Benefits Of Liver Elastography In A Vascular Lab
Kush Patel, David Wedderman, RVT, John Franzese, MD, Clifford M. Sales, MD MBA.
Overlook Medical Center, Summit, NJ, USA.
OBJECTIVESHepatic anatomy and physiology have, historically, not fallen under the purview of the Noninvasive Vascular Laboratory. We have developed an interest in the diagnosis and progression of portal hypertension and liver fibrosis by applying the principles of vascular ultrasound technology. We have added elastography to our portal venous investigation in our vascular laboratory. Our early experience is reported herein.
METHODSWe initiated our elastography program in early 2019 and report the initial 18 months of experience. All patients who were referred for portal vein studies underwent elastography in addition to the portal vein study. Analysis was performed and accuracy measurements applied according to protocol.
RESULTSPortal Duplex ultrasonography was performed in 237 patients and elastography was able to be completed in 201 (85%) of those patients. Primary indications for the study were abnormal liver functions tests (32%), Steatosis (27%), Cirrhosis (15%), Hepatitis (8%) and others (17%.) 47 (20%) patients demonstrated portal vein hypertension and 9 were “suggestive” of portal vein hypertension. Elastography results demonstrated severe liver stiffness in 38 (19%) and mild to moderate stiffness in 55 (27%). Splenomegaly and ascites were the most common accompanying findings. Of the 47 patients that demonstrated portal vein hypertension, we were able to obtain liver stiffness readings in 29. 15 of the 29 (52%) with demonstrated PVHT had severe liver stiffness and 18 of the 38 (47%) with severe liver stiffness had no indication of PVHT.
DISCUSSIONBringing elastography into the Noninvasive Vascular Laboratory adds another dimension. We have demonstrated that, with dedication, it is possible and not overwhelming. Identifying liver stiffness by use of elastography allows for the diagnosis of fibrosis thus identifying those at risk for hepatocellular cancer. Those at risk are then able to be screened with further imaging and serologic markers with the end result being to identify, and treat, hepatocellular carcinoma earlier in the disease process allowing for improved mortality.
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