Primary Clinical Study Of Shear Wave Speed In Non-invasive Assessing The Effect Of TIPS And Predicting The Risk Of Esophageal Variceal Bleeding In Patients With Liver Cirrhosis

PART I PRIMARY CLINICAL STUDY OF SHEARWAVE SPEED IN NON-INVASIVE ASSESSING THEEFFECT OF TIPSObjective： To explore the feasibility of liver shear wave speed(LSWS) and spleen shear wave speed (SSWS) with virtual touch tissuequantification (VTQ) technique in non-invasive assesssing the effect oftransjugular intrahepatic portosystemic shunt（TIPS）.Methods：Twenty healthy volunteers and twenty-four patients wereenrolled in this study. Shear wave speed of the liver and spleen wereobtained by VTQ technique on one day before TIPS insertion and one weekafter TIPS placement, and the portal vein pressure was measured whileplacing the TIPS. The correlation between LSWS and SSWS and PPG were analyzed. In addition, fourteen patients were followed up for one monthafter TIPS placement.Results：There was significant difference in PPG pre and post TIPSplacement（P<0.001）.There were significant differences in LSWS andSSWS between healthy subjects and patients with TIPS insertion（all P<0.001）. A statistically significant difference in SSWS pre and post TIPSplacement was demonstrated（P<0.001）, and as well as the patients whichwere followed up for one month after TIPS placement（all P<0.05）.However，there was no significant difference in LSWS pre and post TIPSinsertion (P=0.130).LSWS was not correlated with the portal venouspressure（r=0.154，P=0.296）, however a statistically significant correlationwas found between SSWS and portal vein pressure(r=0.602, P<0.001).Conclusion：SSWS measured by VTQ technique has a significantcorrelation with portal vein pressure. Hence, SSWS based on VTQtechnique can be used as a non-invasive method for quantitatively inmonitoring the portal vein pressure as the function of the TIPS. However,evidence to support a similar role for LSWS is lacking. PART II PRIMARY CLINICAL STUDY OF SHEARWAVE SPEED IN NON-INVASIVE PREDICTING THERISK OF ESOPHAGEAL VARICEAL BLEEDING INPATIENTS WITH LIVER CIRRHOSISObjective: To explore the predictive value of liver shear wave speed(LSWS) and spleen shear wave speed (SSWS) measured by virtual touchtissue quantification (VTQ) technique on esophageal variceal bleeding(EVB) in patients with liver cirrhosis.Methods: Ninety-nine subjects, of whom thirty were healthyvolunteers (normal control group), sixty-nine were patients with hepatitis Bcirrhosis who have different degrees of esophageal varices (EVs) based onupper endoscopy (esophageal variceal bleeding group, EVB：36； noesophageal variceal bleeding group, NEVB：33), were involved in thisexperiment. LSWS and SSWS were obtained by VTQ technique, and Liverfunction was also tested. LSWS and SSWS were compared among threegroups，and the relationship between LSWS、SSWS and the risk of EVBwere analyzed.Results: Significant differences in LSWS and SSWS were observedbetween healthy subjects and patients with liver cirrhosis (all P<0.001). Nosignificant difference in LSWS was observed between patients with andwithout EVB (P=0.158). However, a statistically significant difference wasobserved in SSWS between patients with and without EVB (P<0.001).Therefore, LSWS was not correlated with the risk of EVB (P=0.164), SSWS and EVB risk exhibited a significant and direct linear correlation (r=0.73, P<0.05). The AUROC of SSWS in predicting the risk of EVB was0.894. The optimal cut-off value of SSWS was3.54m/s with sensitivity of81.3%and specificity of84.6%.Conclusion: SSWS can be evaluated with VTQ technique as a usefulnon-invasive tool that can predict the risk of EVB in patients with livercirrhosis. However, insufficient evidence supports that the measurement ofLSWS could predict the risk of EVB.