Noninvasive Assessment Of Portal Hypertension Research Articles

Bibliometric-analysis visualization and review of non-invasive methods for monitoring and managing the portal hypertension.

BackgroundPortal hypertension monitoring is important throughout the natural course of cirrhosis. Hepatic venous pressure gradient (HVPG), regarded as the golden standard, is limited by invasiveness and technical difficulties. Portal hypertension is increasingly being assessed non-invasively, and hematological indices, imaging data, and statistical or computational models are studied to surrogate HVPG. This paper discusses the existing non-invasive methods based on measurement principles and reviews the methodological developments in the last 20 years.MethodsFirst, we used VOSviewer to learn the architecture of this field. The publications about the non-invasive assessment of portal hypertension were retrieved from the Web of Science Core Collection (WoSCC). VOSviewer 1.6.17.0 was used to analyze and visualize these publications, including the annual trend, the study hotspots, the significant articles, authors, journals, and organizations in this field. Next, according to the cluster analysis result of the keywords, we further retrieved and classified the related studies to discuss.ResultsA total of 1,088 articles or review articles about our topic were retrieved from WoSCC. From 2000 to 2022, the number of publications is generally growing. “World Journal of Gastroenterology” published the most articles (n = 43), while “Journal of Hepatology” had the highest citations. “Liver fibrosis” published in 2005 was the most influential manuscript. Among the 20,558 cited references of 1,088 retrieved manuscripts, the most cited was a study on liver stiffness measurement from 2007. The highest-yielding country was the United States, followed by China and Italy. “Berzigotti, Annalisa” was the most prolific author and had the most cooperation partners. Four study directions emerged from the keyword clustering: (1) the evaluation based on fibrosis; (2) the evaluation based on hemodynamic factors; (3) the evaluation through elastography; and (4) the evaluation of variceal bleeding.ConclusionThe non-invasive assessment of portal hypertension is mainly based on two principles: fibrosis and hemodynamics. Liver fibrosis is the major initiator of cirrhotic PH, while hemodynamic factors reflect secondary alteration of splanchnic blood flow. Blood tests, US (including DUS and CEUS), CT, and magnetic resonance imaging (MRI) support the non-invasive assessment of PH by providing both hemodynamic and fibrotic information. Elastography, mainly USE, is the most important method of PH monitoring.

Detection of liver and spleen stiffness in rats with portal hypertension by two-dimensional shear wave elastography

BackgroundThe measurement of liver stiffness (LS) and spleen stiffness (SS) based on ultrasound elastography can be used for non-invasive assessment of portal hypertension (PH). However, there are few studies on the corresponding mechanism of increased spleen stiffness. Our aim was to use two-dimensional shear wave elastrography (2D-SWE) to evaluate the relationship between LS and SS and the severity of PH in rats. And explore the mechanism of the increase of LS and SS in PH.MethodsSixty male Sprague–Dawley rats were randomly divided into portal hypertension (PH group, n = 45) and normal control (NC group, n = 15). At 12 weeks, LS and SS was detected by 2D-SWE in vivo. Related hemodynamic parameters and portal vein pressure (PVP) was measured. Spleen and liver 2D-SWE detection was performed again after sacrifice. Pathological changes were observed.ResultsThe SS and LS were increased in PH group (P < 0.05). The SS decreased after sacrifice, and what's more the magnitude of SS decline significantly higher in PH group than in NC group (P < 0.05). The correlation between SS and PVP is stronger than LS (r = 0.624, P < 0.001). SS has positive correlation with indexes of hyperdynamic circulation, but LS was weakly. The correlation between SS and the pathological grade (r = 0.633, P < 0.001) was lower than that in LS (r = 0.905, P < 0.001). Multiple linear regression analysis revealed that SS, portal vein inner diameter (PVD) and splenic vein blood flow velocity (SVV) were significantly associated with PH.ConclusionsSpleen and liver measurement by 2D-SWE may be helpful in evaluating PVP. The correlation between SS and PVP is stronger than LS in rats measured by 2D-SWE. Hemodynamic circulation are important in the elevation of SS with portal hypertension. Pathological changes also have a degree of influence, but have more significance for the elevation of LS. SS may be a more effective noninvasive predictor of PH than LS.

