Usefulness of virtual touch tissue quantification for predicting the presence of esophageal varices in patients with liver cirrhosis

Abstract

Background and Aim: Measuring the hepatic venous pressure gradient (HVPG) is an established technique to detect increased portal pressure and predict the presence of esophageal varices (EVs); however, the risk of the test is greater than the information it provides. This study aimed to clarify the usefulness of virtual touch tissue quantification (VTQ), which assesses liver stiffness, in predicting the presence of EVs in patients with liver cirrhosis by comparing it with HVPG. Methods: Two hundred seventeen patients with liver cirrhosis underwent VTQ, HVPG measurement, and upper endoscopy. Patients were divided into three groups: group V, hepatitis C virus liver cirrhosis (n = 40); group A, alcoholic liver cirrhosis (n = 116); and group N, other liver cirrhosis (n = 61). In each group, we performed linear regression analysis of VTQ and HVPG data. The accuracy of VTQ and HVPG measurement in predicting the presence of EVs and high-risk EVs (EV category F2 and F3) was assessed by area under the receiver operating characteristic curve (AUROC). Results: VTQ was significantly correlated with the HVPG in the whole patients and in each group, and both VTQ and HVPG values were significantly higher in patients with EVs and high-risk EVs than in those without. The AUROC for the presence of EVs for VTQ was 0.76 in the whole sample, 0.76 in group V, 0.79 in group A, and 0.67 in group N; and for HVPG, 0.92, 0.94, 0.93, and 0.88, respectively. For VTQ, the AUROC for the presence of high-risk EVs was 0.78 in the whole sample, 0.78 in group V, 0.73 in group A, and 0.73 in group N; and for HVPG, it was 0.85, 0.82, 0.85, and 0.82, respectively. Conclusion: VTQ was reliable at predicting the presence of EVs and high-risk EVs. Therefore, we propose that VTQ is a useful, noninvasive tool for predicting the presence of EVs in daily medical care.

Recent Advances in the Pathogenesis and Clinical Evaluation of Portal Hypertension in Chronic Liver Disease

“…In addition, the usefulness of ultrasound techniques, such as point shear wave elastography, 2D shear wave elastography, acoustic radiation force impulse quantification and virtual touch tissue quantification, for the diagnosis of portal hypertension has been shown. 70 , 91 - 93 Other methods to evaluate portal hypertension include per-rectal portal scintigraphy using Tc-99m-pertechnetate, which has been reported to correlate with the HVPG and be useful in the diagnosis of chronic liver disease or sinusoidal obstruction syndrome after allogeneic hematopoietic cell transplantation. 94 , 95 Further research on CSPH risk stratification based on noninvasive imaging is warranted.…”

Small varices in chronic liver diseases

“…Liver stiffness (LS) is effective in predicting EVs [46]. In a study where LS was measured by virtual touch tissue quantification (VTQ), the AUROC curve for VTQ was 0.76 for the presence of EVs [47 ▪ ]. Yu JB et al reported the AUROC for predicting EVs using LS was 0.895 [48].…”