Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 May 12;22(1):85.
doi: 10.1186/s12880-022-00817-2.

The severity of portal hypertension by a non-invasive assessment: acoustic structure quantification analysis of liver parenchyma

Wen-Bin Cai #  1   2 , Ji-Kai Yin #  3 , Qiao-Ying Li  1 , Yi-Lin Yang  1 , Yun-You Duan  1 , Li Zhang  4
Affiliations

The severity of portal hypertension by a non-invasive assessment: acoustic structure quantification analysis of liver parenchyma

Wen-Bin Cai et al. BMC Med Imaging. .

Abstract

Background: Acoustic structure quantification (ASQ) has been applied to evaluate liver histologic changes by analyzing the speckle pattern seen on B-mode ultrasound. We aimed to assess the severity of portal hypertension (PHT) through hepatic ultrasonography.

Methods: Sixty patients diagnosed with PHT and underwent surgical treatment with portosystemic shunts were enrolled. Portal pressure (PP) was measured intraoperatively. Patients were divided into subgroups according to the severity of gastroesophageal varices and Child-Pugh class. Three difference ratio (Cm2) values on ASQ histogram mode were analyzed for their relationships with PP, degree of gastroesophageal varices and Child-Pugh liver function. Thirty healthy volunteers matched with the patients for gender and age were enrolled as controls. Comparisons among groups and correlation of the parameters with PP were analyzed. Area under the receive operating characteristic curve was used to evaluate the predicting value of ASQ parameters.

Results: In the patients, the ASQ parameters peak Cm2 (Cm2max), mean Cm2 (Cm2mean) and the highest occurred Cm2 value of the obtained red curve (RmaxCm2) were all greatly increased (P < 0.0001, P < 0.0001, P = 0.027). Multiple comparisons indicated that, regardless of Child-Pugh class and degree of gastroesophageal varices, the patients had significantly increased Cm2max and Cm2mean compared with the controls (all P < 0.0001). No differences among subgroups were observed. Cm2max was significantly statistically correlated with PP (r = 0.3505, P < 0.01), degree of varices (r = 0.4998, P < 0.0001). Youden's index for Cm2max with a cut-off value of 140.3 for predicting the presence of PHT, gastroesophageal varices and liver function equal to or worse than Child-Pugh class B were 0.8, 0.91 and 0.84, respectively.

Conclusions: ASQ analysis of ultrasonographic images may have a role in the evaluation of the severity of PHT by detecting liver histologic changes in the speckle pattern caused by cirrhosis.

Keywords: Acoustic; Gastroesophageal varices; Noninvasive; Portal hypertension; Ultrasound.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Acoustic structure quantification (ASQ) analysis images obtained from a patient with portal hypertension, right lobe of liver. a Histogram display of the right lobe; b the corresponding ASQ curve for the difference ratio (Cm2). The red curve represents the value of Cm2 in the region of interest; higher inhomogeneous inconsistent values are indicated by the blue curve
Fig. 2
Fig. 2
Statistical significance of differences for acoustic structural quantification parameters analyzed by unpaired Student’s t-tests or Tukey’s multiple comparison tests as indicated. a Peak difference ratio (Cm2max) with Child–Pugh class; b mean difference ratio (Cm2mean) with Child–Pugh class; c Cm2max with severity of gastroesophageal varices; d Cm2mean with severity of gastroesophageal varices. N.S., not significant
Fig. 3
Fig. 3
Correlations among acoustic structure quantification parameters, portal hypertension severity and Doppler parameters. Positive relationships were found between a peak difference ratio (Cm2max) and portal pressure (PP); b both Cm2max and mean difference ratio (Cm2mean) with degree of varices; and c Cm2max and the Doppler parameter portal hypertension index (PHI)
Fig. 4
Fig. 4
Correlation between the Doppler parameter portal hypertension index (PHI) and portal pressure (PP). PHI was found to be positively correlated with PP
Fig. 5
Fig. 5
Receiver operating characteristic curves for peak difference ratio (Cm2max) in diagnosing portal hypertension (PHT) and evaluating PHT severity
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Gunarathne LS, Rajapaksha H, Shackel N, Angus PW, Herath CB. Cirrhotic portal hypertension: from pathophysiology to novel therapeutics. World J Gastroenterol. 2020;26(40):6111–6140. doi: 10.3748/wjg.v26.i40.6111. - DOI - PMC - PubMed
    1. Suk KT. Hepatic venous pressure gradient: clinical use in chronic liver disease. Clin Mol Hepatol. 2014;20(1):6–14. doi: 10.3350/cmh.2014.20.1.6. - DOI - PMC - PubMed
    1. Snowdon VK, Fallowfield JA. Editorial: measuring inflammatory and fibrotic components of portal hypertension—a noninvasive hepatic venous pressure gradient? Aliment Pharmacol Ther. 2016;44(2):204–205. doi: 10.1111/apt.13667. - DOI - PubMed
    1. Bochnakova T. Hepatic venous pressure gradient. Clin Liver Dis (Hoboken) 2021;17(3):144–148. doi: 10.1002/cld.1031. - DOI - PMC - PubMed
    1. Shao R, Li Z, Wang J, Qi R, Liu Q, Zhang W, Mao X, Song X, Li L, Liu Y, et al. Hepatic venous pressure gradient-guided laparoscopic splenectomy and pericardial devascularisation versus endoscopic therapy for secondary prophylaxis for variceal rebleeding in portal hypertension (CHESS1803): study protocol of a multicenter randomised controlled trial in China. BMJ Open. 2020;10(6):e030960. doi: 10.1136/bmjopen-2019-030960. - DOI - PMC - PubMed

Publication types

MeSH terms