Neinvazivní metody v posuzování závažnosti portální hypertenze

Portal hypertension represents a wide spectrum of complications of chronic liver diseases and may present by ascites, oesophageal varices, splenomegaly, hypersplenism, hepatorenal and hepatopulmonary syndrome or portopulmonary hypertension. Portal hypertension and its severity predicts the patient‘s prognosis: as an invasive technique, the portosystemic gradient (HPVG – hepatic venous pressure gradient) measurement by hepatic veins catheterisation has remained the gold standard of its assessment. A reliable, non-invasive method to assess the severity of portal hypertension is of paramount importance; the patients with clinically significant portal hypertension have a high risk of variceal bleeding and higher mortality. Recently, non-invasive methods enabling the assessment of liver stiffness have been introduced into clinical practice in hepatology. Not only may these methods substitute for liver biopsy, but they may also be used to assess the degree of liver fibrosis and predict the severity of portal hypertension. Nowadays, we can use the quantitative elastography (transient elastography, point shear-wave elastrography, 2D-shear-wave elastography) or magnetic resonance imaging. We may also assess the severity of portal hypertension based on the non-invasive markers of liver fibrosis (i.e. ELF test) or estimate clinically signifi cant portal hypertension using composite scores (LSPS – liver spleen stiff ness score), based on liver stiffness value, spleen diameter and platelet count. Spleen stiffness measurement is a new method that needs further prospective studies. The review describes current possibilities of the non-invasive assessment of portal hypertension and its severity.

Magnetic resonance parametric mapping of the spleen for non-invasive assessment of portal hypertension

ObjectivesIn patients with advanced liver disease, portal hypertension is an important risk factor, leading to complications such as esophageal variceal bleeding, ascites, and hepatic encephalopathy. This study aimed to determine the diagnostic value of T1 and T2 mapping and extracellular volume fraction (ECV) for the non-invasive assessment of portal hypertension.MethodsIn this prospective study, 50 participants (33 patients with indication for trans-jugular intrahepatic portosystemic shunt (TIPS) and 17 healthy volunteers) underwent MRI. The derivation and validation cohorts included 40 and 10 participants, respectively. T1 and T2 relaxation times and ECV of the liver and the spleen were assessed using quantitative mapping techniques. Direct hepatic venous pressure gradient (HVPG) and portal pressure measurements were performed during TIPS procedure. ROC analysis was performed to compare diagnostic performance.ResultsSplenic ECV correlated with portal pressure (r = 0.72; p < 0.001) and direct HVPG (r = 0.50; p = 0.003). No significant correlations were found between native splenic T1 and T2 relaxation times with portal pressure measurements (p > 0.05, respectively). In the derivation cohort, splenic ECV revealed a perfect diagnostic performance with an AUC of 1.000 for the identification of clinically significant portal hypertension (direct HVPG ≥ 10 mmHg) and outperformed other parameters: hepatic T2 (AUC, 0.731), splenic T2 (AUC, 0.736), and splenic native T1 (AUC, 0.806) (p < 0.05, respectively). The diagnostic performance of mapping parameters was comparable in the validation cohort.ConclusionSplenic ECV was associated with portal pressure measurements in patients with advanced liver disease. Future studies should explore the diagnostic value of parametric mapping accross a broader range of pressure values.Key Points• Non-invasive assessment and monitoring of portal hypertension is an area of unmet interest.• Splenic extracellular volume fraction is strongly associated with portal pressure in patients with end-stage liver disease.• Quantitative splenic and hepatic MRI-derived parameters have a potential to become a new non-invasive diagnostic parameter to assess and monitor portal pressure.

Noninvasive Assessment of Portal Hypertension Using Spectral Computed Tomography.

