Similar performance of liver stiffness measurement and liver surface nodularity for the detection of portal hypertension in patients with hepatocellular carcinoma

Alexandra Souhami; Riccardo Sartoris; Pierre-Emmanuel Rautou; François Cauchy; Mohamed Bouattour; François Durand; Valerio Giannelli; Elia Gigante; Laurent Castera; Dominique Valla; Olivier Soubrane; Valérie Vilgrain; Maxime Ronot

doi:10.1016/j.jhepr.2020.100147

Similar performance of liver stiffness measurement and liver surface nodularity for the detection of portal hypertension in patients with hepatocellular carcinoma

JHEP Rep. 2020 Jul 17;2(5):100147. doi: 10.1016/j.jhepr.2020.100147. eCollection 2020 Oct.

Authors

Alexandra Souhami¹, Riccardo Sartoris¹, Pierre-Emmanuel Rautou^{2

3

4}, François Cauchy⁵, Mohamed Bouattour², François Durand^{2

3}, Valerio Giannelli², Elia Gigante², Laurent Castera², Dominique Valla^{2

3}, Olivier Soubrane⁵, Valérie Vilgrain^{1

3

6}, Maxime Ronot^{1

3

6}

Affiliations

¹ Department of Radiology, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France.
² Service d'Hépatologie, DHU Unity, DMU Digest, Hôpital Beaujon, AP-HP, Clichy, France.
³ Université de Paris, Centre de Recherche sur l'Inflammation, Inserm, U1149, CNRS, ERL8252, F-75018 Paris, France.
⁴ Centre de Référence des Maladies Vasculaires du Foie, French Network for Rare Liver Diseases (FILFOIE), European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Clichy, France.
⁵ Department of Hepatobiliary Surgery, APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Clichy, France.
⁶ INSERM U1149, CRI, Paris, France.

Abstract

Background & aims: We compare the performance of liver surface nodularity (LSN) and liver stiffness measurements (LSM) using transient elastography (TE) for the detection of clinically significant portal hypertension (CSPH) in patients with cirrhosis and hepatocellular carcinoma (HCC).

Methods: All patients with cirrhosis and HCC who underwent computed tomography, LSM and hepatic venous pressure gradient (HVPG) measurements within 30 days between 2015 and 2018 were included. The estimation of CSPH by LSN and LSM, and the LSM-spleen-size-to-platelet ratio score (LSPS) were evaluated and compared.

Results: In total, 140 patients were included (109 men [78%], mean age 63 ± 9 years old), including 39 (28%) with CSPH. LSN measurements were valid in 130 patients (93%) and significantly correlated with HVPG (r = 0.68; p <0.001). Patients with CSPH had higher LSN measurements compared with those without [3.1 ± 0.4 vs. 2.5 ± 0.3, p <0.001; area under the receiver operating characteristic (AUROC): 0.87 ± 0.31]. LSM and LSPS were valid in 132 patients (94%) and significantly correlated with HVPG (r = 0.75, p <0.001; AUROC 0.87 ± 0.04 and r = 0.68, p <0.001; AUROC 0.851 ± 0.04, respectively). There was no significant difference in the diagnostic performance between LSN and LSM-LSPS (DeLong, p = 0.28, 0.37, and 0.65, respectively) in patients with both valid tests (n = 122). LSN <2.50 had a 100% negative predictive value for CSPH. A 2-step algorithm combining LSN and LSPS for the diagnosis of CSPH classified 108/140 patients (77%) with an 8% error.

Conclusions: The diagnostic performance and feasibility of LSN measurements were similar to those of LSM for the detection of CSPH in patients with compensated cirrhosis and HCC. Combining LSN and LSPS accurately detected CSPH in >75% of patients. Such a combination could be useful in centres where the HVPG measurement is unavailable.

Lay summary: The diagnostic performance and feasibility of liver surface nodularity was similar to that of liver stiffness measurement (LSM) for the detection of clinically significant portal hypertension in patients with compensated cirrhosis. Thus, liver surface nodularity could be an option for the preoperative detection of clinically significant portal hypertension in patients with hepatocellular carcinoma. Combining liver surface nodularity with LSM-spleen-size-to-platelet ratio score resulted in the accurate detection of clinically significant portal hypertension in >75% of patients, thus limiting the need for HVPG measurements.

Keywords: AUROC, area under the receiver operating characteristic; CSPH, clinically significant portal hypertension; HCC, hepatocellular carcinoma; HPV, hepatic venous pressure; HVPG, hepatic venous pressure gradient; LSM, liver stiffness measurements; LSN, liver surface nodularity; LSPS, LSM-spleen-size-to-platelet ratio score; NRI, Net Classification Index Improvement; PHT, portal hypertension; TE, transient elastography.