Clinical application of subharmonic aided pressure estimation (SHAPE) in the assessment of portal hypertension in patients with decompensated cirrhosis: A pilot study

Abstract

PurposeThe aim of the study was to explore the possibility of subharmonic aided pressure estimation (SHAPE) measurement for noninvasive evaluation of portal hypertension in patients with decompensated liver cirrhosis.Materials and MethodsPatients diagnosed with decompensated liver cirrhosis were prospectively enrolled. SHAPE measurement was performed by using an ultrasound system. A continuous infusion of sonazoid at a rate of 0.18 ml/kg/h and saline at 120 ml/h was performed. The hepatic venous pressure gradient (HVPG) value are the gold standard for evaluating portal hypertension. The Pearson coefficient and areas under the receiver operating characteristic curves (AUCs) were analyzed.ResultsFrom February 2023 to August 2023, 15 patients (mean age, 61.1 ± 8.3 years; eight men and seven women) were included. The correlation coefficient of the SHAPE gradient and HVPG was 0.33. The mean SHAPE gradient of patients with clinically significant portal hypertension (CSPH) (HVPG ≥ 10 mmHg) was significantly higher than that of patients with lower risk (0.5 ± 4.4 dB vs. -7.4 ± 5.1 dB, P = 0.01). Patients with increased risk for variceal hemorrhage (HVPG ≥ 12 mmHg) had a significantly higher mean SHAPE gradient than patients with lower risk (HVPG < 12 mmHg) (1.3 ± 4.4 dB vs. -5.9 ± 4.8 dB; P = 0.01). The optimal cut-off values of the SHAPE gradient for diagnosing patients with CSPH and at increased risk for variceal hemorrhage were -1.3 dB and -0.6 dB (both AUC = 0.89), respectively.ConclusionSHAPE measurement is a potential noninvasive, effective imaging method to evaluate portal hypertension among patients diagnosed with decompensated liver cirrhosis in clinical practice.

Keywords: contrast enhanced ultrasound (CEUS); hepatic venous pressure gradient (HVPG); portal hypertension; sonazoid; subharmonic aided pressure estimation (SHAPE).