title: Real-time shear-wave elastography: applicability, reliability and accuracy for clinically significant portal hypertension.
abstract: OBJECTIVE
  Real-time shear wave elastography (RT-SWE) might be useful to assess the severity of portal hypertension; reliability criteria for measurement are needed.
  
  
  METHODS
  We prospectively included 88 consecutive patients undergoing hepatic venous pressure gradient measurement (HVPG, reference standard) for portal hypertension. Liver stiffness (LS) was measured by RT-SWE and by transient elastography (TE). Spleen stiffness (SS) was measured by RT-SWE. Reliability criteria for RT-SWE were searched, and the accuracy of these techniques to identify HVPG ⩾10mmHg (clinically significant portal hypertension, CSPH) was tested and internally validated by bootstrapping analysis.
  
  
  RESULTS
  LS and SS by RT-SWE were feasible respectively in 87 (99%) and 58 (66%) patients. Both correlated with HVPG (LS: R=0.611, p<0.0001 and SS: R=0.514, p<0.0001). LS performed well for diagnosing CSPH (optimism corrected AUROC=0.858). Reliability of measurements was influenced by standard deviation (SD)/median ratio and depth. SD/median ⩽0.10 and depth of measurement <5.6cm were associated to 96.3% well classified for CSPH, while when one or none of the criteria were fulfilled the rates were 76.4% and 44.4%, respectively. Measurements fulfilling at least one criterion were considered acceptable; in these patients, RT-SWE performance to detect CSPH was excellent (AUROC=0.939; 95% CI: 0.865-1.000; p<0.0001; best cut-off: 15.4kPa). LS by RT-SWE and by TE were strongly correlated (R=0.795, p<0.0001) and performed similarly both in "per protocol" and in "intention-to-diagnose" analysis after applying reliability criteria.
  
  
  CONCLUSIONS
  LS by RT-SWE is an accurate method to diagnose CSPH if reliability criteria (SD/median ⩽0.10 and/or depth <5.6cm) are fulfilled.
authors.affiliation: Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Spain.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Procopet
authors.affiliation: Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Spain. Electronic address: aberzigo@clinic.ub.es.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Berzigotti
authors.affiliation: Cirrhosis Care Clinic (CCC), Liver Unit, Division of Gastroenterology, University of Alberta, Edmonton, Canada.
authors.forename: Juan G
authors.initials: JG
authors.lastname: Abraldes
authors.affiliation: Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Spain.
authors.forename: Fanny
authors.initials: F
authors.lastname: Turon
authors.affiliation: Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Spain.
authors.forename: Virginia
authors.initials: V
authors.lastname: Hernandez-Gea
authors.affiliation: Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Pagán
authors.affiliation: Hepatic Hemodynamic Laboratory, Liver Unit, Hospital Clinic, IDIBAPS, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (Ciberehd), Spain.
authors.forename: Jaime
authors.initials: J
authors.lastname: Bosch
mesh_terms: D000368:Aged; D061827:Dimensional Measurement Accuracy; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000503:physiopathology; D008099:Liver / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure; D011168:Portal System / Q000000981:diagnostic imaging / Q000503:physiopathology; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013154:Spleen / Q000473:pathology / Q000503:physiopathology
keywords: Cirrhosis; HVPG; Liver disease; Sonoelastography; Ultrasound