Application of Ultrasound Elastography Scoring in Diagnosing Potential Porto-Sinusoidal Vascular Disease in Patients with Portal Vein Thrombosis

The “Hepatology Digest-Vascular Liver Disease Column” is an academic column jointly initiated by Dr. Xingshun Qi of the Department of Gastroenterology, Northern Theater Command General Hospital, at the invitation of the editorial department of ” Hepatology Digest”. This column regularly collects and organizes research progress in the field of vascular liver disease. Every two weeks (on Wednesday), an important piece of literature is selected for in-depth discussion. The aim is to help readers understand the rationale behind these advancements and to inspire clinical and scientific thinking, putting knowledge into practice.

Article Summary

Porto-sinusoidal vascular disease (PSVD) is a liver vascular disease characterized by portal vein and hepatic sinusoid alterations, with or without portal hypertension, in the absence of cirrhosis (De Gottardi A, et al. Lancet Gastroenterol Hepatol. 2019;4:399-411). Approximately 40% of PSVD cases are associated with a prothrombotic state (Hillaire S, et al. Gut. 2002;51:275-280). This prothrombotic state can lead to extrahepatic portal vein thrombosis (PVT). In fact, 30%-40% of patients with PSVD have concurrent PVT (Gioia S, et al. Dig Liver Dis. 2018;50:839-844; Siramolpiwat S, et al. Hepatology. 2014;59:2276-2285). Any patient with PVT should be suspected of having an underlying, undiagnosed PSVD. However, differentiating PVT secondary to PSVD from simple PVT is relatively difficult. Liver biopsy remains a necessary method for diagnosing PSVD, but its effectiveness in differentiating the two types of PVT is still controversial (De Gottardi A, et al. Lancet Gastroenterol Hepatol. 2019;4:399-411; Gioia S, et al. World J Hepatol. 2019;11:613-618). In this context, ultrasonography may have some value in differentiating these two types of PVT.

In July 2023, the journal Hepatobiliary & Pancreatic Diseases International published an article online titled “Application of Ultrasound Elastography Scoring in Diagnosing Potential Porto-Sinusoidal Vascular Disease in Patients with Portal Vein Thrombosis.” The article aims to distinguish PSVD from simple PVT using non-invasive ultrasound parameters, thereby diagnosing PVT secondary to PSVD.

Gioia and colleagues included 101 patients with non-cirrhotic portal hypertension, among whom 53 had PSVD and 48 had chronic PVT. All patients underwent abdominal ultrasound and Acoustic Radiation Force Impulse (ARFI) elastography. The study found that spleen vein (SV), superior mesenteric vein (SMV) diameter, and liver stiffness in PSVD patients were greater than in those with chronic PVT. Therefore, a prognostic score derived from a linear combination of ARFI values and SMV diameter had good discriminative ability for PSVD and chronic PVT.

In summary, a prognostic score based on ARFI values and SMV diameter may help diagnose potential PSVD in PVT patients and determine those who need a liver biopsy.

Analysis of Key Research Results and Their Clinical Significance

Baseline Characteristics of Patients

Patients with PSVD (Porto-sinusoidal Vascular Disease) tend to be younger and predominantly male; chronic PVT (Portal Vein Thrombosis) patients have higher platelet counts. Thrombophilia was present in 5 (9.4%) PSVD patients and 23 (47.9%) chronic PVT patients; myeloproliferative neoplasms were found in 6 (11.3%) PSVD patients and 9 (18.8%) chronic PVT patients. The Acoustic Radiation Force Impulse (ARFI) values, spleen vein (SV), and superior mesenteric vein (SMV) diameter in PSVD patients were greater than those in chronic PVT patients.

2. Accuracy of ARFI Values and SMV Diameter in Differentiating PSVD and Chronic PVT

The Area Under Curve (AUC) for ARFI values in differentiating PSVD from chronic PVT was 0.712 (95% CI: 0.603–0.821); the AUC for SMV diameter was 0.839 (95% CI: 0.754–0.924).

3. Accuracy of Combining ARFI Values and SMV Diameter in Differentiating PSVD and Chronic PVT

The AUC for a Logistic regression model based on ARFI values and SMV diameter in differentiating PSVD from chronic PVT was 0.852 (95% CI: 0.771–0.934).

4. Accuracy of Prognostic Scoring (USE Score) in Differentiating PSVD and Chronic PVT

The USE score, obtained by a linear combination of ARFI values and SMV diameter (USE score = 0.3ARFI + 0.6SMV), had an AUC of 0.780 (95% CI: 0.690–0.869) in differentiating PSVD from chronic PVT. The optimal cutoff value was 6.8, with a sensitivity of 81% and specificity of 76%.

Summary and Prospects

This study found that ARFI values and SMV diameter in PSVD patients were significantly higher than those in chronic PVT patients. A USE score was derived by linearly combining these two parameters. A USE score > 6.8 suggests the presence of PSVD in PVT patients, recommending liver biopsy for confirmation. However, this method still needs further validation.

Recruitment for Multicenter Study on the Prevalence of Portal Vein Thrombosis in Cirrhosis

Portal Vein Thrombosis (PVT), especially complete occlusive PVT, can increase portal vein pressure in patients with cirrhosis, thereby increasing the risk of ascites and esophagogastric variceal bleeding. Currently, the proper management of portal vein thrombosis in cirrhosis remains a challenging clinical issue. Moreover, the prevalence of PVT in cirrhosis is not clear, and large-scale epidemiological studies are lacking, especially domestically. To address this, Dr. Xingshun Qi from the Department of Gastroenterology, Northern Theater Command General Hospital, is preparing to initiate a nationwide multicenter study. This study aims to clarify the prevalence of PVT in cirrhosis based on enhanced CT scan results and to retrospectively analyze related risk factors. We sincerely invite doctors from gastroenterology, hepatology, infectious diseases, and radiology departments to participate. If you are interested in this study, please contact us for more detailed research information.

Contact Person: Dr. Wang

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