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Evaluation of Liver and Spleen Stiffness by ARFI in Non-Cirrhotic Portal Hypertension (NCPH)
VASCULAR LIVER DISEASE
Vascular Liver Disease
congestion (SDC) in liver biopsy. However, the finding of SDC is not always due to venous outflow impairment. Objectives: To determine the specificity of SDC in liver biopsies for venous outflow impairment and to seek an explanation for SDC in patients without clinical or radiologic features of venous outflow impairment. Method: Retrospective study wherein 250 liver biopsies of chronic liver disease patients from 2012 to 2015 were reviewed. Biopsies from transplant recipients and patients with hepatic mass (primary or metastatic) were not included. Clinical records were reviewed for laboratory tests and final diagnosis. Results: 5 out of 250 biopsied showed sinusoidal dilatation. 2 patients (40%) had confirmed venous outflow impairment on imaging studies. Of the 3 cases (60%) without clinical and/or radiologic evidence of venous outflow impairment, portal vein thrombosis was present in 1 case (20%). Tubercular infiltration was identified in 1patient (20%). Remaining 1 patient had Non cirrhotic portal fibrosis. No other disease association was apparent in these cases. Conclusion: Sinusoidal dilatation and congestion in liver biopsy is associated with venous outflow impairment in 40% of the cases. In the absence of clinical and/or radiological evidence of venous outflow, diagnostic considerations include other vascular conditions, such as portal vein insufficiency, systemic inflammatory diseases. Corresponding author: Vinay Zanwar. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2015.07.109
EVALUATION OF LIVER AND SPLEEN STIFFNESS BY ARFI IN NON-CIRRHOTIC PORTAL HYPERTENSION (NCPH) Apurva Shah Bombay Hospital & Medical Research Center, Mumbai, India
Aim: Patients with NCPH can mimic cirrhosis on routine imaging like ultrasonography and CT scan hence this study was planned to evaluate liver stiffness (LS) and spleen stiffness (SS) by acoustic radiation force impulse (ARFI) in NCPH.
S56
Table 1 Demographic and Biochemical Profiles of Subjects. Parameters
NCPH subjects (n = 40)
Control subjects (n = 61)
P-value
Mean age (y)
39.7 14.4 (14–77) 10.9 (6–16)
41.6 17.9 (18–81) 13 (8–16)
0.641 0.004
154
250
0.059
3.8 0.6
3.9 0.7
0.468
Median hemoglobin (g/dL) Median platelet count (thousands/mL) Mean serum albumin (g/dL) Mean LS (m/s)
1.7 0.5
1.4 0.2
0.001
Mean SS (m/s)
3.4 0.5
2.4 0.5
0.000
APRI
0.7 0.6
0.3 0.2
0.001
Means are given standard deviations.
Methods: In a prospective study 171 patients undergoing liver biopsy for evaluation of liver disease with or without portal hypertension, were subjected to LS and SS stiffness prior to biopsy. 40 patients, EHPVO – 30 and NCPF – 10 were diagnosed on the basis of clinical history, laboratory parameters, imaging and histology. Comparison in LS & SS measured by ARFI between the NCPH, controls and cirrhotic patients (diagnosed on histology) was made by Student t-test and Mann–Whitney test. APRI score were also compared in all three groups (Table 1). Results: 40 patients with NCPH (EHPVO, n = 30 and NCPF, n = 10) (mean age, 39.7 14.4 years; 20 men) were erroneously diagnosed as cirrhosis on imaging. Mean LS & SS in NCPH patients (1.7 m/s + 0.5 and 3.4 m/s + 0.5 respectively) were significantly higher than the controls (mean LS & SS were 1.4 m/s 0.2 and 2.4 m/s 0.5, respectively). The mean score in LS in NCPH patients was significantly lower as compared to patients with cirrhosis (LS 2.5 m/s + 0.5) No significant differences were observed regarding mean LS, SS and APRI scores in NCPH with small and large varices (P = 0.79, P = 0.62 and P = 0.39 respectively). Patients who had a bleed had higher SS than did those without a bleed (3.76 m/s 0.27 vs. 3.32 m/s 0.41, P = .028). Conclusion: Liver and spleen stiffness measured by ARFI in context of the clinical history, liver function test, and Doppler sonography helps to correct the erroneous diagnosis of cirrhosis in patients with NCPH. http://dx.doi.org/10.1016/j.jceh.2015.07.110
