Prognostication of Liver Disease Patients via the WFUMB 'Rule-of-4' Algorithm Using SSI-2D-SWE-Based Liver Stiffness...

Area of Science:

• Hepatology
• Medical Imaging
• Diagnostic Accuracy

Background:

• The World Federation for Ultrasound in Medicine and Biology (WFUMB) 2024 guidance proposed the 'rule-of-4' for Acoustic Radiation Force Impulse (ARFI) liver stiffness measurement (LSM).
• This rule stratifies advanced chronic liver disease (ACLD) risk at ≥13 kPa and clinically significant portal hypertension (CSPH) risk at >21 kPa.

Purpose of the Study:

• To prospectively evaluate the WFUMB 'rule-of-4' using supersonic imaging 2D-LSM (SSI-2D-LSM) for risk stratification of liver disease.
• To compare the diagnostic accuracy of SSI-2D-LSM with hepatic venous pressure gradient (HVPG) and vibration-controlled transient elastography (VCTE) for predicting decompensation events.

Main Methods:

• 187 patients underwent same-day SSI-2D-LSM and HVPG measurements.
• Patients were stratified into three LSM groups: <13 kPa, 13-21 kPa, and >21 kPa.
• Follow-up for 1 year (Y1) assessed decompensation events.

Main Results:

• The WFUMB 'rule-of-4' thresholds showed high accuracy for predicting CSPH (AUC: 0.83) and decompensation.
• Y1 decompensation rates were 0% (<13 kPa), 10% (13-21 kPa), and 24.7% (>21 kPa).
• HVPG was superior for predicting decompensation in compensated ACLD (cACLD) (AUC: 0.92), while SSI-2D-LSM (AUC: 0.75) and VCTE (AUC: 0.77) showed similar performance.

Conclusions:

• The WFUMB 'rule-of-4' using ARFI-LSM provides accurate, non-invasive risk stratification for liver disease patients.
• Short-term decompensation risk begins at SSI-2D-LSM ≥13 kPa and is considerable at >21 kPa.
• These findings support the clinical implementation of ARFI-LSM for risk assessment.