Hepatic Vein Contrast-Enhanced Ultrasound Subharmonic Imaging Signal as a Screening Test for Portal Hypertension

Machado, Priscilla; Gupta, Ipshita; Gummadi, Sriharsha; Stanczak, Maria; Wessner, Corinne E.; Fenkel, Jonathan M.; Shaw, Colette M.; Shamini-Noori, Susan; Schultz, Susan M.; Soulen, Michael C.; Sehgal, Chandra M.; Wallace, Kirk; Eisenbrey, John R.; Forsberg, Flemming

doi:10.1007/s10620-020-06790-6

Cited by 15 publications

(6 citation statements)

References 33 publications

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“…However, since the MRI examination time was much longer and the preparation was more difficult and complicated, few patients underwent MRI at the very beginning. A study recruiting 131 patients concluded that contrast-enhanced ultrasonography could discover portal hypertension with a sensitivity and specificity of up to 88% and 63%, respectively [ 77 ]. In 2020, Gupta I et al found that a subharmonic-aided pressure estimation under contrast-enhanced ultrasonography had a relatively satisfactory sensitivity and specificity of 90% and 80% [ 78 ], respectively.…”

Section: Discussionmentioning

confidence: 99%

Application of Ultrasound Elastography in Assessing Portal Hypertension

et al. 2022

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Portal hypertension is a common manifestation in late-to-end-stage liver diseases and can cause severe complications such as ascites, hepatic encephalopathy, etc. However, an early diagnosis of portal hypertension is often difficult as it can be asymptomatic. Though the gold standard to diagnose portal hypertension is hepatic vein catheterization, ultrasound elastography is regarded as a noninvasive alternative that can be used to accurately predict portal hypertension and a few further complications such as gastro-esophageal varices. Since ultrasound elastography is available in most medical centers, and is cheaper and noninvasive, studying its function in predicting portal hypertension is of paramount importance. Therefore, this review generalized the results of recently published articles in order to establish the indicators that were related to diagnostic and prediction efficiency. Our study found that various technologies of ultrasound elastography could be used to predict portal hypertension with satisfactory diagnostic sensitivity, specificity, accuracy, and AUC. Meanwhile, we also recognized similar diagnostic efficiency of ultrasound elastography in gastro-esophageal varices.

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Section: Discussionmentioning

confidence: 99%

Application of Ultrasound Elastography in Assessing Portal Hypertension

et al. 2022

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“…11,13 More recently, these findings were validated as part of a multi-center clinical trial and also shown to be effective for monitoring progression of portal pressures in patients with chronic liver disease. 14,15,28 in addition, Sonazoid-based SHAPE has been shown to be feasible for the noninvasive measurement of cardiac pressures in both canines and humans. 10,29 Similar translation has been undertaken using SHAPE with Definity (Lantheus Medical Imaging, N Billerica, MA) for cardiac pressure estimation, 16 and for tracking changes in interstitial fluid pressure in breast cancers over the course of neoadjuvant chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Sonazoid was first shown to be useful for the diagnosis of portal hypertension in canine models and in a pilot, human clinical trial 11,13 . More recently, these findings were validated as part of a multi‐center clinical trial and also shown to be effective for monitoring progression of portal pressures in patients with chronic liver disease 14,15,28 . in addition, Sonazoid‐based SHAPE has been shown to be feasible for the noninvasive measurement of cardiac pressures in both canines and humans 10,29 .…”

Section: Discussionmentioning

confidence: 99%

Improved Sensitivity of Ultrasound‐Based Subharmonic Aided Pressure Estimation Using Monodisperse Microbubbles

Hoeve

Serrano

Winkel

et al. 2021

J of Ultrasound Medicine

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Objectives-Subharmonic aided pressure estimation (SHAPE) has been shown effective for noninvasively measuring hydrostatic fluid pressures in a variety of clinical applications. The objective of this study was to explore potential improvements in SHAPE sensitivity using monodisperse microbubbles.Methods-Populations of monodisperse microbubbles were created using a commercially available microfluidics device (Solstice Pharmaceuticals). Size distributions were assessed using a Coulter Counter and stability of the distribution following fabrication was evaluated over 24 hours. Attenuation of the microbubble populations from 1 to 10 MHz was then quantified using single element transducers to identify each formulation's resonance frequency. Frequency spectra over increasing driving amplitudes were investigated to determine the nonlinear phases of subharmonic signal generation. SHAPE sensitivity was evaluated in a hydrostatic pressure-controlled water bath using a Logiq E10 scanner (GE Healthcare).Results-Monodisperse lipid microbubble suspensions ranging from 2.4 to 5.3 μm in diameter were successfully created and they showed no discernable change in size distribution over 24 hours following activation. Calculated resonance frequencies ranged from 2.1 to 6.3 MHz and showed excellent correlation with microbubble diameter (R 2 > 0.99). When investigating microbubble frequency response, subharmonic signal occurrence was shown to begin at 150 kPa peak negative pressure, grow up to 225 kPa, and saturate at approximately 250 kPa. Using the Logiq E10, monodisperse bubbles demonstrated a SHAPE sensitivity of À0.17 dB/mmHg, which was nearly twice the sensitivity of the commercial polydisperse microbubble currently being used in clinical trials.Conclusions-Monodisperse microbubbles have the potential to greatly improve the sensitivity of SHAPE for the noninvasive measurement of hydrostatic pressures.

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“…In addition, as SHAPE is a quantitative technique based on RF data, the measurements have good reproducibility and reported standard deviations <1 dB. Machado et al 4 conducted a trial with 131 patients (31 subclinical PH and 33 clinical PH), revealing two readers achieved for PH sensitivity of 77%–100%, specificity of 61%–88%, and receiver operating characteristic curve area of 0.70–0.93. The intraobserver reproducibility, assessed by κ value of 0.66.…”

Section: Figurementioning

confidence: 99%