Early diagnosis of portal hypertension is imperative for timely treatment to reduce the mortality rate. However, there is still no adequate method to noninvasively and accurately assess the portal hypertension in routine clinical practice. We aimed to evaluate the accuracy of parameters measured using dual energy spectral computed tomography (LightSpeed CT750 HD) in assessing portal venous pressure in patients with liver cirrhosis. Forty-five patients with liver cirrhosis who underwent percutaneous transhepatic portal vein puncture as part of their treatment for liver disease were enrolled in this study. Measurement of direct portal venous pressure was performed preoperatively. All patients underwent dual energy spectral computed tomography within 3 days before their operations. The iodine concentrations of portal vein and hepatic parenchyma during the portal venous phase and the alanine aminotransferase level were found to be independently correlated with the direct portal venous pressure according to stepwise multivariate linear regression analysis (P<0.001, 0.004, and 0.024, respectively). In a receiver operating characteristic analysis, the area under the receiver operating characteristic of iodine concentrations of the portal vein (ICPV) for identifying clinically significant portal hypertension (≥10 mm Hg) was significantly higher than that of iodine concentrations of hepatic parenchyma (ICliver) and the alanine aminotransferase level (0.944, 0.825, and 0.301, respectively). The threshold ICPV of 58.27 yielded a sensitivity of 93.8%, specificity of 69.2%, positive predictive value of 88.2%, and negative predictive value of 81.8%, respectively. ICPV values may be a useful tool in noninvasively assessing the portal venous pressure and identifying clinically significant portal hypertension in liver cirrhosis.

Non-invasive assessment of portal hypertension by multi-parametric magnetic resonance imaging of the spleen: A proof of concept study

Background and aimsNon-invasive assessment of portal hypertension is an area of unmet need. This proof of concept study aimed to evaluate the diagnostic accuracy of a multi-parametric magnetic resonance technique in the assessment of portal hypertension. Comparison to other non-invasive technologies was a secondary aim.MethodsT1 and T2* maps through the liver and spleen were acquired prior to trans-jugular liver biopsy and hepatic vein pressure gradient (HVPG) measurement. T1 measurements reflect changes in tissue water content, but this relationship is confounded by the presence of iron, which in turn can be quantified accurately from T2* maps. Data were analysed using LiverMultiScan (Perspectum Diagnostics, Oxford, UK) which applies an algorithm to remove the confounding effect of iron, yielding the “iron corrected T1” (cT1). Sensitivity, specificity, diagnostic values and area under the curve were derived for spleen cT1, liver cT1, transient elastography, and serum fibrosis scores. HVPG was the reference standard.ResultsNineteen patients (15 men) with median age 57 years were included. Liver disease aetiologies included non-alcoholic fatty liver disease (n = 9; 47%) and viral hepatitis (n = 4; 21%). There was strong correlation between spleen cT1 and HVPG (r = 0.69; p = 0.001). Other non-invasive biomarkers did not correlate with HVPG. Spleen cT1 had excellent diagnostic accuracy for portal hypertension (HVPG >5 mmHg) and clinically significant portal hypertension (HVPG ≥10 mmHg) with an area under the receiver operating characteristic curve of 0.92 for both.ConclusionSpleen cT1 is a promising biomarker of portal pressure that outperforms other non-invasive scores and should be explored further.

SAT-040-Is spleen stiffness the new frontier for non-invasive assessment of portal hypertension?

SAT-040-Is spleen stiffness the new frontier for non-invasive assessment of portal hypertension?

Spleen and liver stiffness for noninvasive assessment of portal hypertension in cirrhotic patients with large esophageal varices.

