upadhyay, Rajeev Khanna, Vikrant Sood, Bikrant Bihari Lal, Seema Alam

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引用次数: 0

Abstract

Background: Differentiation of Non-cirrhotic Portal Fibrosis (NCPF) from chronic liver disease (CLD) in children and adolescents with portal hypertension (PHT) is challenging especially in cases where liver stiffness measurement (LSM) and hepatic venous pressure gradient are higher. This objective of the current study was to evaluate the diagnostic accuracy of the splenic stiffness measurement (SSM)/LSM ratio in the diagnosis of NCPF.

Methods: From January 2019 to December 2023, consecutive children and adolescents of 6 months to 18 years of age with PHT (CLD and NCPF) were prospectively enrolled. Transient elastography (TE) for SSM and LSM, upper gastrointestinal endoscopy (UGIE), liver biopsy/trans-jugular liver biopsy, abdominal imaging, and laboratory evaluation were done. The relationship of TE parameters for diagnosis of NCPF and CLD was evaluated. Receiver-operating characteristic (ROC) statistics were applied using R Studio-4.2.2 statistical software.

Results: One hundred and forty seven with CLD and 27 patients with NCPF were evaluated. Median age was 10.0 (IQR 2.4-14.0) years; 68.4% were males. The AUROC of SSM/LSM ratio was better (0.992, 95%CI 0.982-1.0001) than LSM (0.945, 95%CI0.913-0.977) and SSM (0.626, 95%CI0.258-0.489) for the diagnosis of NCPF. SSM/LSM ratio cut-off of 3.67 predicted NCPF with an excellent sensitivity (100%), specificity (95.9%), and diagnostic accuracy (95.91%). The AUROC of SSM/LSM ratio was excellent and outperformed other TE parameters in the subgroups, i.e., LSM between 10 and 20 kPa (0.982, 95%CI 0.947-1.000), without clinically significant varices (CSV) (1.000, 95%CI 1.000-1.000) and with CSV (0.993, 95%CI 0.983-1.000). Diagnostic performance of SSM/LSM Ratio was better than LSM for discriminating NCPF from CLD using McNemar test (p = 0.01).

Conclusion: The SSM/LSM ratio is an excellent tool in differentiating NCPF from CLD.

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脾肝弹性成像比值在区分儿童和青少年非肝硬化门脉纤维化和慢性肝病中的作用。

背景：在患有门静脉高压症（PHT）的儿童和青少年中，非肝硬化性门静脉纤维化（NCPF）与慢性肝病（CLD）的鉴别具有挑战性，尤其是在肝脏硬度测量（LSM）和肝静脉压力梯度较高的病例中。本研究旨在评估脾脏硬度测量（SSM）/LSM 比值在诊断 NCPF 中的诊断准确性：从2019年1月至2023年12月，连续招募了6个月至18岁患有PHT（CLD和NCPF）的儿童和青少年。对 SSM 和 LSM、上消化道内窥镜（UGIE）、肝活检/经颈静脉肝活检、腹部成像和实验室评估进行了瞬态弹性成像（TE）。评估了TE参数与NCPF和CLD诊断的关系。使用 R Studio-4.2.2 统计软件进行受体运算特征（ROC）统计：结果：共评估了 147 名 CLD 患者和 27 名 NCPF 患者。中位年龄为 10.0（IQR 2.4-14.0）岁；68.4% 为男性。在诊断 NCPF 时，SSM/LSM 比值的 AUROC（0.992，95%CI 0.982-1.0001）优于 LSM（0.945，95%CI0.913-0.977）和 SSM（0.626，95%CI0.258-0.489）。SSM/LSM 比值临界值为 3.67 时，预测 NCPF 的敏感性（100%）、特异性（95.9%）和诊断准确性（95.91%）都非常好。SSM/LSM 比值的 AUROC 非常好，在亚组中优于其他 TE 参数，即 LSM 在 10 和 20 kPa 之间（0.982，95%CI 0.947-1.000）、无临床意义静脉曲张（CSV）（1.000，95%CI 1.000-1.000）和有 CSV（0.993，95%CI 0.983-1.000）。通过 McNemar 检验（P = 0.01），SSM/LSM 比值在区分 NCPF 和 CLD 方面的诊断性能优于 LSM：结论：SSM/LSM 比值是区分 NCPF 和 CLD 的绝佳工具。

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来源期刊

Hepatology International 医学-胃肠肝病学

CiteScore

10.90

自引率

3.00%

发文量

167

审稿时长

6-12 weeks

期刊介绍： Hepatology International is the official journal of the Asian Pacific Association for the Study of the Liver (APASL). This is a peer-reviewed journal featuring articles written by clinicians, clinical researchers and basic scientists is dedicated to research and patient care issues in hepatology. This journal will focus mainly on new and emerging technologies, cutting-edge science and advances in liver and biliary disorders. Types of articles published: -Original Research Articles related to clinical care and basic research -Review Articles -Consensus guidelines for diagnosis and treatment -Clinical cases, images -Selected Author Summaries -Video Submissions