Hepatic Vein Contrast-Enhanced Ultrasound Subharmonic Imaging Signal as a Screening Test for Portal Hypertension.
Contrast-enhanced ultrasound
Hepatic vein
Portal hypertension
Screening
Subharmonic imaging
Journal
Digestive diseases and sciences
ISSN: 1573-2568
Titre abrégé: Dig Dis Sci
Pays: United States
ID NLM: 7902782
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
17
07
2020
accepted:
14
12
2020
pubmed:
5
1
2021
medline:
15
12
2021
entrez:
4
1
2021
Statut:
ppublish
Résumé
Portal hypertension is the underlying cause of most complications associated with cirrhosis, with the hepatic venous pressure gradient (HVPG) used for diagnosis and disease progression. Subharmonic imaging (SHI) is a contrast-specific imaging technique receiving at half the transmit frequency resulting in better tissue suppression. To determine whether the presence of optimized SHI signals inside the hepatic vein can be used as a screening test for portal hypertension. This prospective trial had 131 patients undergoing SHI examination of portal and hepatic veins using a modified Logiq 9 scanner (GE, Waukesha, WI). Images acquired after infusion of the ultrasound contrast agent Sonazoid (GE Healthcare, Oslo, Norway) were assessed for the presence of optimized SHI signals in the hepatic vein and compared to the HVPG values obtained as standard of care. Of 131 cases, 64 had increased HVPG values corresponding to subclinical (n = 31) and clinical (n = 33) portal hypertension (> 5 and > 10 mmHg, respectively), and 67 had normal HVPG values (< 5 mmHg). Two readers performed independent, binary qualitative assessments of the acquired digital clips. Reader one (experienced radiologist) achieved for the subclinical subgroup sensitivity of 98%, specificity of 88%, and ROC area of 0.93 and for the clinical subgroup sensitivity of 100% and specificity of 61%, with an ROC area of 0.74. Reader two (less experienced radiologist) achieved for the subclinical subgroup sensitivity of 77%, specificity of 76%, and ROC area of 0.76 and for the clinical subgroup sensitivity of 88% and specificity of 63%, with an ROC area of 0.70. Readers agreement was of 83% with kappa value of 0.66. The presence of optimized SHI signals inside the hepatic vein can be a qualitative screening test for portal hypertension, which could reduce the need for invasive diagnostic procedures.
Sections du résumé
BACKGROUND
Portal hypertension is the underlying cause of most complications associated with cirrhosis, with the hepatic venous pressure gradient (HVPG) used for diagnosis and disease progression. Subharmonic imaging (SHI) is a contrast-specific imaging technique receiving at half the transmit frequency resulting in better tissue suppression.
AIMS
To determine whether the presence of optimized SHI signals inside the hepatic vein can be used as a screening test for portal hypertension.
METHODS
This prospective trial had 131 patients undergoing SHI examination of portal and hepatic veins using a modified Logiq 9 scanner (GE, Waukesha, WI). Images acquired after infusion of the ultrasound contrast agent Sonazoid (GE Healthcare, Oslo, Norway) were assessed for the presence of optimized SHI signals in the hepatic vein and compared to the HVPG values obtained as standard of care.
RESULTS
Of 131 cases, 64 had increased HVPG values corresponding to subclinical (n = 31) and clinical (n = 33) portal hypertension (> 5 and > 10 mmHg, respectively), and 67 had normal HVPG values (< 5 mmHg). Two readers performed independent, binary qualitative assessments of the acquired digital clips. Reader one (experienced radiologist) achieved for the subclinical subgroup sensitivity of 98%, specificity of 88%, and ROC area of 0.93 and for the clinical subgroup sensitivity of 100% and specificity of 61%, with an ROC area of 0.74. Reader two (less experienced radiologist) achieved for the subclinical subgroup sensitivity of 77%, specificity of 76%, and ROC area of 0.76 and for the clinical subgroup sensitivity of 88% and specificity of 63%, with an ROC area of 0.70. Readers agreement was of 83% with kappa value of 0.66.
CONCLUSION
The presence of optimized SHI signals inside the hepatic vein can be a qualitative screening test for portal hypertension, which could reduce the need for invasive diagnostic procedures.
Identifiants
pubmed: 33392869
doi: 10.1007/s10620-020-06790-6
pii: 10.1007/s10620-020-06790-6
pmc: PMC9026769
mid: NIHMS1794943
doi:
Substances chimiques
Ferric Compounds
0
Oxides
0
Sonazoid
0
Iron
E1UOL152H7
Types de publication
Controlled Clinical Trial
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
4354-4360Subventions
Organisme : NIDDK NIH HHS
ID : R01 DK098526
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK118964
Pays : United States
Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.
Références
Lancet. 2008 Mar 8;371(9615):838-51
pubmed: 18328931
JACC Cardiovasc Imaging. 2012 Jan;5(1):87-92
pubmed: 22239898
Indian J Gastroenterol. 2008 Mar-Apr;27(2):74-80
pubmed: 18695309
Ultrasonics. 2011 Dec;51(8):890-7
pubmed: 21621239
Korean J Hepatol. 2010 Dec;16(4):347-52
pubmed: 21415576
J Clin Gastroenterol. 2005 Apr;39(4 Suppl 2):S125-30
pubmed: 15758647
Ultrasound Med Biol. 2017 Jul;43(7):1401-1410
pubmed: 28433436
J Hepatol. 2007 Aug;47(2):284-94
pubmed: 17561303
J Physiol Pharmacol. 2008 Aug;59 Suppl 2:231-8
pubmed: 18812641
Gastroenterology. 2008 May;134(6):1715-28
pubmed: 18471549
Gut. 2007 Sep;56(9):1283-90
pubmed: 17452425
J Hepatol. 2003 Mar;38(3):266-72
pubmed: 12586291
Radiology. 2002 Feb;222(2):361-6
pubmed: 11818600
Ultrasound Med Biol. 2008 Mar;34(3):494-501
pubmed: 18096304
Ultrasonics. 2014 Sep;54(7):1938-44
pubmed: 24856899
Best Pract Res Clin Gastroenterol. 2011 Apr;25(2):281-90
pubmed: 21497745
Ultrasonics. 2013 Apr;53(4):880-8
pubmed: 23347593
J Ultrasound Med. 2017 Jan;36(1):3-11
pubmed: 27943411
Hepatology. 2011 Sep 2;54(3):1071-81
pubmed: 21574171
Ultrasound Med Biol. 2009 Sep;35(9):1555-63
pubmed: 19616359
Expert Rev Gastroenterol Hepatol. 2013 Feb;7(2):141-55
pubmed: 23363263
Ultrasound Med Biol. 2017 Nov;43(11):2718-2724
pubmed: 28807449
Radiology. 2013 Aug;268(2):581-8
pubmed: 23525208
J Hepatol. 2006 Jan;44(1):217-31
pubmed: 16298014
Ultrason Imaging. 2019 Jan;41(1):35-48
pubmed: 30417745
Lancet. 2014 May 17;383(9930):1749-61
pubmed: 24480518
Radiology. 2017 Oct;285(1):53-62
pubmed: 28467142
Ultrasound Med Biol. 1999 Feb;25(2):275-83
pubmed: 10320317
IEEE Trans Ultrason Ferroelectr Freq Control. 2005 Apr;52(4):581-3
pubmed: 16060506
J Hepatol. 2008;48 Suppl 1:S68-92
pubmed: 18304681
Ultrasonics. 2000 Mar;38(1-8):93-8
pubmed: 10829636
J Hepatol. 2010 Sep;53(3):558-67
pubmed: 20561700