Noninvasive evaluation of portal hypertension is needed for cirrhotic patients with large esophageal varices. This study was aimed at assessing the diagnostic value of liver/spleen stiffness in predicting hepatic vein pressure gradient (HVPG) in this special population. In the present prospective cohort study, liver/spleen stiffness was measured by transient elastography. Patients also underwent HVPG assessment, upper gastrointestinal endoscopy, and other noninvasive serum models. Ninety-nine cirrhotic patients with large esophageal varices were enrolled. Liver/spleen stiffness strongly correlated with HVPG. In regards to significant portal hypertension, area under receiver operating characteristic curves (AUROCs) for liver/spleen stiffness were 0.74 and 0.91. Accuracy for detecting significant portal hypertension was 79% for spleen stiffness of 48.9 kPa (sensitivity: 76%, specificity: 100%, positive predictive value: 100%, negative predictive value: 38%) and 75% for liver stiffness of 16.0 kPa (sensitivity: 78%, specificity: 54%, positive predictive value: 92%, negative predictive value: 27%). Similarly, spleen stiffness had significant higher AUROCs for predicting HVPG ≥16 and ≥20 mm Hg than that of liver stiffness and other noninvasive serum models. In cirrhotic patients with large esophageal varices, liver stiffness and spleen stiffness correlate with HVPG, and spleen stiffness is superior to liver stiffness in predicting portal hypertension.

Noninvasive Assessment of Portal Hypertension in Advanced Chronic Liver Disease: An Update.

The assessment of portal hypertension is a relevant step in the evaluation of newly diagnosed advanced chronic liver disease (ACLD). The current gold standard includes the invasive evaluation of hepatic venous pressure gradient (HVPG) and endoscopy. However, noninvasive or minimally invasive techniques to assess portal hypertension have been proposed and well established. In the present manuscript, we review clinical studies on the use of noninvasive or minimally invasive techniques to assess portal hypertension in ACLD patients.

Non-invasive diagnosis of portal hypertension in cirrhosis using ultrasound based elastography.

Liver stiffness measurement (LSM) by ultrasound-based elastography may be used to non-invasively discriminate betweenthe stages of liver fibrosis, rule out cirrhosis and follow its evolution, including the prediction of the presence ofoesophageal varices. The same is possible in order to diagnose clinically significant portal hypertension, referring primarilyto transient elastography and LSM values ≥20-25 kPa. The same approach may be used to reliably rule out the presence ofoesophageal varices (LSM <20 kPa + platelets >150x109/L). These recommendations refer primarily to patients with viral aetiologyof chronic liver disease (hepatitis C), while additional studies are required for other aetiologies. While spleen stiffnessmeasurement (SSM) also poses a logical choice in this indication, controversial results have nevertheless been published on this issue. It should be emphasized, however, that more recent data indicate that this parameter should be included in the diagnosticalgorithm for portal hypertension, if not as the sole then as a part of a sequential algorithm, combined with LSM. Untilnow, transient elastography has been most extensively studied and founded on scientific evidence, although the results of otherultrasound-based elastography techniques demonstrate the same trend for the non-invasive assessment of portal hypertension.

Short article: Noninvasive assessment of portal hypertension and detection of esophageal varices in cirrhosis: state-of-the-art.

Portal hypertension (PHT) is a major consequence of any chronic liver disease and it is the main cause of complications in patients with cirrhosis. Measurement of hepatic vein pressure gradient is considered the gold standard for PHT assessment, together with its diagnosis and prognosis relevance. Even though hepatic vein pressure gradient measurement is a safe procedure, it is still considered an invasive technique and not widely available. There is thus a need for noninvasive methods that can predict the progression of PHT as well as the presence and the risk of complications related to esophageal varices. This review aimed to discuss the noninvasive markers used in the assessment of PHT and detection of high-risk esophageal varices in patients with liver cirrhosis. We focus on the main biomarkers, particularly those used in the routine assessment of chronic liver disease, and the physical methods that use tissue elastography as a diagnosis tool.

Invasive and non-invasive assessment of portal hypertension.

Portal hypertension is the central driver of complications in patients with chronic liver diseases and cirrhosis. The diagnosis of portal hypertension has important prognostic and clinical implications. In particular, screening for varices in patients with portal hypertension can effectively reduce the morbidity and mortality of variceal bleeding. In this article, we review the invasive and non-invasive methods to assess portal hypertension. Hepatic venous pressure gradient remains the gold standard to measure portal pressure but is invasive and seldom performed outside expert centers and research settings. In recent years, a number of non-invasive tests of fibrosis have shown good correlation with liver histology. They also show promise in identifying patients with portal hypertension and large varices. As a result, the latest Baveno VI consensus guidelines endorse the use of liver stiffness measurement by transient elastography and platelet count as initial assessment to select patients for varices screening. On the other hand, the performance of non-invasive tests in assessing the response to non-selective beta-blockers or transjugular intrahepatic portosystemic shunting is either suboptimal or unclear.

