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Published on: June 18, 2020
Shear Wave Dispersion Slope Measured with Shear Wave Dispersion Imaging Is Associated with Variceal Hemorrhage in
Xiaohui Sun1, Li Zhang2, Ling Jiang1
1Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China.
Insights
This study identifies shear wave dispersion slope (SWDS), spleen diameter, and ascites as key predictors of variceal hemorrhage (VH) in cirrhosis patients. Combining these factors offers a more accurate method for diagnosing VH risk.
Area of Science:
- Hepatology
- Medical Imaging
- Gastroenterology
Background:
- Portal hypertension (PH) is a primary complication of cirrhosis, leading to gastroesophageal varices (GEVs).
- Rupture of GEVs causes variceal hemorrhage (VH), a life-threatening condition requiring accurate risk prediction.
- Identifying risk factors for VH is crucial for managing cirrhosis patients.
Purpose of the Study:
- To identify independent risk factors for variceal hemorrhage (VH) in patients with cirrhosis.
- To evaluate the diagnostic performance of shear wave dispersion (SWD) imaging parameters, including shear wave dispersion slope (SWDS), in predicting VH.
- To develop and validate a predictive formula for VH risk.
Main Methods:
- Prospective study including cirrhotic patients, divided into VH and non-VH groups.
- Conventional ultrasound and SWD imaging to measure portal vein diameter, spleen diameter, ascites, liver stiffness (LS), and SWDS.
- Laboratory tests (platelets, liver enzymes, bilirubin, albumin) were recorded.
- Univariate and multivariate logistic regression analyses were used to identify risk factors, with ROC curves assessing diagnostic accuracy.
Main Results:
- Sixty-five patients (22 with VH) were analyzed.
- SWDS, spleen diameter, and ascites were identified as independent risk factors for VH.
- SWDS demonstrated good diagnostic performance for VH (AUC = 0.768).
- A predictive formula incorporating SWDS, spleen diameter, and ascites achieved higher diagnostic accuracy (AUC = 0.900) compared to individual parameters.
Conclusions:
- SWDS is a sensitive parameter for assessing VH risk in cirrhosis.
- The combination of SWDS, spleen diameter, and ascites provides a highly accurate diagnostic tool for predicting VH.
- This multi-parameter approach improves risk stratification and aids in clinical decision-making for cirrhosis management.
Abstract:
Background and Objectives: Portal hypertension (PH), as the main consequence of cirrhosis, leads to the development of gastroesophageal varices (GEVs). Variceal hemorrhage (VH) caused by the rupture of GEVs is a life-threatening emergency. Thus, the prediction of VH risk is considerably important. Our pilot study aimed to identify the risk factors of variceal hemorrhage (VH) in cirrhosis. Materials and Methods: Cirrhotic patients were prospectively included and divided into two groups according to the presence or absence of VH. Conventional ultrasound and shear wave dispersion (SWD) imaging were conducted to detect the portal vein diameter, spleen diameter, ascites, liver stiffness (LS) and shear wave dispersion slope (SWDS). The laboratory tests were recorded, including platelets (PLT), alanine transaminase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL) and albumin (ALB). The risk factors of VH were screened using univariate analyses and identified using multivariate logistic regression. The ROC curves were used to assess diagnostic accuracy. Comparisons between AUCs were performed using the Delong method. Results: Sixty-five patients with 22 VHs were finally included. The SWDS, spleen diameter and ascites were identified as independent risk factors for VH. The SWDS showed good performance for diagnosing VH (AUC = 0.768, 95% CI: 0.647−0.864), and sensitively identified 95.5% (95% CI: 77.2%−99.9%) of patients with VH. Including the three risk factors in multivariate logistic regression, we obtained a formula for diagnosing VH: −20.749 + 0.804 × SWDS + 0.449 × spleen diameter + 1.803 × ascites (no ascites = 0, ascites = 1). Comparison of AUCs revealed that the formula (AUC = 0.900, 95% CI: 0.800−0.961) performed better than LS, SWDS, and spleen diameter in diagnosing VH (p < 0.001; p < 0.05; p < 0.05). Conclusions: SWDS is a sensitive parameter for assessing the risk of VH. Combining the SWDS, spleen diameter and ascites resulted in good diagnostic accuracy.
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