© 2015, INASL
Vascular Liver Disease
congestion (SDC) in liver biopsy. However, the finding of SDC is not always due to venous outflow impairment. Objectives: To determine the specificity of SDC in liver biopsies for venous outflow impairment and to seek an explanation for SDC in patients without clinical or radiologic features of venous outflow impairment. Method: Retrospective study wherein 250 liver biopsies of chronic liver disease patients from 2012 to 2015 were reviewed. Biopsies from transplant recipients and patients with hepatic mass (primary or metastatic) were not included. Clinical records were reviewed for laboratory tests and final diagnosis. Results: 5 out of 250 biopsied showed sinusoidal dilatation. 2 patients (40%) had confirmed venous outflow impairment on imaging studies. Of the 3 cases (60%) without clinical and/or radiologic evidence of venous outflow impairment, portal vein thrombosis was present in 1 case (20%). Tubercular infiltration was identified in 1patient (20%). Remaining 1 patient had Non cirrhotic portal fibrosis. No other disease association was apparent in these cases. Conclusion: Sinusoidal dilatation and congestion in liver biopsy is associated with venous outflow impairment in 40% of the cases. In the absence of clinical and/or radiological evidence of venous outflow, diagnostic considerations include other vascular conditions, such as portal vein insufficiency, systemic inflammatory diseases. Corresponding author: Vinay Zanwar. E-mail: [email protected] http://dx.doi.org/10.1016/j.jceh.2015.07.109
EVALUATION OF LIVER AND SPLEEN STIFFNESS BY ARFI IN NON-CIRRHOTIC PORTAL HYPERTENSION (NCPH) Apurva Shah Bombay Hospital & Medical Research Center, Mumbai, India
Aim: Patients with NCPH can mimic cirrhosis on routine imaging like ultrasonography and CT scan hence this study was planned to evaluate liver stiffness (LS) and spleen stiffness (SS) by acoustic radiation force impulse (ARFI) in NCPH.
S56
Table 1 Demographic and Biochemical Profiles of Subjects. Parameters
NCPH subjects (n = 40)
Control subjects (n = 61)
P-value
Mean age (y)
39.7 14.4 (14–77) 10.9 (6–16)
41.6 17.9 (18–81) 13 (8–16)
0.641 0.004
154
250
0.059
3.8 0.6
3.9 0.7
0.468
Median hemoglobin (g/dL) Median platelet count (thousands/mL) Mean serum albumin (g/dL) Mean LS (m/s)
1.7 0.5
1.4 0.2
0.001
Mean SS (m/s)
3.4 0.5
2.4 0.5
0.000
APRI
0.7 0.6
0.3 0.2
0.001
Means are given standard deviations.
Methods: In a prospective study 171 patients undergoing liver biopsy for evaluation of liver disease with or without portal hypertension, were subjected to LS and SS stiffness prior to biopsy. 40 patients, EHPVO – 30 and NCPF – 10 were diagnosed on the basis of clinical history, laboratory parameters, imaging and histology. Comparison in LS & SS measured by ARFI between the NCPH, controls and cirrhotic patients (diagnosed on histology) was made by Student t-test and Mann–Whitney test. APRI score were also compared in all three groups (Table 1). Results: 40 patients with NCPH (EHPVO, n = 30 and NCPF, n = 10) (mean age, 39.7 14.4 years; 20 men) were erroneously diagnosed as cirrhosis on imaging. Mean LS & SS in NCPH patients (1.7 m/s + 0.5 and 3.4 m/s + 0.5 respectively) were significantly higher than the controls (mean LS & SS were 1.4 m/s 0.2 and 2.4 m/s 0.5, respectively). The mean score in LS in NCPH patients was significantly lower as compared to patients with cirrhosis (LS 2.5 m/s + 0.5) No significant differences were observed regarding mean LS, SS and APRI scores in NCPH with small and large varices (P = 0.79, P = 0.62 and P = 0.39 respectively). Patients who had a bleed had higher SS than did those without a bleed (3.76 m/s 0.27 vs. 3.32 m/s 0.41, P = .028). Conclusion: Liver and spleen stiffness measured by ARFI in context of the clinical history, liver function test, and Doppler sonography helps to correct the erroneous diagnosis of cirrhosis in patients with NCPH. http://dx.doi.org/10.1016/j.jceh.2015.07.110
© 2015, INASL