Spleen and liver two-dimensional shear wave elastography for clinically significant portal hypertension

Liver (LSM) and spleen (SSM) stiffness measurements correlate with hepatic venous pressure gradient (HVPG), the reference standard for defining clinically significant portal hypertension (CSPH, i.e. HVPG ≥10 mmHg). LSM, SSM and derived scores have been proposed for non-invasive CSPH risk assessment.

Compensated advanced chronic liver disease (cACLD) patients undergoing same-day HVPG, Supersonic (SSI)-LSM, and SSI-SSM were prospectively included. Reliable SSI-LSM and SSI-SSM were defined by IQR/Med ≤30%. SSI-LSM, SSI-SSM and derived Baveno VII rules, Anticipate-SSI, LPS-SSI, and the newly developed SSI-4PH (LSM/SSM, platelet count: PLT, BMI) model were evaluated in a derivation cohort (DeCo) and an external validation cohort (VaCo).

The DeCo comprised 220 patients, paired reliable SSI-LSM/SSI-SSM measurements were available in 118 (53.6%) patients including 74.6% with CSPH. The VaCo comprised 86 eligible patients, of whom 73 (84.9%) had paired reliable measurements including 43.8% with CSPH. In reliable paired analyses, AUROCs for CSPH detection in the DeCo were 0.84 for Anticipate-SSI, 0.87 for LPS-SSI, and 0.90 for SSI-4PH; the corresponding AUROCs in the VaCo were 0.78, 0.77, and 0.73. At the fixed ≥75% predicted-risk threshold, specificity of SSI-4PH was 83.3% in the DeCo and 87.8% in the VaCo.

Reliable SSI-LSM and SSI-SSM provide robust non-invasive assessment of CSPH risk, however, the requirement of reliable (IQR/Med ≤30%) paired measurements may limit applicability. Combined SSI-LSM/SSM-based rules and multivariable models reduced gray-zone, and the SSI-4PH yielded a favorable decision-curve utility for CSPH risk assessment.