Liver Stiffness by Transient Elastography to Detect Porto-Sinusoidal Vascular Liver Disease With Portal Hypertension

IF 12.9 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Hepatology Pub Date : 2020-12-21 DOI:10.1002/hep.31688

Laure Elkrief, Marie Lazareth, Sylvie Chevret, Valérie Paradis, Marta Magaz, Lorraine Blaise, Laura Rubbia-Brandt, Lucile Moga, Fran?ois Durand, Audrey Payancé, Aurélie Plessier, Cendrine Chaffaut, Dominique Valla, Marion Malphettes, Alba Diaz, Jean-Charles Nault, Pierre Nahon, Etienne Audureau, Vlad Ratziu, Laurent Castera, Juan-Carlos Garcia Pagan, Nathalie Ganne-Carrie, Pierre-Emmanuel Rautou, the ANRS CO12 CirVir Group

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引用次数: 34

Abstract

Background and Aims

Porto-sinusoidal vascular liver disease (PSVD) is a rare cause of portal hypertension. PSVD is still often misdiagnosed as cirrhosis, emphasizing the need to improve PSVD diagnosis strategies. Data on liver stiffness measurement using transient elastography (TE-LSM) in PSVD are limited. The aim of this study was to evaluate the accuracy of TE-LSM to discriminate PSVD from cirrhosis in patients with signs of portal hypertension.

Approach and Results

Retrospective multicenter study comparing TE-LSM in patients with PSVD, according to Vascular Liver Disease Interest Group criteria, with patients with compensated biopsy-proven cirrhosis associated with alcohol (n = 117), HCV infection (n = 110), or NAFLD (n = 46). All patients had at least one sign of portal hypertension among gastroesophageal varices, splenomegaly, portosystemic collaterals, history of ascites, or platelet count < 150 × 10⁹/L. The 77 patients with PSVD included in the test cohort had lower median TE-LSM (7.9 kPa) than the patients with alcohol-associated, HCV-related, and NAFLD-related cirrhosis (33.8, 18.2, and 33.6 kPa, respectively; P < 0.001). When compared with cirrhosis, a cutoff value of 10 kPa had a specificity of 97% for the diagnosis of PSVD with a 85% positive predictive value. A cutoff value of 20 kPa had a sensitivity of 94% for ruling out PSVD with a 97% negative predictive value. Of the patients, 94% were well-classified. Even better results were obtained in a validation cohort including 78 patients with PSVD.

Conclusions

This study including a total of 155 patients with PSVD and 273 patients with cirrhosis demonstrates that TE-LSM < 10 kPa strongly suggests PSVD in patients with signs of portal hypertension. Conversely, when TE-LSM is >20 kPa, PSVD is highly unlikely.

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肝刚度瞬态弹性成像检测门窦血管性肝病伴门脉高压

背景与目的门窦性血管性肝病(PSVD)是一种罕见的门静脉高压症。PSVD仍然经常被误诊为肝硬化，这强调了改进PSVD诊断策略的必要性。在PSVD中使用瞬态弹性成像(TE-LSM)测量肝脏刚度的数据有限。本研究的目的是评估TE-LSM在门静脉高压症患者中区分PSVD和肝硬化的准确性。方法和结果回顾性多中心研究比较TE-LSM患者的PSVD，根据血管性肝病兴趣组标准，代偿活检证实肝硬化与酒精(n = 117)， HCV感染(n = 110)，或NAFLD (n = 46)。所有患者在胃食管静脉曲张、脾肿大、门静脉系统侧枝、腹水史或血小板计数中至少有一种门静脉高压症征象;150 × 109/ l。试验队列中77例PSVD患者的TE-LSM中位数(7.9 kPa)低于酒精相关、hcv相关和nafld相关肝硬化患者(分别为33.8、18.2和33.6 kPa);P & lt;0.001)。与肝硬化相比，10 kPa的临界值诊断PSVD的特异性为97%，阳性预测值为85%。20 kPa的临界值对于排除PSVD的敏感性为94%，而PSVD的阴性预测值为97%。94%的患者分类良好。在包括78名PSVD患者的验证队列中获得了更好的结果。结论本研究共纳入155例PSVD患者和273例肝硬化患者，结果表明TE-LSM <10kpa强烈提示门静脉高压症患者有PSVD。相反，当TE-LSM为20 kPa时，PSVD极不可能发生。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hepatology 医学-胃肠肝病学

CiteScore

27.50

自引率

3.70%

发文量

609

审稿时长

1 months

期刊介绍： HEPATOLOGY is recognized as the leading publication in the field of liver disease. It features original, peer-reviewed articles covering various aspects of liver structure, function, and disease. The journal's distinguished Editorial Board carefully selects the best articles each month, focusing on topics including immunology, chronic hepatitis, viral hepatitis, cirrhosis, genetic and metabolic liver diseases, liver cancer, and drug metabolism.