Non-invasive assessment of portal hypertension using quantitative magnetic resonance imaging

Hepatic venous pressure gradient (HVPG) measurement is currently the only validated technique to accurately evaluate changes in portal pressure. In this study, we evaluate the use of non-contrast quantitative magnetic resonance imaging (MRI) as a surrogate measure of portal pressure. Thirty patients undergoing HVPG measurement were prospectively recruited. MR parameters of longitudinal relaxation time (T1), perfusion of the liver and spleen (by arterial spin labelling), and blood flow in the portal, splanchnic and collateral circulation (by phase contrast MRI) were assessed. We estimated the liver stiffness measurement (LSM) and enhanced liver fibrosis (ELF) score. The correlation of all non-invasive parameters with HVPG was evaluated. The mean (range) HVPG of the patients was 9.8 (1-22) mmHg, and 14 patients (48%) had clinically significant portal hypertension (CSPH, HVPG ⩾10mmHg). Liver T1 relaxation time, splenic artery and superior mesenteric artery velocity correlated significantly with HVPG. Using multiple linear regression, liver T1 and splenic artery velocity remained as the two parameters in the multivariate model significantly associated with HVPG (R=0.90, p<0.001). This correlation was maintained in patients with CSPH (R=0.85, p<0.001). A validation cohort (n=10) showed this linear model provided a good prediction of HVPG. LSM and ELF score correlated significantly with HVPG in the whole population but the correlation was absent in CSPH. MR parameters related to both hepatic architecture and splanchnic haemodynamics correlate significantly with HVPG. This proposed model, confirmed in a validation cohort, could replace the invasive HVPG measurement. In patients with cirrhosis, the development and progression of portal hypertension is related to worse outcomes. However, the standard technique of assessing portal pressure is invasive and not widely used in clinical practice. Here, we have studied the use of non-invasive MRI in evaluating portal pressure. The MRI measures of liver architecture and blood flow in the splenic artery correlated well with portal pressure. Therefore, this non-invasive method can potentially be used to assess portal pressure in clinical trials and monitoring treatment in practice.

Non-invasive assessment of portal hypertension and liver fibrosis using contrast-enhanced ultrasonography.

Portal hypertension and hepatic fibrosis are key pathophysiologies with major manifestations in cirrhosis. Although the degree of portal pressure and hepatic fibrosis are pivotal parameters, both are determined using invasive procedures. Ultrasound (US) is a simple and non-invasive technique that is available for use worldwide in the abdominal field. Because of its safety and easy of use, contrast-enhanced US is one of the most frequently used tools in the management of liver tumors for the detection and characterization of lesions, assessment of malignancy grade, and evaluation of therapeutic effects. This wide range of applications drives the practical use of contrast-enhanced US for evaluation of the severity of portal hypertension and hepatic fibrosis. The present article reviews the recent progress in contrast-enhanced US for the assessment of portal hypertension and hepatic fibrosis.

Noninvasive assessment of portal hypertension in cirrhosis: liver stiffness and beyond.

Liver stiffness measurement (LSM) is a good, but still limited tool to noninvasively assess complications and prognosis in patients with advanced liver disease. This review aims to consider the role of LSM for the diagnosis of portal hypertension-related complications and for assessment of prognosis in cirrhotic patients, and to highlight the drawbacks as well as some alternatives for improving the performance. Hence, this field is far from being closed, and deserves more attention. There is still a place for more carefully designed studies to find new, innovative and reliable approaches.

