Diagnosing Portal Hypertension with Noninvasive Subharmonic Pressure Estimates from a US Contrast Agent
Diagnosing Portal Hypertension with Noninvasive Subharmonic Pressure Estimates from a US Contrast Agent
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DOI：
10.1148/radiol.2020202677
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发表时间：
2021-01-01
期刊：
影响因子：
19.7
通讯作者：
Forsberg, Flemming
中科院分区：
文献类型：
--
作者：
Gupta, Ipshita;Eisenbrey, John R.;Forsberg, Flemming
背景：目前评估门静脉高压症严重程度的标准是肝静脉压力梯度（HVPG）的侵入性采集。美国一种名为次谐波辅助压力评估（SHAPE）的无创技术可以降低风险，并使这些压力评估的常规采集成为可能。目的：比较定量SHAPE和HVPG测量对经颈静脉肝活检患者门脉高压的诊断。材料和方法：这是一项2015年4月至2019年3月在两家医院进行的前瞻性横断面试验（ClinicalTrials.gov标识符，NCT02489045）。该试验招募了计划经颈静脉肝活检的参与者。经过标准护理经颈静脉肝活检和HVPG压力测量后，参与者接受了美国造影剂和生理盐水的输注。在输注过程中，从门静脉和肝静脉收集SHAPE数据，并与HVPG测量值进行比较。使用Pearson相关系数确定数据集之间的相关性，使用Student t检验确定组间的统计学显著性。进行受试者工作特征分析以确定SHAPE的敏感性和特异性。结果：共纳入125例资料完整的受试者（平均年龄6标准差，59岁6 12岁，男性80例）。与hvpg较低的参与者相比，静脉曲张出血（HVPG.12 mm Hg）风险增加的参与者具有更高的平均SHAPE梯度(0.79 dB 6.2.53 vs 24.95 dB 6.3.44； P，。这相当于灵敏度为90% （13 / 14;95% CI: 88, 94）和特异性为80% （79 / 99;95% CI: 76, 84）。门静脉和肝静脉之间的SHAPE梯度与HVPG测量值总体上吻合良好（r = 0.68）。结论：亚谐波辅助压力评估是一种准确的无创检测门静脉高压症的技术。(c) rsna, 2020。
Background: The current standard for assessing the severity of portal hypertension is the invasive acquisition of hepatic venous pressure gradient (HVPG). A noninvasive US-based technique called subharmonic-aided pressure estimation (SHAPE) could reduce risk and enable routine acquisition of these pressure estimates.Purpose: To compare quantitative SHAPE to HVPG measurements to diagnose portal hypertension in participants undergoing a transjugular liver biopsy.Materials and Methods: This was a prospective cross-sectional trial conducted at two hospitals between April 2015 and March 2019 (ClinicalTrials.gov identifier, NCT02489045). This trial enrolled participants who were scheduled for transjugular liver biopsy. After standard-of-care transjugular liver biopsy and HVPG pressure measurements, participants received an infusion of a US contrast agent and saline. During infusion, SHAPE data were collected from a portal vein and a hepatic vein, and the difference was compared with HVPG measurements. Correlations between data sets were determined by using the Pearson correlation coefficient, and statistical significance between groups was determined by using the Student t test. Receiver operating characteristic analysis was performed to determine the sensitivity and specificity of SHAPE.Results: A total of 125 participants (mean age 6 standard deviation, 59 years 6 12; 80 men) with complete data were included. Participants at increased risk for variceal hemorrhage (HVPG.12 mm Hg) had a higher mean SHAPE gradient compared with participants with lower HVPGs (0.79 dB 6 2.53 vs 24.95 dB 6 3.44; P,.001), which is equivalent to a sensitivity of 90% (13 of 14; 95% CI: 88, 94) and a specificity of 80% (79 of 99; 95% CI: 76, 84). The SHAPE gradient between the portal and hepatic veins was in good overall agreement with the HVPG measurements (r = 0.68).Conclusion: Subharmonic-aided pressure estimation is an accurate noninvasive technique for detecting clinically significant portal hypertension. (C) RSNA, 2020.