Quantitative Assessment of Liver Stiffness Using Ultrasound Shear Wave Elastography in Patients With Chronic Graft‐Versus‐Host Disease After Allogeneic Hematopoietic Stem Cell Transplantation: A Pilot Study

Abstract

Objectives The purpose of this study was to compare hepatic stiffness on ultrasound (US) shear wave elastography (SWE) in patients with chronic graft‐versus‐host disease (GVHD) after allogeneic hematopoietic stem cell transplantation versus patients with no underlying liver disease. Methods We performed a retrospective analysis of 4901 patients who underwent abdominal US examinations with adjunctive liver SWE between August 2014 and December 2016. Each patient was scanned supine with gentle breath holding on LOGIQ E9 (GE Healthcare, Waukesha, WI) or Epiq (Philips Healthcare, Andover, MA) US machines (3–6 MHz). Three to 10 measurements were made intercostally in the right hepatic lobe, following manufacturers' guidelines before release of the 2015 Society of Radiologists in Ultrasound consensus or the 2015 Society of Radiologists in Ultrasound consensus. The median and standard deviation of the shear wave velocity (SWV) were obtained. A 2‐sample t test with the Welch approximation was used for statistical analysis. Results Six patients had documented hepatic chronic GVHD or a high clinical suspicion of liver chronic GVHD. All had normal pretransplant liver function test results and no pretransplant or posttransplant hepatic infection. The control group, obtained from the same database, contained 10 patients with normal liver function test results, no abdominal pain, and no history of liver disease or conditions that may have caused liver stiffness changes. The SWVs in patients with chronic GVHD were double those in the control group (1.96 ± 0.28 versus 0.98 ± 0.27 m/s; P < .0001). Conclusions Patients with chronic GVHD had substantially higher hepatic parenchymal SWVs than patients without liver disease, indicating increased tissue stiffness. To our knowledge, this phenomenon has not been previously reported in chronic GVHD and suggests potential utility of SWE for diagnosis and monitoring of disease progression and the treatment response in this cohort of patients.

Potenzial des Ultraschalls bei allogener Stammzelltransplantation und transplantationsassoziierten Komplikationen

“…Analog zur akuten GvHD sind die Befunde grundsätzlich uncharakteristisch und müssen immer im klinischen Kontext beurteilt werden. 2019 erschienen erste Daten zum Stellenwert der Elastografie bei chronischer GvHD der Leber in einem kleinen Patientenkollektiv (n = 10) [70]. Hier konnte bei den Patienten eine erhöhte Scherwellengeschwindigkeit im Ver- gleich zur Kontrollgruppe beobachtet werden [70].…”

“…2019 erschienen erste Daten zum Stellenwert der Elastografie bei chronischer GvHD der Leber in einem kleinen Patientenkollektiv (n = 10) [70]. Hier konnte bei den Patienten eine erhöhte Scherwellengeschwindigkeit im Ver- gleich zur Kontrollgruppe beobachtet werden [70]. Zur besseren Einschätzung ist allerdings eine prospektive Studie mit größerer Patientenzahl notwendig [70].…”

“…Die chronische GvHD tritt nach allogener SZT in 6-80 % der Patienten auf [54,[66][67][68]. Dabei werden meist Haut, Leber, die Mundhöhle oder die Augen befallen [69] gleich zur Kontrollgruppe beobachtet werden [70]. Zur besseren Einschätzung ist allerdings eine prospektive Studie mit größerer Patientenzahl notwendig [70].…”

“…Dabei werden meist Haut, Leber, die Mundhöhle oder die Augen befallen [69] gleich zur Kontrollgruppe beobachtet werden [70]. Zur besseren Einschätzung ist allerdings eine prospektive Studie mit größerer Patientenzahl notwendig [70]. Zusammenfassend wird in den Leitlinien zur Nachsorge von Patienten nach allogener SZT primär eine symptomorientierte Diagnostik empfohlen [65].…”

Quantitative analysis of contrast-enhanced ultrasonography in rat models of hepatic acute graft-versus-host disease

“…Therefore, the histopathological assessment provides an important basis. However, biopsy has several limitations, including some of the complications (post-biopsy hemorrhage, and biopsy-related infections) associated with invasiveness and false-negative results ( 9 , 10 ), especially the need for biopsy in patients with immunosuppressive therapy which is still debated ( 11 ). In addition, the biopsy is limited by sampling and cannot assess the overall liver involvement and thus delay diagnosis, resulting in GVHD progression to grades 3–4 and poor patient outcomes.…”