Non-invasive assessment of portal hypertension in patients with liver cirrhosis using FibroScan transient elastography

To investigate the clinical value of FibroScan transient elastography for assessing portal hypertension in liver cirrhosis patients by determining the relationship between the liver or spleen stiffness measurement with the imaging parameters of esophageal varices, portal vein width, spleen volume, and splenic vein width. A total of 259 patients with liver cirrhosis underwent FibroScan measurement, ultrasound, computed tomography and routine blood analyses. One-hundred-and-one of those patients also underwent endoscopy to diagnose esophageal varices. Receiver operating characteristic (ROC) curves were generated and the areas under the curves (AUCs) were calculated to assess the accuracy of the FibroScan liver and spleen stiffness measurements to predict esophageal varices. Pearson's correlation analysis was used to assess the relationship between clinical features. The median liver and spleen stiffness of the cirrhotic patients were 24.27 kPa and 44.64 kPa, respectively. Liver and spleen stiffness increased in conjunction with increases in Child-Pugh score. Liver stiffness was positively correlated with spleen stiffness (P less than 0.05). Liver and spleen stiffness were positively correlated with esophageal varices, portal vein width, spleen thickness, spleen volume, and splenic vein width. The correlation of spleen stiffness was higher than that of liver stiffness. Spleen stiffness was also negatively correlated with white blood cell count and platelet count. Liver and spleen stiffness also increased in conjunction with increased severity of esophageal varices. The AUC of spleen stiffness was higher than that of liver stiffness for predicting esophageal varices (0.804 vs. 0.737). The optimal cut-off level of spleen stiffness was 44.5 kPa (sensitivity: 88%; specificity: 68%). The estimated prevalence of esophageal varices was 97.87% and the optimized cut-off level of liver stiffness was 18.0 kPa. FibroScan appears to be a clinically valuable non-invasive method to assess portal hypertension in cirrhotic patients. Both liver and spleen stiffness measurements correlated with portal hypertension but the spleen stiffness measurement may be of higher clinical value.

Noninvasive Assessment of Portal Hypertension by Ultrasonography

To explore the feasibility of noninvasive assessment of portal hypertension (PHT) by ultrasonography. A total of 18 PHT patients who were planning to undergo splenectomy combiend with pericardial devascularization received ultrasonography one week before surgery (PHT group). In addition, 20 healthy volunteers were enrolled as the controls (control group). The conventional two-dimentional (2D) ultrasound, Doppler ultrasound and contrast-enhanced ultrasound (CEUS) parameters were compared between these two groups. For patients in the PHT group, the portal vein pressure was measured using portal vein puncture, and its relationship with the above parameters were further analyzed. The 2D ultrasound, Doppler ultrasound and CEUS parameters showed significant differences between the PHT group and control group (p < 0.01). Three ultrasonographic features including area under the time-intensity curve (TIC) of portal venous phase/hepatic arterial phase (Qp/Qa), intensity of portal venous phase/hepatic arterial phase (Ip/Ia), and base-to-peak ascending slope (βp/βa) were negatively correlated with the portal vein pressure (correlation coefficient: -0.701, -0.625, and -0.494, respectively). In this study, Qp/Qa and Ip/Ia have reduced significantly in PHT group compared with that in the control group (p <0.01), suggesting that in PHT patients, intensity and proportion of portal vein perfusion declined; while intensity and proportion of hepatic artery perfusion gradually rise due to buffering effect, thus gradually reversed the proportion of blood supplying through portal vein and hepatic arteries. Meanwhile, the decline of βp/βa, TTP, and RT confirmed that the increased flow velocity of the hepatic artery and decreased flow velocity of portal vein led to increased slope of TIC curve of the ascending branch of hepatic artery segment and decreased slope in portal vein segment, moreover; meanwhile, the increased overall slope of curve caused an advanced time to peak. In PHT group, Qp/Qa, Ip / Ia, and βp/βa were negatively correlated with the portal vein pressure, with correlation coefficients of -0.701, -0.625 and -0.494, respectively, indicating that these three ultrasound contrast parameters not only objectively reflected the pathophysiological process and the hemodynamic characteristics of chronic liver diseases but also showed a good correlation with portal pressure, therefore it was expected for clinical use as a new method for noninvasive assessment of portal vein pressure in PTH patients.

