Utility of ElastPQ point-shear wave elastography in the work-up of patients with primary sclerosing cholangitis
Background & Aims: Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) have been shown to be useful tools for assessing the risk of fibrosis and portal hypertension, respectively. However, data on the accuracy of LSM and SSM measured by point-shear wave elastography (pSW...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-11-01
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| Series: | JHEP Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589555923002045 |
| _version_ | 1797647795997376512 |
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| author | Davide Roccarina Francesca Saffioti Matteo Rosselli Aileen Marshall Massimo Pinzani Douglas Thorburn |
| author_facet | Davide Roccarina Francesca Saffioti Matteo Rosselli Aileen Marshall Massimo Pinzani Douglas Thorburn |
| author_sort | Davide Roccarina |
| collection | DOAJ |
| description | Background & Aims: Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) have been shown to be useful tools for assessing the risk of fibrosis and portal hypertension, respectively. However, data on the accuracy of LSM and SSM measured by point-shear wave elastography (pSWE) in patients affected by primary sclerosing cholangitis (PSC) are still lacking. Thus, we aimed to prospectively assess their performance in a cohort of patients with PSC. Methods: We determined the correlation between LSM assessed by a pSWE technique (ElastPQ) and by FibroScan-transient elastography (F-TE). Furthermore, we used receiver-operating characteristic curves and area under the curves (AUROC) to evaluate the performance of LSM by ElastPQ for the staging of fibrosis, using F-TE as a reference standard, and the performance of LSM and SSM by ElastPQ in predicting the presence of oesophageal varices (OVs). Results: One hundred and fifty-two patients with PSC (93 males [61.2%], mean age 46 ± 16 years) were prospectively recruited. ElastPQ and F-TE LSMs were available for all patients, while ElastPQ SSM was available in 109 (72%) patients of whom 35 underwent upper gastrointestinal endoscopy within 1 year of the ultrasound assessment. ElastPQ LSM showed an excellent correlation with F-TE (p <0.001, Spearman’s 0.93; Lin’s 0.86) and a good diagnostic accuracy for fibrosis staging along all stages of liver fibrosis (AUROCs 0.96, 0.97, 0.97 and 0.99 for fibrosis stages F≥1, F≥2, F≥3 and F=4, respectively), using F-TE as a surrogate of histological fibrosis. ElastPQ SSM showed a good diagnostic performance in predicting the presence of OVs at endoscopy. Conclusions: LSM and SSM by ElastPQ can be used as accurate tools for liver fibrosis risk assessment and fibrosis staging, as well as for predicting the presence of OVs in the work-up of patients with PSC. Impact and implications: Liver and spleen stiffness measurement (LSM and SSM, respectively) by ElastPQ point-shear wave elastography in patients with primary sclerosing cholangitis represent reliable and reproducible tools for non-invasively staging the severity of liver disease and stratifying patients according to their risk of developing liver-related outcomes. In particular, LSM shows good accuracy for staging liver fibrosis and therefore detecting those patients at high risk of having compensated advanced chronic liver disease who require close monitoring. SSM seems to be promising to detect the risk of portal hypertension and therefore of oesophageal varices, enabling the triaging of patients who really need to undergo a screening endoscopy. |
| first_indexed | 2024-03-11T15:21:41Z |
| format | Article |
| id | doaj.art-01c884ba5f59477188fb401af7cec99d |
| institution | Directory Open Access Journal |
| issn | 2589-5559 |
| language | English |
| last_indexed | 2024-03-11T15:21:41Z |
| publishDate | 2023-11-01 |
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| series | JHEP Reports |
| spelling | doaj.art-01c884ba5f59477188fb401af7cec99d2023-10-28T05:09:33ZengElsevierJHEP Reports2589-55592023-11-01511100873Utility of ElastPQ point-shear wave elastography in the work-up of patients with primary sclerosing cholangitisDavide Roccarina0Francesca Saffioti1Matteo Rosselli2Aileen Marshall3Massimo Pinzani4Douglas Thorburn5UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UK; Corresponding author. Sheila Sherlock Liver Unit and UCL Institute for Liver and Digestive Health, Royal Free Hospital, London NW3 2QG, United Kingdom; Current address: Medicina Interna ed Epatologia Azienda Ospedaliero-Universitaria Careggi, L.go Brambilla 3, 50134, Florence, Italy; Tel.: +390557947937.UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UKUCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UKUCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UKUCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UKUCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, UKBackground & Aims: Liver stiffness measurement (LSM) and spleen stiffness measurement (SSM) have been shown to be useful tools for assessing the risk of fibrosis and portal hypertension, respectively. However, data on the accuracy of LSM and SSM measured by point-shear wave elastography (pSWE) in patients affected by primary sclerosing cholangitis (PSC) are still lacking. Thus, we aimed to prospectively assess their performance in a cohort of patients with PSC. Methods: We determined the correlation between LSM assessed by a pSWE technique (ElastPQ) and by FibroScan-transient elastography (F-TE). Furthermore, we used receiver-operating characteristic curves and area under the curves (AUROC) to evaluate the performance of LSM by ElastPQ for the staging of fibrosis, using F-TE as a reference standard, and the performance of LSM and SSM by ElastPQ in predicting the presence of oesophageal varices (OVs). Results: One hundred and fifty-two patients with PSC (93 males [61.2%], mean age 46 ± 16 years) were prospectively recruited. ElastPQ and F-TE LSMs were available for all patients, while ElastPQ SSM was available in 109 (72%) patients of whom 35 underwent upper gastrointestinal endoscopy within 1 year of the ultrasound assessment. ElastPQ LSM showed an excellent correlation with F-TE (p <0.001, Spearman’s 0.93; Lin’s 0.86) and a good diagnostic accuracy for fibrosis staging along all stages of liver fibrosis (AUROCs 0.96, 0.97, 0.97 and 0.99 for fibrosis stages F≥1, F≥2, F≥3 and F=4, respectively), using F-TE as a surrogate of histological fibrosis. ElastPQ SSM showed a good diagnostic performance in predicting the presence of OVs at endoscopy. Conclusions: LSM and SSM by ElastPQ can be used as accurate tools for liver fibrosis risk assessment and fibrosis staging, as well as for predicting the presence of OVs in the work-up of patients with PSC. Impact and implications: Liver and spleen stiffness measurement (LSM and SSM, respectively) by ElastPQ point-shear wave elastography in patients with primary sclerosing cholangitis represent reliable and reproducible tools for non-invasively staging the severity of liver disease and stratifying patients according to their risk of developing liver-related outcomes. In particular, LSM shows good accuracy for staging liver fibrosis and therefore detecting those patients at high risk of having compensated advanced chronic liver disease who require close monitoring. SSM seems to be promising to detect the risk of portal hypertension and therefore of oesophageal varices, enabling the triaging of patients who really need to undergo a screening endoscopy.http://www.sciencedirect.com/science/article/pii/S2589555923002045Autoimmune cholangiopathieschronic cholestatic liver diseasescompensated advanced chronic liver diseaserisk stratificationportal hypertensionupper gastrointestinal varices |
| spellingShingle | Davide Roccarina Francesca Saffioti Matteo Rosselli Aileen Marshall Massimo Pinzani Douglas Thorburn Utility of ElastPQ point-shear wave elastography in the work-up of patients with primary sclerosing cholangitis JHEP Reports Autoimmune cholangiopathies chronic cholestatic liver diseases compensated advanced chronic liver disease risk stratification portal hypertension upper gastrointestinal varices |
| title | Utility of ElastPQ point-shear wave elastography in the work-up of patients with primary sclerosing cholangitis |
| title_full | Utility of ElastPQ point-shear wave elastography in the work-up of patients with primary sclerosing cholangitis |
| title_fullStr | Utility of ElastPQ point-shear wave elastography in the work-up of patients with primary sclerosing cholangitis |
| title_full_unstemmed | Utility of ElastPQ point-shear wave elastography in the work-up of patients with primary sclerosing cholangitis |
| title_short | Utility of ElastPQ point-shear wave elastography in the work-up of patients with primary sclerosing cholangitis |
| title_sort | utility of elastpq point shear wave elastography in the work up of patients with primary sclerosing cholangitis |
| topic | Autoimmune cholangiopathies chronic cholestatic liver diseases compensated advanced chronic liver disease risk stratification portal hypertension upper gastrointestinal varices |
| url | http://www.sciencedirect.com/science/article/pii/S2589555923002045 |
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