International journal of hepatology · 2025
Noninvasive Assessment of Prehepatic Portal Hypertension: Pilot Data on Spleen Stiffness in Portal Vein Thrombosis.
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Chan Kelly Tin Long, Chan Oi Ling, Lam Yin Yee, Lai Siu Wing Lawrence
Аннотация
BACKGROUND: Portal vein thrombosis (PVT) is a vascular liver disorder defined by a thrombus in the portal vein or its intrahepatic branches. Computed tomography (CT) and upper endoscopy are, respectively, used to monitor for PVT progression and portal hypertensive complications. A noninvasive modality-spleen stiffness (SS)-has shown promise in identifying clinically significant portal hypertension (CSPH) in cirrhosis. It is unknown whether SS demonstrates any correlation with PVT, a condition associated with prehepatic portal hypertension.
AIMS: The primary aim was to determine the association between SS and the presence of PVT. The secondary aim was to evaluate the association between SS and portal hypertension-related complications among patients with PVT.
METHODS: This cross-sectional study was undertaken at two regional hospitals in Hong Kong from January 2023 to March 2024. Patients were identified via CT and allocated to either the PVT or non-PVT group. Chronic liver disease was an exclusion criterion for both groups. SS was assessed using transient elastography within 3 months of PVT diagnosis. Demographic, clinical, and laboratory data were collected within 3 months of PVT diagnosis.
RESULTS: A total of 46 patients with PVT (median age, 69 years; interquartile range [IQR], 62-78; 74% male) were compared with 45 controls. Both SS and liver stiffness (LS) were significantly higher in the PVT cohort than in controls (SS: 27.9 [IQR, 19.5-42.8] vs. 16.9 kPa [IQR, 13.6-21.2], p < 0.001; LS: 6.0 [IQR, 4.8-8.6] vs. 4.6 kPa [IQR, 3.7-5.9], p < 0.001). Among patients with PVT, those with portal hypertension-related complications demonstrated markedly elevated SS compared with those without complications (77.7 [IQR, 47.2-85.0] vs. 24.4 kPa [IQR, 18.9-37.1], p < 0.001). Furthermore, SS values increased in proportion to the anatomical extent of PVT involvement.
CONCLUSION: Elevated SS was observed in patients with PVT, particularly in those with PVT-induced portal hypertension. Large-scale, prospective studies are warranted to confirm the association between SS and PVT and to establish its potential role in noncirrhotic portal hypertension.
AIMS: The primary aim was to determine the association between SS and the presence of PVT. The secondary aim was to evaluate the association between SS and portal hypertension-related complications among patients with PVT.
METHODS: This cross-sectional study was undertaken at two regional hospitals in Hong Kong from January 2023 to March 2024. Patients were identified via CT and allocated to either the PVT or non-PVT group. Chronic liver disease was an exclusion criterion for both groups. SS was assessed using transient elastography within 3 months of PVT diagnosis. Demographic, clinical, and laboratory data were collected within 3 months of PVT diagnosis.
RESULTS: A total of 46 patients with PVT (median age, 69 years; interquartile range [IQR], 62-78; 74% male) were compared with 45 controls. Both SS and liver stiffness (LS) were significantly higher in the PVT cohort than in controls (SS: 27.9 [IQR, 19.5-42.8] vs. 16.9 kPa [IQR, 13.6-21.2], p < 0.001; LS: 6.0 [IQR, 4.8-8.6] vs. 4.6 kPa [IQR, 3.7-5.9], p < 0.001). Among patients with PVT, those with portal hypertension-related complications demonstrated markedly elevated SS compared with those without complications (77.7 [IQR, 47.2-85.0] vs. 24.4 kPa [IQR, 18.9-37.1], p < 0.001). Furthermore, SS values increased in proportion to the anatomical extent of PVT involvement.
CONCLUSION: Elevated SS was observed in patients with PVT, particularly in those with PVT-induced portal hypertension. Large-scale, prospective studies are warranted to confirm the association between SS and PVT and to establish its potential role in noncirrhotic portal hypertension.