Mo2077 A New Paradigm in the Noninvasive Assessment of Portal Hypertension: A Single Ultrasound Procedure Incorporating Acoustic Radiation Force Impulse Elastography Predicts >90% of Esophagogastric Varices and Portal Gastropathy

Introduction Accurate non-invasive techniques for imaging portal hypertension (PHT) have long been the goal of hepatologists. However the sensitivity of standard ultrasound (US) alone is too low to achieve this. The combined use of elastography with US to detect PHT has not been investigated. ARFI (Virtual Touch © ) elastography is a novel validated technique for measuring liver stiffness (LS), with practical advantages over transient elastography including real-time scanning. We report our experience of this technique in assessing PHT in a consecutive secondary care cohort. Aims To establish whether the addition of LS estimation by ARFI to conventional US Doppler assessment of the spleno-portal venous system can reliably predict the presence of significant endoscopic PHT. Methods Conventional US and elastography were performed simultaneously at one session by a single radiologist, using a Siemens Acuson S2000 TM and 4C1 probe 4 MHz transducer and a standard, validated 10 observation right lobe ARFI technique. Within the study period, 82/108 chronic liver disease (CLD) patients (60 hospitalised and 48 outpatients) underwent both elastography and upper GI endoscopy. Standard US data collected included spleen size, portal vein Doppler flow velocity, direction and waveform, presence of collaterals, and platelet count. Results Significant endoscopic PHT, defined as oesophageal/gastric varices and/or moderate to severe portal hypertensive gastropathy, was seen in 34/82 patients (41%). Median LS measured by shear velocity was significantly higher in the PHT group (2.9 vs 2.2 m/s, p Conclusion In this retrospective “real world” study the addition of ARFI to standard US parameters using a combined scoring system achieved high (>90%) predictive value for the non-invasive detection of endoscopic PHT. A further prospective study, with refinement of US Doppler technique, is now in progress to confirm these promising results. Single session ARFI+US may accurately guide PHT diagnosis and selection for endoscopic surveillance in CLD. Competing interests None declared.

Noninvasive assessment of portal hypertension in patients with alcoholic cirrhosis

Portal hypertension and development of esophageal varices is one of the major complications of liver cirrhosis. The aim of our study was to evaluate the possibility of the presence of esophageal varices and their size using biochemical and ultrasonography parameters in patients with alcoholic liver cirrhosis. We included in our study 86 patients (74 males, mean age 55±7) with alcoholic liver cirrhosis. The control group consisted of 102 patients with cirrhosis of other etiologies. All patients underwent a complete biochemical workup, upper digestive endoscopy and ultrasonography examination. The right liver lobe diameter/albumin and platelet count/spleen diameter ratios were calculated. The correlation of the calculated ratios with the presence and degree of esophageal varices in patients with liver cirrhosis was also determined. The mean value of right liver lobe diameter-albumin ratio was 6.15±1.77, and statistically significantly differed from values determined in the control group (4.97±1.68). The mean platelet count-spleen diameter ratio was 972.5±599.0 in alcoholic liver cirrhosis and 1055.9±821.3 in controls (p>0.05). In patients with alcoholic liver cirrhosis, none of the analyzed noninvasive markers was shown to be a good predictor of the presence and size of esophageal varices. Despite the important role of noninvasive markers in providing information pertinent to determination of esophageal varices in patients with liver cirrhosis, these markers have limited relevance in patients with alcoholic cirrhosis.

PTU-025 A new paradigm in the non-invasive assessment of portal hypertension: a single ultrasound procedure incorporating acoustic radiation force impulse (ARFI) elastography predicts over 90% of oesophago-gastric varices and portal gastropathy

IntroductionAccurate non-invasive techniques for imaging portal hypertension (PHT) have long been the goal of hepatologists. However the sensitivity of standard ultrasound (US) alone is too low to achieve this. The...