Predicting the risk of gastric variceal rupture in patients with hepatitis B-related cirrhosis by shear wave elastography and portal venous hemodynamics

Abstract

Abstract: Objective To investigate the application value of shear wave elastography (SWE) technology and portal vein hemodynamic parameters for predicting the risk of gastric varices (GV) rupture in patients with hepatitis B virus (HBV)-related cirrhosis. Methods A total of 81 patients with HBV-related cirrhosis admitted to Suzhou Hospital of Traditional Chinese and Western Medicine from August 2021 to May 2024 were selected as study subjects. Based on the classification system of the Japan Society for Portal Hypertension, patients were categorized into a high-risk group (n=18) and a low-risk group (n=63) according to their risk of GV rupture. All participants underwent color Doppler ultrasound and SWE to assess Child-Pugh classification, portal venous hemodynamics [portal vein diameter (PVD), portal venous flow volume (PVQ), splenic index (SI), portal venous velocity (PVV)], and spleen stiffness. The correlations between Child-Pugh classification and hemodynamic/spleen stiffness parameters were analyzed. Receiver operating characteristic (ROC) curves were generated to evaluate predictive performance. Results The high-risk group exhibited significantly higher proportions of Child-Pugh-B (44.44%) and Child-Pugh-C (38.89%) patients compared to that of the low-risk group (31.75% and 9.52%, respectively; χ²=13.190, P<0.05). Elevated PVD (1.62±0.09 cm vs. 1.41±0.07 cm), PVQ (1424.83±186.37 mL/min vs. 1320.95±171.19 mL/min), SI (77.29±8.12 cm² vs. 71.58±7.03 cm²), and spleen stiffness (16.36±3.18 kPa vs. 12.22±2.27 kPa) were observed in patients of the high-risk group (all P<0.05), whereas their PVV was reduced (10.49±1.37 cm/s vs. 13.84±1.52 cm/s, P<0.05). Child-Pugh classifications were positively correlated with PVD (r=0.303), PVQ (r=0.302), SI (r=0.361), and spleen stiffness (r=0.464), but negatively correlated with PVV (r=-0.311; all P<0.05). ROC analysis demonstrated superior predictive performance of the combined SWE-hemodynamic model (AUC=0.974, sensitivity=94.4%, specificity=98.4%). Conclusion The integration of SWE and portal venous hemodynamic parameters provides an effective noninvasive approach for stratifying GV rupture risk in patients with HBV-related cirrhosis, supporting its clinical utility in the risk assessment.

Key words: Shear wave elastography, Portal vein hemodynamics, Hepatitis B, Cirrhosis, Gastric varices, Risk prediction

LI Feng, NIU Na, WU Ying. Predicting the risk of gastric variceal rupture in patients with hepatitis B-related cirrhosis by shear wave elastography and portal venous hemodynamics[J]. Chinese Hepatolgy, 2025, 30(8): 1071-1075.

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