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Abstract
BackgroundLiver stiffness measurement (LSM) using transient elastography (TE) is a common noninvasive method for assessing hepatic fibrosis. The purpose of this study was to show the utility of LSM in the evaluation and short-term follow-up of Budd-Chiarri syndrome (BCS) patients as well as to investigate the relationships between LSM, hepatic venous pressure, and liver fibrosis. We conducted a prospective cohort study in which 25 patients with a confirmed diagnosis of primary BCS underwent endovascular intervention for BCS treatment. All patients had pressure gradient changes across the stenosed hepatic veins/inferior vena cava (HV/IVC) measured before and after the procedure, a transvenous liver biopsy during the procedure, and LSM (using Transient Elastography 3 days before and 3 months after the intervention as a short-term follow-up). Comparisons and correlations were made between liver stiffness, hepatic venous pressure, and fibrosis.ResultsThe HV/IVC pressure gradient measured immediately before and after the intervention had a direct proportionate correlation with the LS measured 3 days before and 3 months after the intervention (r = 0.41 & 0.44, p: 0.04 & 0.03, respectively). LSM drops significantly 3 months after intervention (from 51.62 ± 22 kPa to 28.80 ± 19.25 kPa (p: 0.001)). There is a significant improvement in LSM post-intervention among patients with moderate to severe fibrosis (METAVIR scores of ≥ F2 before intervention (p: 0.001).ConclusionsLSM in BCS patients reflects congestion rather than fibrosis stage. TE can be used for the short-term monitoring of patients with BCS following the endovascular intervention as a noninvasive tool.
Highlights
Liver stiffness measurement (LSM) using transient elastography (TE) is a common noninvasive method for assessing hepatic fibrosis
Exclusion criteria Patients with other etiologies of liver disease unrelated to Budd-Chiarri syndrome (BCS), those who had BCS due to secondary causes (e.g., tumoral hepatic venous (HV) or inferior vena caval (IVC) invasion or compression), patients who had a contraindication for transjugular intrahepatic portosystemic shunt (TIPS), and patients who had one or more confounder which could affect the proper assessment of liver stiffness (LS) (e.g., Body mass index (BMI) > 30, acute hepatitis, and extrahepatic cholestasis) were excluded
TIPS was performed on 18 patients, with 7 undergoing angioplasty in the form of Inferior vena cava (IVC) balloon dilatation without stenting (5 patients) and hepatic vein stenting (2 patients)
Summary
Liver stiffness measurement (LSM) using transient elastography (TE) is a common noninvasive method for assessing hepatic fibrosis. In BCS, hepatic venous outflow obstruction causes venous stasis, post-sinusoidal portal hypertension, and a decrease in portal perfusion, culminating in ischemic damage to hepatocytes and hepatic cell inflammation. These biological factors all contribute to increased liver stiffness, which can be measured using one-dimensional transient elastography (TE) [1]. LSM correlates with the hepatic venous pressure gradient (HVPG) [3, 4], the gold standard of portal hypertension (PH) evaluation [5], and could be used to indirectly assess PH in patients with advanced chronic liver disease (ACLD) [6].
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