Real-time shear-wave elastography: applicability, reliability and accuracy for clinically significant portal...

Area of Science:

• Hepatology
• Medical Imaging
• Diagnostic Techniques

Background:

• Portal hypertension severity assessment is crucial for patient management.
• Real-time shear wave elastography (RT-SWE) shows potential for non-invasively evaluating portal hypertension.
• Establishing reliability criteria for RT-SWE measurements is essential for clinical application.

Purpose of the Study:

• To determine the reliability criteria for RT-SWE measurements of liver stiffness (LS) and spleen stiffness (SS).
• To assess the accuracy of RT-SWE in diagnosing clinically significant portal hypertension (CSPH), defined as hepatic venous pressure gradient (HVPG) ⩾10mmHg.
• To compare the performance of RT-SWE with transient elastography (TE).

Main Methods:

• Prospective study of 88 patients undergoing HVPG measurement.
• Liver stiffness measured by RT-SWE and TE; spleen stiffness by RT-SWE.
• Exploration of reliability criteria (SD/median ratio, measurement depth) and validation of diagnostic accuracy for CSPH using bootstrapping.

Main Results:

• RT-SWE was feasible for LS in 99% and SS in 66% of patients.
• Both LS and SS by RT-SWE correlated significantly with HVPG.
• Reliability criteria (SD/median ⩽0.10 and depth <5.6cm) improved CSPH classification accuracy to 96.3%; RT-SWE demonstrated excellent performance (AUROC=0.939) with these criteria.
• LS by RT-SWE and TE showed strong correlation (R=0.795) and similar performance.

Conclusions:

• Liver stiffness measurement by RT-SWE is accurate for diagnosing CSPH.
• Adherence to specific reliability criteria (SD/median ⩽0.10 and/or depth <5.6cm) is critical for accurate RT-SWE assessment.
• RT-SWE offers a reliable non-invasive method for evaluating portal hypertension severity.