Real-time shear-wave elastography: applicability, reliability and accuracy for clinically significant portal hypertension

J Hepatol. 2015 May;62(5):1068-75. doi: 10.1016/j.jhep.2014.12.007. Epub 2014 Dec 13.


Background & aims: Real-time shear wave elastography (RT-SWE) might be useful to assess the severity of portal hypertension; reliability criteria for measurement are needed.

Methods: We prospectively included 88 consecutive patients undergoing hepatic venous pressure gradient measurement (HVPG, reference standard) for portal hypertension. Liver stiffness (LS) was measured by RT-SWE and by transient elastography (TE). Spleen stiffness (SS) was measured by RT-SWE. Reliability criteria for RT-SWE were searched, and the accuracy of these techniques to identify HVPG ⩾10mmHg (clinically significant portal hypertension, CSPH) was tested and internally validated by bootstrapping analysis.

Results: LS and SS by RT-SWE were feasible respectively in 87 (99%) and 58 (66%) patients. Both correlated with HVPG (LS: R=0.611, p<0.0001 and SS: R=0.514, p<0.0001). LS performed well for diagnosing CSPH (optimism corrected AUROC=0.858). Reliability of measurements was influenced by standard deviation (SD)/median ratio and depth. SD/median ⩽0.10 and depth of measurement <5.6cm were associated to 96.3% well classified for CSPH, while when one or none of the criteria were fulfilled the rates were 76.4% and 44.4%, respectively. Measurements fulfilling at least one criterion were considered acceptable; in these patients, RT-SWE performance to detect CSPH was excellent (AUROC=0.939; 95% CI: 0.865-1.000; p<0.0001; best cut-off: 15.4kPa). LS by RT-SWE and by TE were strongly correlated (R=0.795, p<0.0001) and performed similarly both in "per protocol" and in "intention-to-diagnose" analysis after applying reliability criteria.

Conclusions: LS by RT-SWE is an accurate method to diagnose CSPH if reliability criteria (SD/median ⩽0.10 and/or depth <5.6cm) are fulfilled.

Keywords: Cirrhosis; HVPG; Liver disease; Sonoelastography; Ultrasound.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Dimensional Measurement Accuracy
  • Elasticity Imaging Techniques / methods*
  • Female
  • Humans
  • Hypertension, Portal* / diagnosis
  • Hypertension, Portal* / physiopathology
  • Liver / pathology
  • Liver / physiopathology
  • Male
  • Middle Aged
  • Portal Pressure
  • Portal System* / diagnostic imaging
  • Portal System* / physiopathology
  • Reproducibility of Results
  • Severity of Illness Index
  • Spleen / pathology
  • Spleen / physiopathology