ABSTRACT

Background:

Hepatiq estimate of the Perfused Hepatic Mass (PHM) is a precise, direct measure of hepatic function. PHM predict clinical disease (AmJGastro;92:2054 ;Hepat;55:1019) whereas shear Wave Elasticity (SWE) and Fibroscan (Rad 276:845) detect cirrhosis (Metavir F4) which is an indirect estimate of hepatic function and clinical disease.

Hypothesis:

SWE is a poor estimate of hepatic function by Hepatiq.

Methods:

Patients: Our initial 190 patients with SWE at US and Hepatiq were reviewed for comparison with other clinical factors. Diagnosis of C was based on combinations of parameters including liver surface nodularity, abnormal blood tests (platelet count, INR, Bilirubin), CT/MRI showing collaterals, Varices by EGD and liver biopsy (reviewed in 19/46 and reported in clinical records 10 more). Non-cirrhotic patients (NC) included 144 with underlying pre-cirrhotic CLD (HBV, HCV, PBC, PSC, ACAH and miscellaneous), non-cirrhotic portal hypertension and acute liver disease with jaundice. 46 cirrhotic patients (C) included those never having clinical complications (ascites, Variceal Bleed and encephalopathy) (C1=19 patients); those with complications in past, but resolved not requiring further treatment (C2=13); active complications requiring ongoing treatment (C3=11) and those on the liver transplant list (C4=3). C3 and C4 are decompensated cirrhotics (DC).

US: All patients had a fasting US (GE LOGIQ E9) with SWE (Shear wave velocity=SWV) and postprandial Hepatiq. The quantitative liver spleen scan was performed with Hepatiq as previously described (Hepat;55:1019). Clinical data was abstracted from the records and expressed as mean (+/-SD).

Results:

Hepatiq was successful in all 190 patients and SWE in 184 (97%). We report 184 with both scans: 141 NC were compared with 43 C in the various subgroups (C1-C4). PHM – NC 103.4(3.7), C1 94.0(8.2), C2 92(7.6), C3 75.1(9.5), and C4 58.87(1.91). SWV – NC 1.5(.2), C1 1.8(.2), C2 1.9(.4), C3 1.8(.3), C4 1.6(.3). All PHM values in C1-C4 groups were significantly different (p < .05) from NC and none of the SWV were significantly different. SWV in DC (C2+C3) were not significantly different from NC. There was no significant correlation of SWV with PHM (figure) and PHM < 95 was diagnostic of cirrhosis. In the figure, there is a wide span of values for SWV in both C and NC (x axis) whereas the PHM was < 95 (y axis). We have previously shown that the PHM < 95 correlates with clinical outcomes.

Conclusion:

1. SWV correlated poorly with cirrhosis even those with DC.

2. SWE did not correlate with quantitative hepatic function,

3. PHM correlated with C and DC,

4. Functional staging with Hepatiq is superior to SWE.

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