The usefulness of hepatic vein arrival time using a microbubble contrast enhanced ultrasonography in non-invasive estimation of the severity of portal hypertension in cirrhotic patients

Abstract

Backgrounds and aim: Hepatic vein arrival time (HVAT) using a microbubble contrastt enhanced ultrasonography (CEUS) is shorter in cirrhosis because of the presence of intrahepatic and intrapulmonary shunts. However, the direct relationship between HVAT and portal hypertension (PHT) has not been evaluated. The aim of the present study is to evaluate the usefulness of HVAT measurement in assessing the PHT in cirrhotic patients. Methods: For the derivation cohort consists of seventy-four cirrhotic patients, both the HVAT and the hepatic venous pressure gradient (HVPG) were measured and the relationship between them was analyzed. Then the results were validated for the validation cohort of thirty-five cirrhotic patients in another medical center. Clinically significant PHT (CSPH) and severe PHT were defined as HVPG ≥ 10mmHg and HVPG ≥ 12mmHg, respectively. Results: In linear regression analysis, HVPG and HVAT showed significant negative correlation (P < 0.001, r2 = 0.602). In ROC curve analysis of HVAT, the AUROC were 0.908 and 0.845 for the prediction of CSPH and severe PHT respectively. The sensitivity, specificity, positive predictive value and negative predictive value for CSPH according to cut-off value of 14sec of HVAT were 83.1, 93.3, 98.0 and 58.3% respectively. In validation, HVAT also showed significant validation results as AUROC 0.906 and 0.872 respectively. Conclusion: HVAT measurement is considered as a potentially non-invasive alternative method in assessment of the severity of portal hypertension in cirrhotic patients.