Liver Cirrhosis Characterization with 2D-SWE

Study design: Prospective single-center comparative study. A total of 86 patients from among the patients admitted to University Hospital “Kaspela” for diagnosis and/or treatment of liver cirrhosis between January and November 2021 were included. Subjects were divided into two groups as follows: (1). Compensated liver cirrhosis, (2). Decompensated liver cirrhosis. The presence of either ascites, prior episode of variceal hemorrhage, hepatic encephalopathy, or jaundice were considered as criteria for inclusion in the dLC group, while the rest were selected for the cLC group. Patients with thrombosis of the portal venous system, prior endoscopic band ligation (EBL), obstructive jaundice, or verified malignant lesions in the liver we considered ineligible and were excluded from the analysis.
Each of the participants underwent a physical examination and biochemical testing including alanine aminotransferase (ALAT), aspartate aminotransferase (ASAT), alkaline phosphatase, gamma-glutamyl transferase, bilirubin, and platelet count. Each participant underwent conventional abdominal ultrasound in B-mode to assess the size, shape, and structure of the liver. Standard liver measurements were performed: the ventro-dorsal size of the liver (mm) on the right midclavicular line, portal vein size (mm), and portal blood flow velocity by Doppler US (m/sec). The presence of ascites and visible portosystemic anastomoses was also recorded.
LSM was performed by 2D-SWE using the QElaXto^® software, version F104513Q101701 of an Esaote MyLab™ 9 eXP (Genoa, Italy) ultrasound device. A convex C1-8IQ appleprobe transducer was used. Ten elastographic measurements were performed with a validation criterion-median interquartile range (IQR/M) <30% in accordance with current recommendations [5 (link)].
LS was assessed elastographically by examining the right hepatic lobe of each patient through the intercostal space. Patients were in a supine position with their right arm at maximum abduction in compliance with the latest requirements for quality measurement [6 (link),7 (link)]. During standard B-mode, an assessment area was selected with no large blood vessels. Location at a distance of at least 1.5 cm from the Glisson’s capsule was selected and the ROI size was fixed by the device. The patient was instructed to hold his breath while the values were calculated (Figure 1). If the colour box was not filled by > 50% of its surface or if breathing was uncontrolled, the elastogram was discarded and a new acquisition was attempted. Ten LSMs were obtained, and the median value in m/s was used for analysis.
Upper endoscopy was utilized as a reference method to evaluate the presence and grade of EVs. An endoscopic processor Olympus Evis Exera III (Hamburg, Germany), coupled with the Olympus GIF-HQ190 (Hamburg Germany) therapeutic gastroscope, was used. Grading of EVs was performed in concordance with the Paquet classification (Table 1) [8 (link)]. Moderate insufflation was used. All procedures were performed by a single endoscopist to ensure adequate comparability.