Transient and Shear-Wave Elastography in the Detection of Hepatic Sinusoidal Obstruction Syndrome in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis.

Hepatic sinusoidal obstruction syndrome (SOS), or veno-occlusive disease, is a severe complication following hematopoietic stem cell transplantation (HSCT), often leading to liver dysfunction and poor outcomes if not detected early. Traditional diagnostic methods, including ultrasound and liver biopsy, have limitations in sensitivity and feasibility. Non-invasive elastography techniques, such as transient elastography (TE) and shear-wave elastography (SWE), offer a promising alternative by quantitatively assessing liver stiffness. This systematic review and meta-analysis evaluate the diagnostic performance of TE and SWE in detecting SOS in post-HSCT patients, focusing on shear wave velocity (SWV) and liver stiffness measurements as early biomarkers. Evaluate TE and SWE in detecting SOS in patients submitted to HSCT. The MEDLINE, EMBASE, and Cochrane databases were systematically accessed for studies that employed elastography in post-HSCT patients and that reported any of the following outcomes of interest: (1) measurement of SWV pre and (2) post-transplantation, (3) liver stiffness values before and (4) after HSCT, and (5) incidence of alterations on conventional ultrasound during a suspicion of SOS. "Software R" (version 2024.04.2+764) was employed for statistical analysis. Heterogeneity was assessed using the I2 statistical model. The "QUADAS-2" tool assessed potential bias. Ten studies were included, totaling 589 patients, of which 100 were diagnosed with SOS. SWV showed a significant increase in patients with SOS (95% CI 1.3 to 7.1; P < .01; I2 = 99%). Liver stiffness values also demonstrate a statistically significant increase in the context of SOS (95% CI 3.9 to 28.0; I2 = 91%, P < .01). Conventional ultrasound demonstrated a high rate of hepatomegaly, 93.1% (95% CI 74.9 to 99.8; I2 = 86%); 81.4% of patients with SOS presented ascites (95% CI 59.9 to 95.8; I2 = 88%); 62.6%, thickening of the gallbladder walls (95% CI 24.8 to 93.1; I2 = 92%); 31.6%, reduced flow in the portal vein (95% CI 10.2 to 58.2; I2 = 64%). Bias analysis showed a high risk in most included articles. Elastography shows promise as a non-invasive tool for early SOS detection in post-HSCT patients, with significant increases in SWV and liver stiffness observed in affected cases. However, due to study heterogeneity and potential bias, further validation is necessary before widespread clinical adoption.